Rural boards of health furious at report
New plan could strip rural municipalities of decision-making
It was hot in southwest Ontario Wednesday afternoon, but it was the local board of health meeting rooms that were sizzling as members went through the Ministry of Health and Long-Term Care’s June report. It was worse than they thought. The report, Public Health within an Integrated Health System, was quietly published June 9. It proposes streamlining public health by, in part, consolidating the 36 municipal boards of health into 14 larger boards, a measure intended to save costs and increase efficiency.
It would also better support areas that currently have smaller health boards, boards that lack resources to function adequately.
A more streamlined, efficient system would be an upgrade to the province’s current system, says the report.
But members of the Elgin-St. Thomas Board of Health – among others – are skeptical, saying the proposed system would save virtually no money while stripping rural municipalities of their leverage.
“The rural areas just get left behind,” said David Marr, councillor on Elgin County council. “The cities, the large cities, will say ‘this is what we’re doing ’ and the rest of us will follow suit. That’s not right.”
“This is the worst thing they could ever do to public health,” said Heather Jackson, mayor of the City of St. Thomas. “This government is going to ruin the way that we deliver public health.”
If the report sticks, Elgin-St. Thomas will be grouped with Middlesex-London, Oxford County, Perth District, Huron County, and Grey Bruce – effectively putting Port Stanley and Tobermory in the same jurisdiction.
The ministry hand-picked an expert panel to create the report. It included four people from Toronto: the chief medical officer of health for the province, the CEO of the Toronto Central LHIN; the chief nursing officer with Toronto Public Health; and a University of Toronto assistant professor.
Other representatives were medical officers of health from the Guelph and Niagara regions, a hospital chief of staff in Ottawa, chair of the Windsor-Essex health unit, and a health advisor from the Nishnawbe Aski Nation near Thunder Bay.
Rural Ontario was conspicuously underrepresented, something the Elgin-St. Thomas board picked up on immediately.
“People in Owen Sound are not going to have the same issues that we have,” Jackson said. “We’re not going to have the oversight. We’re not going to have control of our programs … this to me reeks of the same system that they use for (accommodation review committees), when they’re looking at closing schools.”
Other members echoed her concerns.
“You’re going to be sitting there by yourself,” Marr said. “One person from this unit … going up against the needs of everybody else.”
Amalgamation is a sore topic for many southwest Ontario municipalities, especially in neighbouring Chatham-Kent. The proposed system would group them with Windsor-Essex and Sarnia Lambton.
Six of the 14 proposed boards would be in the GTA.
“I lived through amalgamation,” said Marr. “What happened back then was the province at that time stepped in and said ‘Chatham-Kent, you’re going to be one (municipality).’ That was the shot across the bow … every other municipality across the province said ‘we’d better come up with something. At least (it will be) our decision and not their decision.’”
Also on Wednesday, medical officers of health from across Ontario met in Toronto to discuss the report.
Dr. David Colby, medical officer of health for Chatham-Kent, was among them.
“The report hinges on some assumptions,” Colby said the next day. “One, that public health should be integrated into the health-care system … I think that’s something that the ministry (wants) but many of us do not see as desirable at all.”
Another of Colby’s concerns is the report, prescribing broader areas spanning numerous municipalities, will render the relationship between municipalities and boards of health null and void.
But the main worry, says Colby, was in the process. He spoke highly of the people involved in the expert panel but said the lack of transparency, coupled with a prescribed mandate, clouds the final report.
“This is basically an opinion piece,” Colby said. “This is not a proposal, this is not a legislative framework … I would hope that there’s going to be a very adequate and thorough consultation period before any of this is implemented.”
Other groups still to meet include the Southwest Board of Health CEOs, to meet at the beginning of October, and the Association of Ontario Public Health Business Administrators.
The deadline for responses is Oct. 31.
The Elgin-St. Thomas Board of Health, among others, will prepare their final response after final deliberations. On the other hand, it’s unlikely that response will be much different than it was Wednesday.
“It’s going to be a problem,” Marr said. “That’s the bottom line.”
The proposed change would lump southwest Ontario into two districts: Windsor-Essex, Chatham-Kent, and Sarnia-Lambton; and everything from Port Stanley to Tobermory. The concern is specific needs in rural areas like Elgin County will be forgotten as public health takes on a broader, more streamlined approach.