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Maintaining Momentum on Public Health Renewal
by Garry Aslanyan1
Last year, Ontario became the latest province in Canada to introduce Local Health Integration Networks (LHINs) as a new strategy for organizing the provision of healthcare within the province.
Real opportunities for improvement are always welcome. However, this development raises a number of questions: While the public health sector was not included in the original LHIN implementation plan, what will happen to public health in the near future? Will LHINs include the public health system or will the two remain separate? Will the province fully regionalize its health system beyond the LHINs? If the organization of the health system was to change yet again, how would that affect the targets for the implementation of the public health system renewal?
As OPHA monitors the implementation of the public health system renewal, our observation is that while the government has made important progress, some areas need long-term planning. Ontario needs to develop a detailed implementation plan for all outstanding recommendations of the Capacity Review Committee [PDF], with a set completion date clearly identified.
Regardless of how public health is organized, we know that population health goals are best achieved through cross-sectoral partnerships and collaboration. Public health practitioners know that we cannot do our jobs if we do not engage partners across a variety of sectors such as education, environment social services and many others. All OPHA members should have already seen a copy of "A Discussion Paper on Public Health, Local Health Integration Networks and Regional Health Authorities" [PDF, 327kb] which was commissioned by OPHA to explore the relationships between public health, LHINs, and the experience with regional health authorities in other provinces. I strongly recommend that you read this paper. It points to some early evidence that the reorganization of health services in other jurisdictions which subsumed public health has often weakened relationships between public health and important partners such as municipalities, resulted in erosion of public health capacity and diverted resources and attention from public health programming to clinical issues.
Of course we know that Ontario's LHINs model differs from regionalized health systems in other provinces, but early experience of LHINs shows that there are difficulties for LHINs and public health to collaborate because of differences in their boundaries. This is not ideal. OPHA would like to explore a potential collaboration with relevant ministries to develop tools that facilitate cross-sectoral partnerships, such as guidelines, training modules and templates for memoranda of understanding between public health and LHINs. Any change in boundaries will damage public health and set back the progress made by the public health renewal process mentioned earlier. There are obvious advantages to maintaining public health separate from the LHINs. Perhaps this should be a "Made in Ontario" solution.
1Dr. Garry Aslanyan is President of the Ontario Public Health Association.
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