I received this message from my municipal councillor in Hamilton - I thought
some on the list might be interested,

Sarah

+++++++++++++++++++++++++++++++++
Sarah Wakefield, PhD
SSHRC Postdoctoral Fellow,
Department of Public Health Sciences,
University of Toronto
(416) 978-7528
[log in to unmask]

----- Original Message -----
From: "Councillor Caplan" <[log in to unmask]>
To: "Councillor Caplan" <[log in to unmask]>
Cc: "Morden, Kay" <[log in to unmask]>; "Brown, Dale"
<[log in to unmask]>
Sent: Sunday, May 11, 2003 10:58 AM
Subject: Public Health


>     Dear Friends,
>     I have forwarded this to people on my e-mail contact list with the
> thought that some of you might be interested in one of the issues that the
> Association of Local Public Health Agencies and I had been working on.  I
> submitted the following op-ed to several newspapers last week.
>
>     Should you have any comment please do not hesitate to let me know.
> If you wish to have your name removed from any further e-mailings please
let
> me know.
>
>     Regards,
>     Marvin
>     ------------------------------------
>     The recent SARS and West Nile outbreaks have clearly illustrated the
> importance of Public Health services.  How Public Health issues are
governed
> in the Province of Ontario is critical.  That the issue of governance has
> not been brought to the forefront is an amazing compliment to the quality
of
> front line service delivered by the Municipal employees who deliver Public
> Health Services.  It is also a fact that we have been very, very lucky.
>
>     Ontario is the only Canadian jurisdiction that has put the costs and
> governance of Public Health issues largely in the hands of Municipalities.
> As co-chair of the Association of Municipalities of Ontario's Health
> Committee, past president of the Association of Local Public Health
> Agencies, Past Chair of Hamilton's Public Health Committee, and as a
former
> member of the Executive of a District Health Council I have first hand
> knowledge of the horrendous risks inherent in downloading the costs and
> governance of public health issues.
>
>     Just imagine what could have happened if the SARS outbreak had
> started in a municipality with a less well-equipped public health
department
> without a full-time Medical Officer of Health to make the quick decisions
> required in an outbreak. Had the outbreak spread more widely in that
> community and not been contained as well as it has been in Toronto, the
> disease could quickly have spread to epidemic proportions across municipal
> boundaries. Even the large and sophisticated health department in Toronto
> required assistance with its response. The adjacent Durham, York Region
and
> Simcoe health units were similarly affected.
>
>     I applaud the superb job done by the very professional Public Health
> staff in Toronto.  And I must congratulate our own staff in Hamilton for a
> job well done. The provincial co-ordination of the public health response
> was assisted greatly through contributions from health units across the
> province.  As a Hamiltonian, I'm proud of the assistance my municipality
> provided to our neighbours and to the Province during this crisis.
Hamilton
> specifically assisted not only Toronto, but also York and the provincial
> response via the Scientific Advisory Committee.
>
>     All Ontario health units were required to reallocate resources
> during this outbreak.  Each had to implement directives aimed at
preventing
> further spread of the disease. Many provided assistance to directly
affected
> health units and to the Ministry of Health and Long Term Care's response
> team. Diverting scarce resources during a crisis means the services that
> should be offered to protect and enhance the health of our communities are
> diminished.
>
>     The importance of the work done by Public Health is often poorly
> understood.  The goal of Public Health is to prevent illness, and
> disability, and to improve the well-being of all citizens.  When it is
doing
> a good job it is invisible:  the ills that don't happen aren't counted.
The
> diseases and epidemics that once ravaged our communities are held in check
> by Public Health. These services include verification of food and water
> safety, vaccinations, community sanitation, promotion of healthy
lifestyles
> and behaviours, sexual health clinics, support for new mothers and their
> babies, nutrition, and a myriad of others. Each of these is aimed at
> preventing negative health outcomes rather than repairing them. Each is
> mandated by the province under the Health Protection and Promotion Act;
and
> each of those vital services is now primarily the responsibility, not of
the
> Federal or Provincial Governments, but of your City or Regional
Government.
> Ontario is the only Canadian jurisdiction that has placed such an onus on
> its municipalities.
>     Why would a Provincial Government download the financial
> responsibility for the health of its citizens to the Municipalities?  It
> seems as if the reason was to save money on your income tax.  The burden
was
> removed from Provincial income tax and put instead on the far smaller and
> less progressive Municipal property tax rate.
>     To be fair to the Province, they do grant up to half of the costs
> incurred by municipalities in providing Public Health services.  But those
> grants are not guaranteed and come with many conditions attached.  If
health
> is the number one priority of our Provincial government, shouldn't it be
> willing to make a firmer financial commitment to the prevention of illness
> and promotion of wellness?
>     Beyond the lack of appropriate financial commitments there are
> further difficulties. There have been hundreds of hours of work done by
> Medical Officers of Health and their staffs on what are the best practices
> in delivering the programs mandated by the Province.  Amazingly the
Province
> has not yet adopted the new standards for Mandatory Programs
>
>     Based on the comments and actions of Municipalities around the
> Province, the system is fraught with difficulties.    No municipality has
> achieved 100% compliance with the mandatory programs. Mounting economic
> pressure forces many municipalities into a reactive role in which
proactive
> public health enhancements become lower priorities. Such a climate makes
it
> easier for city councils to choose spending on pothole repairs over a
> tobacco cessation program for teens. It also diminishes their capacity to
> focus on visions of meeting needs for future improvements.  The province
> must make the commitments that logic demands in order to rectify this
> situation.
>
>     Clearly, the emerging issue in Public Health is the importance of
> the social and economic determinants of health.  Poverty and low social
> status are the most important indicators for a host of adverse health
> outcomes.   The evidence that this is the case is overwhelming.  Yet those
> municipalities with the greatest numbers of poor and marginalised
> populations are the very communities with the least ability to pay for
> needed programs.
>
>     The realities of public health practice originate from the realities
> of the communities in which it takes place. But they must be guided by
> priorities and standards that originate from healthy public policy as set
by
> the senior governments. This clearly demonstrates a shared responsibility
> that must be taken seriously and leave nothing to chance. Overall public
> health priorities, education and research must be federally and
provincially
> mandated and funded. Maintaining a voice in how to best deliver community
> services that meet those priorities requires that municipalities continue
to
> bear a small portion of the cost.
>
>     As an example, to leave thirty-seven individual health units to
> decide how to handle West Nile without the best information and standards
> Province-wide is just wrong.  Not having a Provincial, and a Canadian
centre
> for disease control is a statement that we are prepared to be unprepared.
> There should also be a board of health at the provincial level, likely
best
> situated at arms length from the government, that co-ordinates responses
> such as that for SARS and other, more common inter-jurisdictional issues,
as
> well as being a consultant resource to the field.  There is a
corresponding
> need Province wide across all program areas (tobacco by-laws, health
hazard
> issues, etc.) as well as the epidemiology, evaluation and planning
resources
> necessary for any good unit.
>
>     There has been a significant and necessary re-investment in acute
> and chronic care. We should now demand equally significant and necessary
> re-investment in prevention of illness and injury and improved quality of
> life. This includes not only the commitments I have listed above, but also
> to a wider emphasis on all of the determinants of health. Such
commitments,
> along with strong support for local decisions to address community health
> needs could repair the much of the damage done to Ontario's Public Health
> infrastructure.
>
>     Improving health cannot be successful without addressing basic
> issues such as poverty, social inequality, access to recreation and other
> community services and education.  Local governance combined with
Provincial
> and Federal funding and standards is the most sensible and effective way
to
> deliver Public Health.
>
>     -30-
>     Marvin Caplan
>     Councillor,
>     Ward One,
>     City of Hamilton,
>     905 - 546 - 2416
>
>
>

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