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

Lyons, Joseph

The findings from this study are important for both the ongoing policy debate in Ontario over the structure of public health units and the debate in the literature on multilevel governance over specialized and general-purpose jurisdictions. The MLHU did exert some independence during a time when the capacity of the public health system was in question. HPHS did not act with the same level of independence, but it started out from a healthier funding position; so, perhaps the need was not as strong. Clearly, more research is necessary, but these findings provide some initial insight into the behaviour of autonomous and integrated health units. Many in the public health field have argued that autonomous health units are in a better position to pursue their legislative responsibilities than health units that are integrated into municipal structures. The MLHU did behave according to these expectations after the funding increase, but, prior to this, it took its budget direction from its largest municipal funder. Under this arrangement, it was not able to act with much independence and fared worse in terms of per capita funding than HPHS. In other words, autonomous health units might only be able to act according to provincial expectations when most of their funding comes from the province. Thus, governing structure appears to matter, but its effects are contingent on where most of the money is coming from.