Page - 47 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

47Have the Post-SARS Reforms Prepared Us for COVID-19? pernicious, illegitimate, and fundamentally destructive of intergov- ernmental relations in Canada. Faster containment of a pandemic would be won only at the cost of decades of provincial acrimony and bitterness, affecting intergovernmental relations across a wide swathe of programs and policies. The hardest lesson may be the requirement that we invest in pub- lic health even (or especially) in periods where threats to public health are not on the horizon (and thus not on the political agenda). Faced with short electoral cycles and the competing financial demands of primary and acute care, public health across jurisdictions has a his- tory of marginal funding. “The pattern,” noted the Naylor Report, “is now familiar. Public health is taken for granted until disease out- breaks occur, whereupon a brief flurry of lip service leads to minimal investments and little real change in public health infrastructure or priorities.”43 Conclusion There is some speculation that disaggregated government exac- erbated the spread of the pandemic in Italy.44 To what extent has Canada’s highly decentralized framework of health care governance affected our ability to address pandemic management? There are two responses to this question. The first simply says that, for better or worse, we have a constitutional structure that does not permit a national command-and-control model of health care governance (Italy, which is essentially a unitary state divided into organizational regions, can more usefully ask this kind of question). The second response is grounded in democratic theory. If there is regional varia- tion across Canada, should we not be concerned if some regions seem to be performing more poorly? In the classical understanding of repre- sentational federalism, we should not: where a multitude of variables coalesce in political decision-making, the particular constellation of choices and values will have different outcomes in different jurisdic- tions. Who is to determine whether the choices made are legitimate? If regional governments are responsible for decisions taken, then their electorates will hold them answerable. 43. Supra note 16 at 64. 44. See e.g. Iris Bosa, “Italy’s Response to the Coronavirus Pandemic” (16 April 2020), online (blog): Cambridge  Core <https://www.cambridge.org/core/blog/2020/04/16/ italys-response-to-the-coronavirus-pandemic/>.