This article is written by Marie Jacuzzi, policy analyst for a provincial health ministry in Canada

In May 2000, bacterial contamination of municipal water in Walkerton, Ontario resulted in the worst public health disaster of its kind in Canadian history.

At least seven people died and 40% of the population (more than 2000 inhabitants) were recorded ill with gastroenteritis. Many are still suffering from its long-term effects, with 22 of the children infected recorded as having permanent kidney damage.

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Causes of the contamination were manifold. There was inadequate water monitoring and testing, improper chlorination of the water supply, and falsification of testing reports by the Walkerton public utility operators. Neither of the two operators had formal training in public utility operation, or in water management.

Then, there had been the privatisation of municipal water testing in 1996, which left many small communities physically and financially responsible for water quality assurance, a task they were ill-equipped to manage. Finally, there was the absence of any independent regulation for testing the quality of the water, as well as the lack of provisions made for authorities to be notified about testing results.

Fast-forward to June of last year, when Canada's national health data agency produced figures showing the country then held the worst record among developed nations for Covid-19-related deaths in long-term elderly care facilities.

As the first wave of infections in Canada began to subside, the country's 2039 homes for older people accounted for about 80% of all Covid-19-related deaths. Six months and a second wave of infections later, little has changed. Canada's long-term facilities remain a vector for the disease. Much like the Walkerton incident, the national data agency’s revelation has been called a “[national disgrace”](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21%2900083-0/fulltext).

Without enforcement, policy instruments are merely wind instruments

As a policy analyst with a 25-year career working in private industry, and more than 12 years in the public sector, my perspective on why these incidents continue to happen in Canada is different from many of my colleagues. The view my peers often take is that we need to strengthen legislation, regulation and policy. In my opinion, it is due to lack of governance.

I arrived here by asking why the above examples, and many similar instances such as the Lac-Megantic rail disaster, or Listeria outbreaks at meat-processing facilities, continue to take place in my country despite robust legislation, regulations, standards and policies. After all, as public servants, we do well in legislating rules, and regulating various private sectors. Where we seem to be lacking is in enforcing accountability.

Before Covid

Prior to the pandemic, governments worldwide were seeking ways to reduce their costs and keep taxes low. This often meant that services designed to protect the public (and which the public largely took for granted, such as food inspection) were cut back or eliminated.

Walkerton is a case in point here. Before the E. Coli and Campylobacter outbreak, the Government of Ontario had closed its own water testing labs, instructing public utilities to seek private industry testing services instead. It remains unclear however if anyone in government followed up by monitoring these services to ensure testing was performed, or ever demanded to see the results of those tests.

Policy without teeth

Within my own jurisdiction in Canada, we have robust legislation when it comes to public protection in various sectors. However, those policy instruments lack teeth without enforcement, or resources allocated to enforcement. I see it frequently in labour and consumer protection laws — despite clear guidelines on what they can and cannot do, private businesses regularly flout the rules and operate under their own parameters. Let me offer an example.

My neighbour’s employer, a health service provider, was forcing employees to take a full vacation day to attend personal medical appointments. My province’s labour legislation makes clear that this is not allowed. And yet, my neighbour has still not been permitted by their employer to take the full 20 days or more vacation that they've accrued over the last two and a half years. The labour board in our jurisdiction declined to intervene in the matter.

The upshot? No accountability from the business, nor any repercussions, except potentially for my neighbour, if their complaint reached the ears of top management at the company.

We are moving into an era where the public is demanding accountability, as well as consequences for neglect, particularly in the health sector where lives are at stake

On the other side of the coin, there is the development of policy that is either simply unenforceable, or poorly communicated to the public at large.

Public health orders throughout the pandemic have sometimes been confusing and difficult to interpret. One such order required medical and long-term care facilities not to share staff, as had often been the practice, to reduce the risk of transmission. Employees were to work in one facility only.

However, cost-cutting in the same period meant staffing levels plunged, leaving the government unable to monitor the private long-term care facilities closely. Covid-19 infections meanwhile left facilities very short-staffed and unable to nurse patients being admitted. The situation became so dire that one facility in Winnipeg called in paramedics for assistance. Ontario and British Columbia’s long-term care facilities had Canadian Red Cross and the Canadian Armed Forces brought in to assist.

The statistics outlined at the beginning sadly bear out the results.

Enforcing accountability

As an analyst, this has led me to rethink my own work in policy development. It has led me to ask whether any policy I am developing is easily understandable and enforceable. If so, how precisely do we hold private corporations or the public accountable? What are the risks involved if we don’t?

We are moving into an era where the public is demanding accountability, as well as consequences for neglect, particularly in the health sector where lives are at stake.

As analysts, we need to take this seriously. If you are a policy analyst like me, know this: You can write the best policy paper in the world, but unless it takes into consideration how that policy should be enforced, and how the enforcers should be held accountable, then your policy will have no teeth to it whatsoever.

Without enforcement, policy instruments are merely wind instruments. – Marie Jacuzzi

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