Upstream determinants of effective COVID-19 response: learning from comparisons across Canada's provinces

We will contribute new knowledge to improve the public health response to emergencies such as COVID-19. This research uses a mixed-methods case study approach with an innovative focus on how upstream determinants: institutions, politics, organization, and governance (IPOG) influence governments' effective activation of public health systems and capacities during a crisis. Better understanding of the effects of IPOG factors will complement current research on interventions to address this pandemic and contribute to efforts to reduce disparities in outcomes. This study incorporates key CIHR priority interests in research to strengthen public health systems in Canada and spans across four provinces: British Columbia (BC), Ontario, Quebec, and Nova Scotia. Province-specific analyses will be carried out followed by a comparative analysis to develop more generalizable findings. These provinces represent a broad cross-section of Canadian geography, differences in province-level health systems, COVID-19 response, and other relevant socio-economic factors. The results will be useful to improve laws, regulations, and organizational capacity to respond to public health crises and to national efforts to support these and other provinces. Previous work by several partners has demonstrated the feasibility of this research. We will build on the organizational analyses of public health systems in Canada conducted by the North American Observatory on Health Systems and Policies; the ongoing data collection of the IPOG case study in BC; and research on interventions and implementation led by the Co-I's at Dalhousie with other Canadian partners, all sponsored by CIHR. These methods will be further adapted to specific provincial contexts and cross-province comparison. Each province-based team has identified knowledge partners in their jurisdiction who will contribute to the research and assist in dissemination and knowledge translation in provinces and nationally.