Who controls Ontario testing and reopening?

Authority lies with balkanized health units

As Ontario struggles with its up-anddown testing numbers, people are demanding to know why Premier Doug Ford and his government can’t do better. Ford seems a bit more ineffectual every time he urges public health units to “pull up their socks” and then they don’t follow through. It’s almost like there’s no one in charge.

Well, here’s the bad news. There are 34 people in charge but Ford isn’t one of them. When the premier blames public health units for low test numbers, it sounds like he’s passing the buck, but he’s not. Testing is the responsibility of the province’s public health units, many of them remarkably small. And it’s not just testing that these little health fiefdoms control. They also decide what gets to open and which businesses and services have to stay closed.

These 34 local public health czars don’t answer to Ford, or even to Ontario’s chief medical officer of health, Dr. David Williams, although the provincial government pays 75 per cent of public health costs. Municipalities pay the rest.

Local medical officers of health report to local health boards, but in practice they are largely independent. That’s innocuous enough in normal times when public health officials concerns themselves largely with advising people about the dangers of sugar or reminding us to drink lots of water when it’s hot. In a pandemic, Ontario’s balkanized public health regime is clearly out of its depth. Both the provincial auditor general and a recent provincial expert panel on public health have noted that many of these little health units lack the size to perform effectively.

But that hasn’t stopped medical officers of health from asserting their independence. Later this week, they are expected to announce data-based thresholds that they will use to determine the pace at which Ontario returns to normal. Their concern is that Ford and his team are reopening things without being absolutely specific about what public health standards have to be met.

That’s a fair criticism, but it’s a smaller problem than letting local public health officials dictate the pace of economic normalization. With all due respect to public health officials, they have a one-dimensional view of the pandemic. Their only concern, naturally, is public health. If people lose their jobs and businesses fail because of extended government shut downs, that’s really not their problem.

It’s important to note that the medical officers of health can only apply brakes, not the accelerator. The provincial government sets the limits of what can be opened. Local officials can’t be more liberal in restarting normal life, but they can slow it down if they think it appropriate.

Both Ford and Health Minister Christine Elliott referred to the power of the local medical officers of health in a media session this week. Sadly, they weren’t questioning the wisdom of it. And yet, there is clearly a power struggle going on between the provincial government and public health officials.

Ontario has leaked — but not yet officially announced — a new strategy that would expand testing to include asymptomatic people with the greatest infection risk, such as taxi drivers, industrial workers, and first responders. Testing asymptomatic people has not been enthusiastically embraced by Williams and his team, so the province is said to be bringing in help from the chief executive of Ontario Health and the province’s chief coroner, not the likeliest pair for the job. Their mandate will be to expand testing and boost numbers.

They face two challenges. They must persuade people with no symptoms to spend a warm spring day waiting to have someone stick a wand up their nose.

Then, they must drum up

THERE ARE 34 PEOPLE IN CHARGE, BUT FORD ISN’T ONE OF THEM.

some enthusiasm in the public health units.

The fact that the province has no control over local public health units is a problem, but there is a solution. Before the pandemic hit, Ontario had announced its intention to reduce public health units from 34 to just 14. Naturally, this set off predictable howls about cuts to public health, but the idea is looking better by the minute. In fact, it doesn’t go far enough.

The pandemic has shown the vital role of public health. It should be a core part of the health-care system, not an awkward hybrid stuck between the province and the municipalities. A pandemic isn’t the time for the challenging job of reducing the number of units, but they should be brought under direct provincial control, with full provincial funding. That would offer a boost to cash-strapped municipalities while upgrading the importance of public health.

It’s ludicrous to have the province’s future controlled by 34 public health officials who have neither the experience nor the information to make tough calls about balancing public health with economic health. That’s the job of political leaders that we can hold accountable.