Tuberculosis control in Alberta. A federal, provincial and regional public health partnership

The number of cases of tuberculosis in Alberta or Canada may not be large, but the public health and medical costs of just a few cases can be prohibitive. For example, the costs of managing cases of multidrug-resistant tuberculosis and their contacts, can exceed the entire annual budget of a program. This was evident in New York City in the late 1980s and early 1990s, when $1 billion in public funds were spent reversing a major resurgence of drug-resistant and susceptible tuberculosis. In Canada, the Walkerton Inquiry has identified an apparent failure of provincial public policy to adequately address public health needs. This has resulted in decreased public confidence and potential liabilities for the policy-makers. In the design of the Tuberculosis Control Program of Alberta, the notion of a quasicentralized or quasidecentralized program is rejected. Rather there is an appeal to the notion of a partnership of responsibility that recognizes jurisdictional and non-jurisdictional public health, case management and epidemiologic realities, the integral contribution of each level of government and the need to be accountable to the public's health and purse. For levels of government not to properly discharge their responsibilities may be perceived as an abrogation of the public trust and a disregard of the Tuberculosis Control Policy Package and operational directives of the World Health Organization.