The Independence of Ontario's Public Health Units: Does Governing Structure Matter?

Lyons, Joseph

The debate over the structure of public health units mirrors debates in the literature on multilevel governance over the advantages and disadvantages of specialized versus general-purpose jurisdictions. Those who support specialized jurisdictions maintain that they are more efficient and responsive, whereas supporters of general-purpose jurisdictions argue that specialization reduces accountability and negatively affects coordination (see, for example, Berry 2009; Foster 1997; Mullin 2009 ). Recent Canadian literature in this area, however, has provided some more nuance to this debate. Specialized jurisdictions with some financial autonomy appear to pursue their mandate more faithfully than general-purpose jurisdictions, but the policy consequence of this characteristic varies (Eidelman 2013; Filion and Sanderson 2014; Lyons 2015a Lyons , 2015b . For example, specialization can lead to coordination problems in policy areas, like economic development and waterfront development, where specialized agencies often lack full functional control (Filion and Sanderson 2014; Lyons 2015b) . But, in other areas, like watershed management, specialization has been shown to contribute positively to the wise management of resources and the protection of public safety (Lyons 2015a) . Public health is a good policy area to further this line of inquiry, because, regardless of governance structure, boards of health must meet the same provincial requirements. For example, all health units must inspect food premises, provide immunizations and support healthy pregnancies, among other things. Thus, comparing the spending growth of autonomous and integrated health units has relevance for both the ongoing debate in Ontario over the structure of public health units and the theoretical debate over specialized and general-purpose jurisdictions.