A vision to change the way public health units are managed in Ontario is not sitting well with municipalities across the province, and Waterloo regional councillors have sent their concerns to the Ministry of Health.

"I don't think there are any of the integrated public health units in Ontario that are in favour of it," said Waterloo Region Chair Ken Seiling. "I think it's pretty unanimous across the board that people are opposed to it."

In January, the province's minister of health, Dr. Eric Hoskins, convened an expert panel to investigate the structure, organization and governance of Ontario's public health sector. 

On July 20, the panel released its final report, which recommended replacing the existing 36 local public health units with 14 regional entities.

The report stated that the sector "would be stronger if there were fewer health units with greater capacity."

public health expert panel recommendations map

The expert panel recommended divided the province into 14 regional public health entities, shown here as the different shaded areas. The dark lines separate LHIN regions. (Ministry of Health)

A step backwards

But Seiling said reducing the number of units would be a step backwards and would result in less programming and less accountability.

In late October, Waterloo regional councillors agreed to send a report to Hoskins, urging him not to adopt the panel's recommendations. 

The region said:

  • There is no evidence to suggest that the recommendations would improve public health delivery or population health in Waterloo Region.
  • There are significant unanswered questions about the implications of the recommendations for this community.
  • There are real risks for the disruption of public health service delivery in the Region of Waterloo if the recommended model is implemented.

Seiling said strong opposition to the panel's recommendations is coming not just from the region, but also from other municipalities in Ontario.

AMO takes a stand

The Association of Municipalities of Ontario sent a letter to Hoskins in early October, stating its opposition to the report.

"If the Expert Panel recommendations are implemented, it will completely change and dilute over time the mandate of the local public health system," the letter declares. 

'There are some people in the public health field who ... feel that they shouldn't be managed by municipal councils.' - Ken Seiling

"Given the grave concerns of what would be lost by implementation of these recommendations without any evidence of benefit led us to our decision not to support them."

According to Seiling, those opposed to the report tend to be municipalities and regional governments that currently have  integrated public health units, which is a unit that works directly with — and under — the direction of a local government. 

The best way to tell whether a public health unit is integrated or not is if its service area matches the borders of a single municipality — like the Region of Waterloo — and if its board of directors is made up of elected officials.

Expert panel 'stacked'

"There are some people in the public health field who want to stand up autonomously and do what they want to do and feel that they shouldn't be managed by municipal councils," Seiling said. 

"I think what it boils down to was the expert panel was stacked against integrated health units by people in the public health fields who wanted these separate, free-standing units." 

That may seem like a strong claim to make, but of the four people on the panel representing local public health units, only one represented an integrated unit: Carol Timmings, the director of child health and development and chief nursing officer of Toronto Public Health.

Timmings is also currently the president of the Registered Nurses Association of Ontario. 

Municipalities and public health units had until Oct. 31 to comment on the expert panel's report.