Ontario’s budget announcement proposes consolidating the province’s 35 public health units into 10 regional agencies by 2021.
The move is intended to reduce health-care bureaucracy and overlapping administration duties, which the government has projected will result in annual savings of $200 million by 2022.
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Public health units are currently jointly funded by the province and the individual city. The proposal suggests this model could be adjusted, but does not elaborate on what the adjustments will be.
A spokesperson for the Ministry of Health and Long-Term Care did not provide additional details but said that the government will continue to work with public health units and municipalities to ensure the effective delivery of public health programs.
“Modernizing and streamlining the role of public health units across the province will better co-ordinate access to health promotion and disease prevention programs at the local level, ensuring that Ontario’s families stay safe and healthy,” Hayley Chazan said in a statement.
The move is part of a broader push by the Ontario Conservatives to consolidate local and provincial health networks.
“Our government will reduce the bloated health-care bureaucracy,” Finance Minister Vic Fedeli said during his budget speech. “We’re redirecting our resources to the front line.”
The public heath unit announcement has already sparked backlash from some city officials. Waterloo Regional Chair Karen Redman released a statement expressing disappointment at the proposed changes to public health.
“This is unfortunate. Waterloo Region has benefited greatly from having Public Health fully integrated with other municipal functions,” said Redman. “How will these regional health units be governed and funded? How will these units be grouped by geography and will residents still receive the same programs and services for their tax dollars? Local accountability is important.”
She told Global News in an interview that she doesn’t believe a centralized public health service can provide the same local assistance and guidance to city officials. She noted that the Region of Waterloo Board of Health has weighed in on a number of issues outside their mandate because of their local focus, including water services, transportation, land use and social services.
Public health units provide a wide range of services. Many administer disease prevention programs to inform the public about healthy life-styles, communicable disease control including education in STDs/AIDS, immunization, food premises inspection, healthy growth and development including parenting education, health education for all age groups and selected screening services.
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For example, Toronto Public Health completes biannual surveillance for blacklegged ticks, ongoing pollutant tracking, annual flu shot rate reporting, overdose tracking, West Nile surveillance, etc., along with general population health reports.
York Region Public Health hosts workshops for injury prevention along with breastfeeding clinics and parenting programs.
Redman added that she’s concerned about the “responsiveness and accountability” of a centralized public health service, and doubted the province’s ability to save $200 million as it predicts.
“That’s a really big number, and regarding services, if we’re not going to cut them then those services are going to have to be delivered by someone.”
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She explained that it came as a surprise that the budget proposal included modifications to public health.
“That was a real surprise to us. Our understanding was that the government wasn’t necessarily going to look at public health boards.”
In addition, the budget pledges to modernize the province’s health laboratory system and to streamline “back-office inefficiencies” through digitization.
What does the current funding model for public health look like?
Ontario public health currently operates on a cost-sharing model where the province funds up to 75 per cent of mandatory programs and the municipality funds 25 per cent, however, this funding breakdown may vary depending on the region.
Programs all public health units are required to run include Health Assessment and Surveillance, Chronic Diseases and Injuries, Family Health, Infectious Diseases, Environmental Health and Emergency Preparedness.
In addition, the province also funds 100 per cent of many non-mandated programs. For example, in Waterloo, these include, Healthy Babies Healthy Children, Infectious Disease control, Needle Exchange, Healthy Smiles Ontario, Smoke Free Ontario, Enhanced Food Safety and Enhanced Water Safety Initiatives and Public Health Nurse initiatives, according to a Region of Waterloo briefing document.
The province also funds vaccines for immunization programs and drugs for the use of treatment in sexually-transmitted diseases, tuberculosis and leprosy in Waterloo.
In Toronto, 100 per cent-provincially funded programs include Healthy Smiles Ontario, Communicable Disease Liaison Unit, AIDS Hotline, Healthy Babies Healthy Children, Preschool Speech and Language, Infant Hearing, Diabetes Strategy and Smoke Free Ontario.
The City of Toronto has two entirely-municipally-funded programs as well, including Dental Treatment for seniors and children and Student Nutrition Program.
Across all public health units, the Ministry of Health approves an annual increase over the prior year’s budget of between 1.5 per cent and 9.5 per cent, and funding decisions are typically made after each public health unit submits a funding request for approval at the beginning of a calendar year.
In 2018, Toronto Public Health submitted an 2019 operating budget proposal for almost $252 million, 72 per cent of which would be funded by the province.