“The institutional design of the CMOH role shapes incumbents’ ability to achieve different public health goals. There is no universal design that is going to be best across jurisdictions. Instead, governments and legislatures must take stock of the opportunities and trade-offs associated with different design options and consider the existing context and capacity in their jurisdictions.” – Tensions and opportunities in the roles of senior public health officials in Canada
In the wake of public health crises like the COVID-19 pandemic, attention often turns to critiquing and reforming the role of senior public health officials, such as Chief Medical Officers of Health (CMOHs). Yet such assessments are often disconnected from a thorough understanding of these officials’ roles and responsibilities as public servants operating with and within government. Efforts to reconfigure their roles must be based on an in-depth understanding of the ways in which institutional design influences incumbents’ opportunities for impact – during both pandemic and non-pandemic times.
Numerous tensions exist within the roles of CMOHs. These tensions contribute to misunderstandings about the position and create trade-offs in the task of designing it. The lack of research about the role, and in particular the dearth of analyses grounded in both public administration and public health, has left a gap in the understanding of how institutional design relates to officials’ capacity to achieve different public health goals.
Our team is investigating the roles of CMOHs in three countries that position them as senior public servants: Australia, Canada, and the United Kingdom. We are drawing on multiple data sources to understand how CMOHs navigate and shape their roles, including in-depth interviews with CMOHs themselves, media communications by and about CMOHs, laws that outline CMOHs’ powers and duties, and public opinion survey data about CMOHs’ trustworthiness.
Our research shows that CMOHs are variously called upon to be government advisors, public health managers, and public communicators. These roles are often in tension with each other and with the expectation among some commentators that the CMOH should be a public advocate and government critic.
CMOHs who are positioned within the senior levels of the public service must carefully balance their government- and public-facing roles. Moreover, the office itself has been stretched and stressed during the COVID-19 pandemic as new questions have arisen about the role of CMOHs in relation to other expert bodies, government decision-makers, and the public.
Our research on CMOHs is a key part of GSL’s efforts to inform the creation of more effective public health institutions. As with projects across the Public Health Institutions stream, this interdisciplinary project draws on public administration and political science insights to understand the role and institutional context of the CMOH. The project is closely connected with our efforts to examine the role of scientific evidence and advice in public health policymaking more broadly.