Public Health and Healthcare in Ontario A Made in Ontario Solution for Public Health and Healthcare Andrew Papadopoulos Director, School of Occupational and Public Health January 20, 2005

The Public Health System Health Unit Structure and Funding Ontario served by 36 boards of health Set the budget, paid for by the municipalities served A grant of 55% is provided by the Minister of Health resulting in a 55/45 funding relationship Will eventually become a 75/25 split set up as apolitical bodies for the health of the public have strong advocacy role

Shifting Ideologies Focus of public health has shifted in past few decades Move away from direct contact and more of a focus on population health A move toward chronic disease prevention Communicable disease outbreaks have moved the focus again Walkerton water outbreak, West Nile virus, SARS

The Inquiries and their Reports Walkerton The public health system is chronically under- funded and its role has been diminished Haines Meat Inquiry Public health’s role requires enhancing and solidification for the public’s interest SARS The public health system is desperately under- funded and is not a system Greater involvement in health care required

Provincial Public Health Initiatives The establishment of: The Agency Implementation Task Force The Local Public Health Capacity Review Committee A website for the Provincial Infectious Disease Advisory Committee The Public Health eHealth Council Increased funding to local Boards of Health Enhanced tobacco legislation Increase in publicly funded vaccines

Public Health Agency of Canada New approach in collaboration with provinces and territories on efforts to renew the public health system in Canada and support a sustainable health care system Focused on efforts to: prevent chronic diseases, prevent injuries and respond to public health emergencies and infectious disease outbreaks keep Canadians healthy and help reduce pressures on the health care system

Public Health Agency of Canada (continued) Headed by the Chief Public Health Officer who will report to the Minister of Health Separate from Health Canada although both will be part of the health portfolio Initial projects include a public health human resources strategy and a development of core competencies for public health personnel

Local Health Integration Networks Government believes we need fundamental changes to the system Community based, responsive to people’s needs and accountable Investment in five key areas: long-term care; home care; primary healthcare through 150 family health teams; community mental health; and, a revitalized public health system focused on prevention

More LHINs Purpose is to integrate and coordinate services at the local level Not intended to be service providers Fund the healthcare system Used ICES study of hospital referral patterns to determine the 14 boundaries Local partnerships will be self-organized Improve population health Primary healthcare reform?

LHIN Governance Governed by Order-in-Council appointed Board of Directors CCAC model Board to oversee Planning System integration and coordination Evaluation of performance through accountability agreements Funding

LHIN Priorities Patient Care Integration Integration of mental health and addictions across the full care continuum Planning for integrated services for seniors Bridging health care delivery from hospitals to community care and support services Community support services in an integrated system

LHIN Priorities (continued) Administrative/Support Services Integration Common health record and electronic exchange of information Governance ensuring accountability to community Maximizing human resources potential through innovation and integration

Next for the LHINs Work is currently underway in each of the 14 LHIN communities to prepare and submit their Integration Priority Report It is the MOHLTC's expectation that members of the public and the full spectrum of health care providers in each LHIN community be engaged in the work Reports due 75 days after the local workshop Will form the foundation for LHIN integrated health system planning

A Revitalized Public Health System Ontario Health Protection and Promotion Agency The enhancement (creation?) of a public health system Creating greater independence for the Chief Medical Officer of Health through legislation Building capacity at the local level Determining the division of responsibility between federal, provincial and local levels of public health Determining the local level

A Revitalized Healthcare System A focus on the determinants of health Have the system think and act as a system Community decision making Fiscal accountability Prevention first, not an after thought Find synergies where possible and recognize local differences