Item - 2017.HL22.2

The Board of Health recommends that:

1.  City Council request the Minister of Health and Long-Term Care to carefully consider the implications of the Expert Panel recommendations on public health as presented in its June 9, 2017 report, Public Health Within an Integrated Health System.

2.  City Council request the Ministry of Health and Long-Term Care to consider evidence-based alternative approaches to achieving the stated goals of the Expert Panel that will:

a.  Ensure there is only one public health entity for the City of Toronto based on municipal geographic boundaries;

b.  Mandate a formal relationship between Local Health Integration Networks, public health entities, and municipalities;

c.  Allow for the continued existence of autonomous, semi-autonomous and regional/single tier boards of health governance models in Ontario; and

d.  Support Board of Health roles, responsibility and membership competency by providing education and training to new members.

3.  City Council request the Ministry of Health and Long-Term Care to undertake an inclusive and comprehensive consultation process on the Expert Panel report, including consulting specifically with the City of Toronto.

4.  City Council forward its decision to the Minister of Health and Long-Term Care.

5.  City Council forward its decision to the Chief Medical Officer of Health for Ontario, the Association of Local Public Health Agencies, the Council of Medical Officers of Health (Ontario), Ontario Public Health Association, the Association of Municipalities of Ontario, Ministry of Education, Ministry of Children and Youth Services, Toronto District School Board, the Toronto Catholic District School Board, Conseil scolaire Viamonde, and Mon Avenir Conseil Scolaire Catholique, the City Manager, Deputy City Managers (Cluster A, B, and C), the City Solicitor and the City Clerk.

The Board of Health also:

1.  Requested the Minister of Health and Long-Term Care to carefully consider the implications of the Expert Panel recommendations on public health as presented in its June 9, 2017 report, Public Health Within an Integrated Health System.

2.  Requested the Ministry of Health and Long-Term Care to consider evidence-based alternative approaches to achieving the stated goals of the Expert Panel that will:

a.  Ensure there is only one public health entity for the City of Toronto based on municipal geographic boundaries;

b.  Mandate a formal relationship between Local Health Integration Networks, public health entities, and municipalities;

c.  Allow for the continued existence of autonomous, semi-autonomous and regional/single tier boards of health governance models in Ontario; and

d.  Support Board of Health roles, responsibility and membership competency by providing education and training to new members.

3.  Requested the Ministry of Health and Long-Term Care to undertake an inclusive and comprehensive consultation process on the Expert Panel report, including consulting specifically with the City of Toronto.

4.  Directed that a copy of the report (October 13, 2017) from the Medical Officer of Health and the Board of Health's decision be submitted to the Ministry of Health and Long-Term Care by October 31, 2017 to meet the provincial consultation deadline for public health.

5.  Directed that a copy of the report (October 13, 2017) from the Medical Officer of Health and the Board of Health's decision be forwarded to the Chief Medical Officer of Health for Ontario, the Association of Local Public Health Agencies, the Council of Medical Officers of Health (Ontario), Ontario Public Health Association, the Association of Municipalities of Ontario, Ministry of Education, Ministry of Children and Youth Services, Toronto District School Board, the Toronto Catholic District School Board, Conseil scolaire Viamonde, and Mon Avenir Conseil Scolaire Catholique, the City Manager, Deputy City Managers (Cluster A, B, and C), the City Solicitor and the City Clerk.

As part of the Government of Ontario's Health System Transformation agenda, the Minister of Health and Long-Term Care (the Minister) established an Expert Panel on Public Health (Expert Panel) in January 2017 and the Ministry of Health and Long Term Care (the Ministry) released a report from the Expert Panel on July 20, 2017. The Expert Panel's mandate was to provide the Minister with advice on structural, organizational, and governance changes to Ontario's public health sector with the stated goal of integrating public health into the health system. 

The report includes recommendations that describe how public health will operate within an integrated health care system. The specific recommendations that impact Toronto Public Health (TPH) and the City of Toronto include:

-  Dividing the City into three (3) separate public health units referred to as regional public health entities (RPHEs); with three (3) Chief Executive Officers and three (3) Medical Officers of Health for the City of Toronto;

-  Aligning these RPHEs with three Local Health Integration Networks (LHINs) - Central, Toronto Central and Central East; and

-  Establishing freestanding, autonomous boards of health removed from the municipal structure, and granting the provincial government the power to appoint members as well as appoint persons to the positions of Chair, Vice Chair and Finance.
 

The proposed recommendations would result in the most significant change to the public health system in decades, and there are serious concerns with the recommendations as presented.  Building linkages, fostering collaboration and health system connection is important to meeting the health needs of all Ontarians, but organizational integration is not the solution to achieving this overarching goal. 

This Board of Health (BOH) report provides an overview of the Expert Panel's recommendations, the impacts on public health in Toronto, and proposed alternatives to support enhanced capacity, collaboration and connectedness with the health system, without compromising public health's core mandate to improve population health.