In September Peterborough residents narrowly avoided the first strike in their health unit’s history. Despite acknowledging significant inequities in how they compensate staff, the Peterborough County-City Health Unit argued they couldn’t afford to play catch-up with the smallest of the unit’s three staff bargaining units. Professional staff at PCCHU were earning as much as $3,000 a year less than internal counterparts with identical job descriptions.
That should be worrying for more reasons than just internal equity.
They key to health reform is to ensure there are sufficient resources upstream so that expensive problems don’t fester downstream.
The PCCHU admits that for some programs there have been no increases in funding for about a decade.
Public Health Units played an important role in limiting the spread of SARS in 2003-04. According its website, Public Health Ontario has been recently working with the Ontario Ministry of Health and Long-Term Care, the Public Health Agency of Canada and other partners to monitor and provide timely guidance regarding the respiratory illness EV-D68. Should Ebola be confirmed in Canada, public health units will also be called upon to track and stem the spread of the deadly virus.
Dr. Gary Kirk, the CEO of the Windsor-Essex County Health Unit, went public late last year arguing his per capita funding was significantly below other units across the province – some were receiving almost three times the funding of Windsor-Essex.
In 2012 the difference in per capita funding ranged from $30.04 to $81.97 – depending on where you lived.
Kirk argued that Windsor-Essex needed the investment given the region exceeds the provincial averages for rates of obesity, smoking, drinking, cancer as well as consuming a less than healthy diet.
This shouldn’t come as a surprise to the Ministry of Health.
In June 2004 the Ontario government launched a three-year plan to revitalize public health. That plan included a capacity review which reported in 2006.
The Capacity Review specifically identified the need for greater equity in public health system funding, calling on the province to bolster the resources of smaller health units like Peterborough.
It wasn’t the first time the government heard this. Two reports from the Auditor General of Ontario in 1997 and 2003 made the same call.
In 2008-09 there was some adjustment: an across-the-board increase of 3 per cent plus a further 2 per cent for health units that served low-income and high growth population areas. That didn’t go nearly far enough.
Few of the other recommendations in that 2006 capacity review were followed, but one was: the need to adjust compensation for the Medical Officers of Health and Associate Medical Officers of Health as part of a recruitment and retention strategy. That took place in 2009 – shortly after the global financial crisis that rocked Ontario’s tax revenues.
According to a recent government funding review, 30 of 36 public health boards requested increases in 2012 greater than the 2 per cent funding they actually received from the province. The average request was closer to 8 per cent and some as high as 25 per cent.
Either the expectations of those boards were out-to-lunch, or they reflect a growing frustration with the gap between funding and the responsibility to protect and promote good health in our communities.
To the credit of the present government, the province has absorbed a greater proportion of overall costs. In 1998 Mike Harris had completely downloaded these costs to the municipalities. The McGuinty/Wynne governments have since restored the funding ratio to 75/25 provincial/municipal. Given their role and the need for integration with the rest of the health system, it has been argued that public health should be 100 per cent provincially funded.
Health Units get too little public attention but are critical in reducing long-term health costs through prevention and health promotion. If the province is serious about long-term stability of the health system, this is not the area to skimp on funding to get over current fiscal challenges.
Public Health Ontario recently appointed a new President and CEO with an impressive background, including four years as the Deputy Chief Medical Officer to the Scottish government. Dr. Peter Donnelly has his work cut out for him.
With Ebola and EV-D68, Ontarians are now likely anxious enough to support these long overdue adjustments. Nobody wants to die or see their kids become ill to keep corporate taxes the lowest in North America.