Public Health andHealthcare in Ontario

A Made in Ontario Solution for Public Health and Healthcare

Andrew PapadopoulosDirector, 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