If the recommendations quietly released last summer by an expert panel appointed by Ontario Health Minister Eric Hoskins to analyze the role of public health in an integrated health care system are implemented, the number of health units across Ontario could decrease from 36 to 14.
But such a drastic decrease is making some nervous, worried that the changes could weaken rather than strengthen the ability of public health to respond to emergencies such as the SARS outbreak of 2003 or its ability to focus on illness prevention.
“Public health interventions have probably been the most powerful forces for improvement in health in the population since public health came into existence 160 years ago,” noted Dr. Charles Gardner, Medical Officer of Health for the Simcoe Muskoka District Health Unit.
The public health movement came about because of the unlivable conditions of cities in the mid-1800s and the earliest of our successes was actually identifying that contaminated water was the major source of repeated deadly outbreaks and therefore that municipal water needed to be cleaned and we’ve found ourselves busy ever since, playing that kind of role, of identifying major problems and organizing for change. Medical Officer of Health Dr. Charles Gardner
The report by the expert panel was presented to the Board of the Simcoe Muskoka District Health Unit in September for input, as requested by Ontario Minister of Health Eric Hoskins. While the board agreed with the panel’s stated objectives of improving public health capacity, maintaining strong and independent boards of health as well as strong relationships with municipalities and other community partners while better aligning with Local Health Integration Networks, there were concerns that larger health units did not necessarily align with municipal boundaries.
“This would be a great concern because so much of our work is done with municipalities. Our mandate is to improve health by improving living conditions, by addressing the underlying broad determinants of health and in fact municipalities have a very heavy influence over those things, to a much greater degree than Local Health Integration Networks do,” said Gardner. “If municipalities find that they’ve now got more than one health unit in their midst, we have a weaker relationship, whereas if you have a one-on-one relationship, it’s a stronger relationship.”
Gardner noted that public health is very much a part of municipalities as they appoint members to their local health board and make financial contributions to their health unit. “All of that helps create legitimacy for us communicating with them about their policies, their bylaws, their legislation,” he explained, adding that in some instances, the health units’ boundaries proposed don’t necessarily align with the Province’s 14 LHINs, a stated goal in the panel’s work. “So it’s hard to say what would be achieved with this change,” he noted.
If saving money is what the Province is after, there would be no guarantees, said Gardner who noted that finding savings is not one of the stated objectives of the report and if it were, things like wage harmonization between larger and smaller amalgamated health units would likely cost more, not less. “Public health is tiny when it comes to our cost compared with the health care system and the report doesn’t explicitly state that they’re seeking to achieve reductions or savings this way,” he said. “The objectives primarily seemed to be a closer alignment with LHINs so that we could support their health planning and other things that they do.”
Gardner said the health unit already works with the North Simcoe Muskoka Local Health Integration Network (NSM LHIN) on specific projects, but relies heavily on other partners, again, especially municipalities. Gardner referenced the 2016 Patients First Act, which is reshaping health care delivery in Ontario. “Definitely Patients First positions that public health could help LHINs and the health care system become more effective, more efficient, more health promoting if we’re more closely aligned with Local Health Integration Networks and I’m sure that we could help to some degree with that, but I believe our greatest contribution to health is by working with the broad community to create healthy public policy,” he said.
The new boundaries proposed for this area would include Parry Sound District, and whether the City of North Bay would be included in the proposed new boundaries is still not clear. Before the local health unit became known as the Simcoe Muskoka District Health Unit, it was known as the Muskoka Parry Sound District Health Unit. In 2005, the Province merged the Muskoka part of the health unit with Simcoe County and the Parry Sound area was merged with North Bay. If the Minister approves the expert panel’s recommendation Simcoe, Muskoka and Parry Sound would all be merged into one health unit.
It will be up to the Minister of Health to determine if some or any of the recommendations by the expert panel will be adopted. You can find the panel’s report here.
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Larger units of anything has inherent problems. Case in point, the Trillium Lakelands Board of Education. Community identification is very important in determining the effectiveness of such organizations and, for example, Huntsville does not identify with Lindsay and this greatly reduces the effectiveness of the Board. The Muskoka Board of Education used to be a vibrant and important organization. All the communities within this geographical unit identified with each other and with the Board. The Trillium Lakelands Board covers a very wide and diverse geographical area and the communities with in it do not all identify with each other. As a result this Board is almost inconsequential to Muskokans.
Including Parry Sound with Simcoe Muskoka makes great sense to me as long as North Bay is part of it. In our circle of friends Parry Sound Hospital and North Bay Hospital are where they are going to get faster service for eye surgery, hip and knee surgery and an MRI. Both are as close as the Royal Victoria Hospital.
There is already a shortage of services in the north, long drives for tests and X-rays, long wait periods for many – this is asinine!