Public health officials were blindsided by news in Thursday’s budget that health units will be slashed from 35 to 10 across Ontario.
“It came out of the blue, we had no previous warning,” said Dr. Paul Roumeliotis, medical officer of health for the Eastern Ontario Health Unit.
Roumeliotis, who takes over as president of the council of medical officers of health in June, said the general reaction among medical officers of health is shock.
The province also announced it would cut $200 million from the $1-billion public health sector.
“That number is large,” said Ottawa’s Medical Officer of Health, Dr. Vera Etches. “It is likely greater than a 10-per-cent cut and that is where we want to be cautious that our capacity to protect the health of the public and to promote health is still there. We provide services that keep people well and prevent illness and those are needed.”
Etches said she and other public health officials “did not have an inkling” of the province’s plan to slash the number of health units.
The changes come at a time when Ottawa and many health units are coping with a worsening overdose crisis as well as a resurgence of measles and other vaccine preventable diseases.
A spokesperson for the Ford government said Friday the move “will better co-ordinate access to health promotion and disease prevention programs at the local level, ensuring that Ontario’s families stay safe and healthy.”
Etches and others say they are interested in finding ways to reduce costs by collaborating and modernizing. “I think we need to look at opportunities to focus on what we can do to find efficiencies and to help with the financial picture without cutting into the core services that keep people well.”
There are few details about how the changes will unfold. Some fear the result will be cuts to front-line and office staff and programs.
“We were shocked by this,” Roumeliotis said. “Our fear is that we will lose the ability to implement local services.”
Health units, including Ottawa Public Health, work on immunization, harm reduction, baby checkups, preventing food-borne and water-borne illnesses and emergency preparedness, among other things. Ottawa Public Health operates a supervised consumption site in Lowertown, now being funded by the City of Ottawa after the province discontinued its funding.
Their work on immunization and harm reduction has taken on a new urgency in recent months as vaccine preventable diseases such as measles make a comeback and Ontario copes with a worsening overdose crisis. In Ottawa, where two people have been diagnosed with measles in recent weeks, public health staff are dealing with both.
This is not the first time the government has looked at reducing the number of health units in the province. The previous Liberal government appointed a task force to look at cutting health units from 35 to 14. The plan was scrapped after broad opposition. Among concerns at the time were that municipalities would lose representation on local health boards and health units would lose their local flavour.
Municipalities are responsible for 25 per cent of health unit funding and have representation on their boards. Ottawa Councillor Keith Egli chairs Ottawa’s board of health.
While some health units are independent institutions, Ottawa’s is entwined with the City of Ottawa. Health unit staff are employees of the city. Ottawa Public Health employs 506 people, of which 210 are nurses.
Untangling those financial, staffing and governance connections will be complex.
Not everyone opposes consolidation, though.
Dr. Rob Cushman, former medical officer of health in Ottawa, says there have long been problems with smaller health units that are unable to recruit staff and have limited resources.
“I think theoretically this looks positive,” he said, “but the devil is in the details.” Cushman added that the budget cuts were worrisome, especially given the ongoing opioid crisis.
At the annual meeting of the Registered Nurses Association of Ontario on Thursday night, public health nurses were concerned about their future, NDP health critic France Gélinas said. Among information about the changes in budget documents was a line saying that the health units would be “more closely aligned with priorities of this government.”
Gélinas said some public health nurses felt as if they were being punished because they pushed for supervised consumption sites and against more access to alcohol. “I could see why they would feel that way,” she said.
Wendy Muckle, executive director of Ottawa Inner City Health, says her organization and others rely heavily on Ottawa Public Health for support. Among other things, Ottawa Public Health organizes and gets rid of biohazardous waste associated with supervised consumption sites and harm reduction.
“That is what you want a public health unit to do,” Muckle said.
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