ST. THOMAS — Some Southwestern Ontario leaders are worried the public’s voice will be lost in the fallout of Ontario’s plan to drastically reduce the number of public health agencies through mergers.
In its first budget Thursday, Doug Ford’s Progressive Conservative government said it will chop the number of health units to 10 from 35.
That could leave regions like Southwestern Ontario, which accounts for about 10 per cent of the province’s population, with as little as one giant public health office.
“We could be talking about an organization from Sarnia to Owen Sound to St. Thomas to Windsor. How is that effective?” said Sarnia Mayor Mike Bradley. “I’m trying to understand the rationale.”
Sarnia Mayor Mike Bradley
Health units, which deal with public health emergencies and programs covering everything from fighting communicable diseases to helping new mothers adjust to babies, are overseen by boards that include representatives of their member communities. Larger boards could dilute individual voices.
Health units, Bradley noted, are on the vanguard of helping people deal with addiction, including the opioid crisis sweeping Canada. “They’re on the front line of protecting people’s health,” he said.
Bradley, Southwestern Ontario’s longest-serving mayor, said he sees parallels between the decision to consolidate health units and the creation of local health integration networks in 2007. The LHIN that includes Sarnia span three counties.
“Show me how that is better. I’m talking about the delivery of services,” Bradley said. “The way I see it, it’s just going to mean less engagement of health units in being proactive in their communities because their communities are going to be so large.”
If the province can find ways to reduce administrative bureaucracy, Bradley said he understands that, but adds Lambton Public Health, the health unit that covers Sarnia and Lambton County is responsive to the area’s needs.
“I greatly fear losing that,” he said. “The needs of every area, community, county are different by history, by social-economic issues. So, you lose that ability to create grassroots solutions to health issues that are specific to your community.”
London area’s medical officer of health said the local perspective is “incredibly important” in public health, not only because needs can be different in different areas but also because partnerships and local community values help to determine what’s possible in public health work.
Dr. Chris Mackie
“It’s so important to have that local voice and the local connections there, and that’ll be really critical. If this is going to go well, it will have to be done with those local issues front of mind,” said Dr. Chris Mackie.
Keeping local voices in the governing process and maintaining a local medical officer of health will be keys to the success of merged health units, Mackie said. “You want the medical officer of health role to include those local connections.”
If local offices close through mergers, there’s a risk of health units not being able to serve areas, Mackie noted.
“The art will be how do you make these mega-entities work together in a co-ordinated way and also strengthen and nurture those local relationships that are so crucial to public health work,” he said.
It’s not the first time the province has proposed changes to how health units operate. Under the former Liberal government, an expert panel recommended putting the then 36 public health units under the control of the 14 LHINs. Health units would be kept, but with regional agencies providing oversight.
The Ford government’s intended mergers came as a surprise, said Cynthia St. John, chief executive of Southwestern Public Health, the public health office for Elgin and Oxford counties.
“There’s certainly no question that one of the things that public health has enjoyed for decades is the fact that public health operates at a local level, it does its best work at a local level,” St. John said.
“We’re hopeful that whatever the changes are, our relationship with our community remains the same in terms of our ability to deliver our programs and services locally.
The health units of Elgin County-St. Thomas and Oxford County merged last year, a process that took eight months to complete. The provincial government’s intention is to go down to 10 regional administration bodies by 2020-2021.
“I would say to you that what appears to be proposed in the budget is a much larger scale change and so it’s really even hard to imagine what is an appropriate timeline because there just aren’t enough details known yet,” St. John said.
WHAT OTHERS SAID
“I guess we all would love everything to be extremely local, but 90 per cent of all things the health units do repeat in every place they are and so perhaps the merging of health units actually gives a far more efficient way to look at it.”
— St. Thomas Mayor Joe Preston
“What is proposed here is a much larger geographic area and so, going forward, we would want to understand exactly what that looks like.”
— Dr. Miriam Klassen, medical officer of health, Perth District Health Unit
“We don’t know what the size of these entities will be, or even where they will be, so we’re not speculating or guessing about that. To know the implications at this point, we just don’t have enough information.”
— JoAnn Tober, chief executive, Brant County Health Unit
“The work needs to be done. I don’t think they’re talking about cutting services.”
— Jim Gunn, Huron County warden
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