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Ontario has quietly proposed sweeping changes to public health units that could make them less nimble responding to emergencies such as SARS, an expert and opposition health critic warn.
An expert panel convened by Ontario’s Liberal government has recommended scrapping the province’s 36 health units and replacing them with 14 much larger bureaucracies that replicate the geographic boundaries local health integration networks (LHINs).
In the London region alone, that would mean replacing seven local health units with a single behemoth to cover communities from Owen Sound to St. Thomas, and that could make them less responsive to local needs, including public health emergencies. (London and surrounding area is covered by the Middlesex-London Health Unit, for example.)
“(The proposals) are a leap of faith. (The panel) didn’t provide any evidence,” said Joseph Lyons, director of the local government program at Western University.
It’s true that there could be better integration between public health and health services generally, Lyons said. It’s also true some of Ontario’s smallest health units have struggled because of a lack of resources, he said, but that is not a good reason to scrap the entire system.
“Smaller health units can be fixed without turning whole systems on their heads,” he said this week.
The group released its report in the summer without much public notice but its recommendations alarm Progressive Conservative health critic Jeff Yurek. Giant health units “would delay a timely response,” to health crisis, the Elgin-Middlesex-London MPP said Tuesday.
Lyons and Yurek highlighted a number of concerns about the proposals:
- While health units now have board members from the communities they serve, many communities would have to go without representatives on LHIN-sized health units.
- The expert panel assumes larger bureaucracies will be more effective and efficient but history has proven otherwise: The amalgamation of communities and hospitals in Ontario in the past did not produce savings and may have added to costs.
- Public health needs in downtown London are nothing like needs in rural Grey and Bruce counties, but a proposed, massive health unit for the region would have to manage both.
- Under the proposed changes, local medical officers of health would have to answer to a CEO, adding another level of bureaucracy.
The science behind public health is driven by evidence but the proposals of the expert panel lack that vigor, Lyons said. “These are pretty sweeping (changes). I’m not sure I’d be comfortable accepting the claims of the expert panel on face value,” he said.
After public health crisis with SARS and an outbreak of E.coli in Walkerton’s drinking water, some recommended that public health units have more autonomy, not less, Lyons said.
The proposal to the province would take us down the opposite path, Yurek said. “We will see centralization. If anything goes wrong, there will be less accountability and less local oversight,” he said.
Ontario now has 36 public health units, with the smallest serving only 34,246 people dispersed over a geographic area as large as France, and the largest servings 2,771,770 people within 630 square kilometres.
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