Systemic and organizational barriers to primary chronic disease prevention: a qualitative study of public health organizations in Canada

<sec> <title>Introduction</title> Public health organizations in Canada play a central role in chronic disease prevention (CDP) but face persistent challenges, including system restructuring, persistent underfunding and shifting policy priorities. The growing complexity of these issues warrants qualitative insight to complement quantitative reports capturing CDP organizations’ perspectives. </sec> <sec> <title>Methods</title> The Public Health Organizational Capacity Study (PHORCAST) is a repeat Canada-wide census of public health organizations engaged in primary CDP at national, provincial, territorial and regional population levels. In 2023, senior managers and staff with in-depth knowledge of their organizations’ CDP activities completed a questionnaire that requested optional comments via an open-ended question. The responses were analyzed using qualitative descriptive methods and inductive content analysis to identify and organize recurring issues. Theme frequencies are reported descriptively to indicate prominence across organizations and not to quantify meaning. </sec> <sec> <title>Results</title> Across the 55 organizations, 125 coded references to barriers to CDP were synthesized into five key themes: organizational capacity and program delivery challenges (n = 38), including chronic underfunding, workforce shortages and limited infrastructure; COVID-19 pandemic disruptions causing staff redeployment and prolonged service interruptions (n = 30); policy and systemic barriers (n = 28), including political interference and poor interjurisdictional coordination; fragile partnerships and the need for stronger intersectoral collaboration (n = 16); and difficulties engaging diverse communities, digital access issues and lack of culturally responsive programming (n = 13). </sec> <sec> <title>Conclusion</title> CDP efforts in Canada are constrained by structural, operational and contextual barriers. Addressing these challenges requires sustained investment, coherent policies and stronger cross-sector partnerships. </sec>