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

Lyons, Joseph

In Ontario, local health units are responsible for the delivery of public health services. Whereas most other provinces have transferred municipal responsibilities for public health to regional authorities with little or no accountability to local governments, municipalities in Ontario continue to play an important funding and oversight role in this policy area (Hancock 2002; Siegel 2009 ). Some health units are integrated into municipal structures, but others operate completely separate from their municipal overseers. There are currently 36 public health units in Ontario. Governance structures vary, but in general, they can be divided into two categories: autonomous and integrated. Twenty-two are autonomous, meaning that they operate as distinct local governments, separate from any municipality. The remaining 14 are integrated, meaning that they operate within the administrative structure of a municipality. The boards of autonomous health units are composed of both municipal and provincial appointees, whereas single-tier or regional councils serve as the board of health for most integrated health units (four of them -Chatham-Kent, Huron, Lambton and Toronto -have provincial appointees on their boards as well. But the health unit staff are municipal employees, and provincial appointees cannot outnumber municipal appointees) (see Pasut 2007: 16) . A medical officer of health (MOH), who is a specialist physician in public health, leads each health unit. In integrated health units, the MOH is a municipal employee and reports to the city manager regarding certain administrative functions, whereas the MOH in an autonomous health unit reports solely to the board of health.