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

Lyons, Joseph

Whenever problems emerge in Ontario's public health system, recommendations are made to make boards of health more autonomous from municipal control (Campbell 2004; Capacity Review Commission 2006) . Despite these repeated calls for structural change, little has been made. Moreover, very little research has been done to determine whether autonomous boards of health actually fulfil their legislative mandate better than boards that are integrated into municipal structures and controlled by municipal councils. There is, however, an emerging strand of the Canadian literature on multilevel governance that has explored these questions in other policy areas (Eidelman 2013; Filion and Sanderson 2014; Horak 2012; Lyons 2015a Lyons , 2015b Sanderson and Filion 2013) . The findings from this literature suggest that specialized jurisdictions, like conservation authorities, economic development agencies and waterfront re-development corporations, perform their mandate more faithfully than general-purpose governments. By comparing the spending growth of the Middlesex-London Health Unit (MLHU) and Hamilton Public Health Services (HPHS), two similar health units with different governing structures, during a time when the capacity of Ontario's public health system was in question, this paper reports on whether the findings from these other policy areas are transferrable to the field of public health. Additionally, the findings provide public health policy makers a wider frame of reference as they continue to grapple with questions about board of health governance. The hypothesis was that the MLHU, which is an autonomous health unit, would behave more in accordance with provincial expectations than HPHS, which is integrated into the City of Hamilton's municipal structure.