POSITION STATEMENT FROM THE EOHU BOARD OF HEALTH: Restructuring of Public Health Must Consider Impact on Community
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’s surprise announcement follows the release of the 2019 provincial budget, which outlines a plan to “modernize” public health by cutting the number of health units in the province from 35 to 10 over the next two years. It has also announced that provincial funding for public health is being cut as it changes the model for cost-shared services with municipalities, offloading a significant portion from the province to municipal governments. With the proposed restructuring, the province plans to slash public health funding by $200 million—a reduction of nearly 30%. 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 Eastern Ontario Health Unit (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 increases 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. Paul Roumeliotis, Medical Officer of Health at the EOHU, 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. Our 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.
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. This includes providing services such as low-income dental clinics, well-baby programs for families who don’t have access to pediatricians or family physicians, and speech services for young children. The EOHU also manages local infectious disease outbreaks (including the recent follow up of measles contacts), provides health and safety inspections of local food premises, daycares, long-term care facilities and personal service settings, and provides public health support to the Mohawk Council of Akwesasne. With the large French 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. 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.”