Dire prog­no­sis for pub­lic health

The Glengarry News - - Front Page - -- Richard Mahoney

The new On­tario gov­ern­ment’s pro­posed restruc­tur­ing of pub­lic health could have sig­nif­i­cant long and short-term im­pacts on the lo­cal com­mu­nity, cau­tions the Eastern On­tario Health Unit’s Board of Health.

The gov­ern­ment made the sur­prise an­nounce­ment in the re­cently re­leased 2019 pro­vin­cial bud­get, out­lin­ing its plan to cut the num­ber of pub­lic health units in On­tario from 35 lo­cal health units to 10 larger re­gional en­ti­ties over the next two years. It has also an­nounced plans to slash pro­vin­cial fund­ing of pub­lic health by $200 mil­lion, of­fload­ing a sig­nif­i­cant por­tion of pub­lic health fund­ing from the province to mu­nic­i­pal­i­ties. The cut in pro­vin­cial fund­ing is ef­fec­tive im­me­di­ately de­spite the fact that mu­nic­i­pal­i­ties were given no ad­vance warn­ing, and have al­ready planned and started spend­ing their bud­gets for the cur­rent year.

The province has pro­vided few de­tails about the restruc­tur­ing, leav­ing the EOHU and mu­nic­i­pal­i­ties un­cer­tain about how the changes will be im­ple­mented. A ma­jor con­cern is that while mu­nic­i­pal­i­ties will be ex­pected to pay more, they could have less de­ci­sion-mak­ing power when it comes to how pub­lic health pro­grams are de­liv­ered lo­cally. Mov­ing gov­er­nance of pub­lic health ser­vices from the eastern coun­ties to a broader re­gional area could re­duce the ca­pac­ity to ad­dress the unique pub­lic health needs of the eastern coun­ties (serv­ing ru­ral pop­u­la­tions, higher rates of chronic dis­eases and poverty, re­duced ac­cess to pri­mary health­care). In a larger re­gion­al­ized model, pub­lic health’s abil­ity to re­spond quickly to lo­cal emer­gen­cies and health threats – such as disease out­breaks or flood emer­gen­cies – may also be neg­a­tively af­fected.

“Hav­ing a lo­cal pres­ence with close ties to com­mu­nity part­ners and res­i­dents has en­sured that the health unit is well-po­si­tioned to re­spond to lo­cal needs,” states Dr. Paul Roume­li­o­tis, Med­i­cal Of­fi­cer of Health. He adds that the EOHU pro­vides a wide range of essential pub­lic health pro­grams, in­clud­ing im­mu­niza­tion clin­ics, in­fec­tious disease out­break man­age­ment (in­clud­ing the re­cent fol­low up of measles con­tacts), low-in­come den­tal clin­ics,

well-baby pro­grams for fam­i­lies who don’t have ac­cess to pe­di­a­tri­cians or fam­ily physi­cians, wa­ter safety mon­i­tor­ing, in­spec­tions of lo­cal food premises and more.

“We’re very con­cerned that mov­ing to a larger re­gional model, com­bined with sig­nif­i­cant cuts to fund­ing, could com­pro­mise the pub­lic health ser­vices that pro­tect the health and safety of our re­gion’s res­i­dents.”

The EOHU and lo­cal mu­nic­i­pal lead­ers are con­cerned about the dra­matic fund­ing cuts and changes to pub­lic health struc­tur­ing. “What the gov­ern­ment is propos­ing could have se­ri­ous im­pacts on mul­ti­ple lev­els, from mak­ing it harder to ac­cess im­por­tant pub­lic health ser­vices, to fur­ther stretching al­ready strained mu­nic­i­pal bud­gets and pos­si­bly forc­ing icreases in prop­erty taxes, to ul­ti­mately im­pact­ing the health and safety of lo­cal res­i­dents,” states Syd Gar­diner, Corn­wall City Coun­cil­lor and in­terim Board of Health Chair.

Dr. Roume­li­o­tis as­serts that cut­ting in­vest­ment in pub­lic health is coun­ter­pro­duc­tive. In­stead, in­vest­ing in pub­lic health is a vi­tal up­stream mea­sure that can re­duce down­stream “hall­way health­care” – a key goal of the Ford gov­ern­ment. “Pub­lic health rep­re­sents only a small frac­tion of the over­all pro­vin­cial health­care bud­get, but it de­liv­ers a very high re­turn on in­vest­ment,” says Dr. Roume­li­o­tis. “Evidence shows that pub­lic health pro­grams im­prove long-term health out­comes. Ul­ti­mately, they save costs by help­ing to keep peo­ple healthy and out of hos­pi­tals.”

A ma­jor con­cern for Dr. Roume­li­o­tis and Mr. Gar­diner is that mov­ing gov­er­nance of pub­lic health ser­vices from the eastern coun­ties to a broader re­gional area will also re­duce the ca­pac­ity for pub­lic health to ad­dress the unique chal­lenges of the eastern coun­ties.

This re­gion has higher rates of chronic disease, poverty, sin­gle par­ent fam­i­lies, and men­tal health is­sues, with lower lev­els of school readi­ness for chil­dren, and re­duced ac­cess to pri­mary health­care.

The health unit cites its abil­ity to re­spond to lo­cal needs.

With the large fran­co­phone pop­u­la­tion in the eastern coun­ties, the EOHU is one of the few health units in the province to of­fer fully bilin­gual ser­vices.

Work­ing di­rectly in the com­mu­nity has also al­lowed the health unit to mo­bi­lize quickly in re­sponse to lo­cal pub­lic health threats, in­clud­ing the rapid de­ploy­ment of im­mu­niza­tion clin­ics dur­ing the H1N1 epi­demic, the emer­gency re­sponse to po­ten­tial wa­ter con­tam­i­na­tion dur­ing the St. Al­bert fire, the cap­sized tug­boat in­ci­dents in the St. Lawrence river, and emer­gency man­age­ment of the re­cent haz­ardous floods along water­front areas in Prescott-Russell.

The EOHU has also co­or­di­nated health ser­vices for flood evac­uees from Kashechewa­n, as well as for re­cent asy­lum seek­ers from the United States.

In a larger re­gion­al­ized model, pub­lic health’s abil­ity to re­spond quickly to lo­cal emer­gen­cies and health needs may be neg­a­tively af­fected. Mu­nic­i­pal­i­ties will be ex­pected to pay more but could have less de­ci­sion-mak­ing power when it comes to how pub­lic health pro­grams are de­liv­ered lo­cally. There is also con­cern about whether is­sues unique to ru­ral areas will be ad­e­quately con­sid­ered. For ex­am­ple, ru­ral res­i­dents rely more heav­ily on lo­cally avail­able ser­vices than res­i­dents in ur­ban set­tings with ac­cess to pub­lic trans­porta­tion. A re­gion­al­ized ap­proach may mean that res­i­dents in the eastern coun­ties have to travel fur­ther to get pub­lic health ser­vices.

While Dr. Roume­li­o­tis sup­ports the idea of mod­ern­iz­ing health ser­vice de­liv­ery to im­prove cost ef­fi­cien­cies, he is con­cerned that such a dra­matic overhaul of pub­lic health struc­ture and fund­ing will jeop­ar­dize vi­tal pro­grams and put com­mu­nity health at risk. He points out that the EOHU has al­ready em­braced a lean ap­proach with a num­ber of cost-cut­ting mea­sures in re­cent years. “The Eastern On­tario Health Unit has made it a pri­or­ity to find cost ef­fi­cien­cies. We’ve im­ple­mented new dig­i­tal and mo­bile tech­nolo­gies that have helped us re­duce our in­fra­struc­ture foot­print and over­head costs, with­out com­pro­mis­ing the qual­ity or scope of ser­vices we pro­vide to the com­mu­nity. We also al­ready work with neigh­bour­ing health units to ex­plore and find ways of achiev­ing larger scale sav­ings and ef­fi­cien­cies, and to en­sure uni­for­mity and con­sis­tency of ser­vices.”

“The pub­lic health restruc­tur­ing and bud­get cuts were an­nounced sud­denly and with few de­tails from the pro­vin­cial gov­ern­ment, leav­ing health units and mu­nic­i­pal­i­ties un­cer­tain about how the changes will be im­ple­mented,” the state­ment reads.

No pub­lic or stake­holder con­sul­ta­tions were held prior to the an­nounce­ment, how­ever, the EOHU Board of Health and mu­nic­i­pal lead­ers are hop­ing the gov­ern­ment will in­clude them in fu­ture dis­cus­sions. “This will have a very di­rect im­pact on our communitie­s, so it’s im­por­tant that we have a voice at the ta­ble,” states Mr. Gar­diner.

“We want to work to­gether with the gov­ern­ment to find so­lu­tions that sup­port com­mu­nity needs within a sus­tain­able health­care sys­tem. It’s good for ev­ery­one, be­cause healthy communitie­s are pros­per­ous communitie­s.”

“This will have a very di­rect im­pact on our communitie­s, so it’s im­por­tant that we have a voice at the ta­ble.”

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