Boards of health, municipalities and public health workers received some good news recently from the province. Both the Premier and the Minister of Health shared publicly their intent to step back from previous announcements to transfer the delivery of public health services away from the current 35 boards of health and instead, create 10 new mega-regions by April, 2020. Instead, Hastings County CAO Jim Pine has been appointed to help lead province-wide consultations on the future structure of public health that is being pitched as a “reset” with “no predetermined outcomes”. Up until February 10, 2020, he has promised to listen hard. In fact, he has promised to hold meetings here in Peterborough with local and regional stakeholders later this month.
Gone is the plan to reduce provincial funding to 60% of total public health costs. It currently sits at about 80%, with municipalities and First Nations paying about 20%. As of January 1, 2020, the local share will shift to 30% of all Ministry of Health funded public health programs, with the exception of the new dental program for low-income seniors. That’s a difference of about $900,000 in Peterborough. It represents an increase of 40%, which will be capped at 10% for this first year.
Local funders are grateful that the province has mitigated the hit for 2020, but are now on pins and needles when it comes to the future sustainability of a strong and local public health system for 2021 and beyond. For this reason, Peterborough’s board of health has requested a meeting with Minister of Health, Christine Elliott at the upcoming Rural Ontario Municipal Association meeting in January. Public health is the first line of defence for the public’s health protection and wellbeing and it plays an important role in keeping communities safe and open for business. In the aftermath of the SARS outbreak, recommendations emerged for the province to commit to at least 75% of public health funding. The province’s decision to reduce its share to 70% is perceived as a threat to local safety and wellbeing.
Whatever the ratio, the important outcome is that public health not be undermined or forgotten – after all, investing in prevention makes sense. And this is not just an old adage that sounds good – it’s actually true. The evidence for interventions like smoking by-laws, clean drinking water, immunization, safe food handling, substance use prevention, healthy baby and child development, healthy built and natural environments, to name a few of the wide repertoire of public health functions, is both sound and impressive. But when emergency department hallways groan with the burden of patients on stretchers and ambulance attendants wait hours to unload, or families wait months and years for a long term bed for their loved one, it is easy to understand why public health may get overlooked.
What might Mr. Pine hear when he comes to town? He will hear that Peterborough is committed to being accountable and responsive to its communities. A majority of the board of health is composed of elected representatives from the County, the City, Curve Lake and Hiawatha First Nations. Maintaining strong ties is important.
The board is open to growing in size to improve our capacity and efficiencies, but only if means pairing up with neighbouring counties that share similar populations, geographies, priorities and a desire to work together. Just over half of Peterborough’s population lives in the urban core, or City, and the rest lives in small rural communities, on agricultural lands or near lakes and rivers. Forging new partnerships with our neighbours so that we can pool our resources and coordinate efforts is definitely on our Christmas list.
As health care is transformed into new Ontario Health Teams, public health will be there as an ally and partner on the prevention front. We would welcome stronger central roles for the province and Public Health Ontario to plan, set goals and targets, create and deliver public communication campaigns and oversee research and population health assessment activities. We certainly will welcome Mr. Pine’s visit in the next few weeks.
By Dr. Rosana Salvaterra, Medical Officer of Health, Peterborough Public Health