Through the COVID-19 pandemic, many Nova Scotians have gotten to know Dr. Robert Strang, the province’s chief medical officer of health and the public face of its response to this emergency. But Dr. Strang doesn’t work alone – he has an entire public health team working with him to help keep Nova Scotians safe and healthy.

This multidisciplinary team includes Deputy Chief Medical Officer of Health Dr. Shelley Deeks and four regional medical officers of health, plus public health nurses, public health nutritionists, dental hygienists, health promoters and school health promoters, health equity consultants, epidemiologists, evaluators, public health officers, administrative assistants and more.

When the pandemic hit, most public health staff in Nova Scotia were reassigned to COVID-19-related tasks. That means a health equity consultant might now be notifying people of their negative test results, for example.

“There are very few people in public health who work in a role that they were originally hired for,” explains Dr. Daniela Kempkens, medical officer of health for Nova Scotia Health’s Eastern Zone.

Public health has been following an extreme business continuity plan throughout the pandemic, even after most health services and programs have returned to more normal operations. “That’s why public health staff are my unsung heroes,” says Dr. Kempkens. “They have all risen to the challenge – they’re taking on new roles in an environment that is constantly evolving.”

They’re also doing so with extremely limited resources. Nova Scotia allocates only about 1.8% of its health care dollars to public health, well below levels spent by other provinces. For example, Saskatchewan is a province with roughly the same population, yet it has three times as many medical officers of health.

“We are at the best of times a severely underfunded public health system,” Dr. Kempkens notes, “and now we are trying to stem a pandemic with a severely underfunded public health system.”

She thinks public health staff stepping up to these unprecedented challenges, along with the strong public health measures, is part of why Nova Scotia’s health care system hasn’t been overwhelmed and why rates of death and disease have remained low during the pandemic.

That doesn’t come without personal sacrifice – everyone in public health is putting in long hours, giving up time with family or for their own physical or mental health needs. “The price they pay is really high in trying to keep Nova Scotians safe,” Dr. Kempkens says.

Their work in non-pandemic times is vitally important too, if often unseen or not fully understood.

“The role of public health is protecting and at the same time improving the health of people and our communities,” says Dr. Kempkens. “Our focus is not individual patients, but looking at entire groups of people and thinking about how we, through a public health lens, can improve the overall health status of the group or a community.”

Some of the responsibilities of those working in public health include health promotion, health protection, chronic disease and injury prevention, epidemiology and surveillance, emergency preparedness, and food and water safety. In Nova Scotia, public health has three main divisions: health protection, healthy communities and early years.

Health protection involves following up on communicable diseases, including COVID-19, to make sure they don’t spread further and put the health of the public or certain populations, like people living in long-term care facilities, at risk. It also looks into food and water safety.

Healthy communities focuses on promoting healthy lifestyles and includes work examining health inequities.

“Health inequities are those differences in health that are unfair and avoidable, and that are brought about by social factors,” Dr. Kempkens explains, such as level of education, race or ethnicity, income, housing and other social determinants of health.

Early years focuses on families and children in the first few years of life.

“We try to identify families even before a child is born that could benefit from more support before delivery and after that, with some parenting resources and family visits to see where they can use support to make sure the youngest generation gets the best start in life.”

Public health also offers immunizations in some areas where access to primary care is limited and delivers the Grade 7 immunization program across the province.

The work of public health is in the spotlight these days, and with that comes questioning and criticism of public health measures. The pandemic necessitates restrictions that have huge consequences on people’s lives, Dr. Kempkens says, and these decisions are never made lightly and always in the context of the best available evidence.

“They come with a huge responsibility and many sleepless nights,” she says. “But the intent behind anything we do is to keep Nova Scotians as safe as possible in this pandemic.”