Changes proposed for boards of health
Map from the report of the Expert Panel, showing LHIN Boundaries (in black)and the proposed new Health Unit jurisdictions (in color).
The Minister's Expert Panel on public health released its report, Public Health within an Integrated Health System, back in June. Among the recommendations: a reduction in the number of Health Units, from 36 to 14; better integration and collaboration between health units and the Local Health Integration Networks (LHINs); and better alignment of the boundaries, between health units, municipalities, and LHINs.
Health Units like the Simcoe Muskoka District Health Unit have been reviewing the document – and the reviews are mixed.
“On the whole, the board was supportive of those intentions,” said Dr. Charles Gardner, medical officer of health – especially maintaining the independence of boards of health; stronger connections for the deliver of health promotion, health protection and health care; and stronger connections with municipalities. “But when they looked at the details, they felt, in a number of ways, the details did not conform with or support the intention,” he said.
The health units currently align with municipal boundaries – which has allowed them to mount civic campaigns, working closely with municipal governments to amend local by-laws. In particular, Dr. Gardner pointed to the no-smoking by-laws that were passed by lower-tier municipalities about 15 years ago, thanks to advocacy by local health units. Those by-laws paved the way for the Provincial Smoke-Free Ontario Act. “It's had a meaningful impact on health,” Dr. Gardner said.
But, he suggested, “If we lose our alignment with municipal boundaries, it will greatly weaken our relationship with municipalities, and greatly weaken our ability to do that kind of work.”
The report recommends an extension of SMDHU beyond its current boundaries westward, to include the Parry Sound area, merging Simcoe Muskoka with the west half of the North Bay Parry Sound District Health Unit, as a new “North Simcoe Muskoka” health unit. Not only would the change divide municipalities, it is unclear how it would promote closer ties between local boards of health and the greater health care system, unless there were also changes to LHIN boundaries.
The new board of health would deal with 3 different LHINs, not just the two it currently operates within.
“The report doesn't actually state LHINs should change their boundaries,” Dr. Gardner said, “If the talk is about LHIN boundary changes, there's a whole bigger picture” - something of concern to a municipality like Bradford West Gwillimbury, which is part of Simcoe County, but currently within the Central LHIN. BWG is in the 905 rather than 705 area code, and utilizes Southlake hospital and other services provided by York Region.
Dr. Gardner also expressed concern over the size of the entities that would be created by the merger of health boards. One of the recommendations is for a new South West Region, merging 6 health units into a single entity that would stretch from the shores of Lake Erie to the Bruce Peninsula, and include cities such as London – a “very large and very diverse area,” he said, that could result in reduced connections between the health unit and local municipalities.
Besides that, there are practical considerations: the potential cost of the mergers, changes in human resources, and the need for a new funding model from the province.
That said, Dr. Gardner noted that the report is a recommendation only, and “no decisions have been made.” The SMDHU drafted a letter in response, which has been sent to the minister.
“We would be actually lightly affected compared with most of the other proposed mergers across the province,” Dr. Gardner said, which is why the board didn't focus on local issues alone, in its response. “They gave feedback about the whole.”
And in the end, he said, “It really rests with the Province.”
Deadline for comments is the end of October.
(With notes by Miriam King, Bradford Times)