Dire prognosis for public health
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.”