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

Lyons, Joseph

The MLHU is an autonomous health unit serving the City of London and the neighbouring Middlesex County. For most of the study period, the board was made up of five provincial representatives, three County councillors, two City of London councillors and one community representative appointed by the City of London. According to a number of interviewees, the MLHU, which was one of the lowest per capita funded health units in Ontario at the time, viewed the increase in funding as a clear commitment by the province to strengthen the public health system -not simply re-arrange the same level of funding. Through negotiations with its municipal funders, the City of London and the County of Middlesex, the MLHU brokered an agreement to keep levy contributions frozen as the province made the transition to the 75/25 funding model. This transition was originally supposed to be phased in over three years; however, with the capping of provincial increases since 2006, this time frame was pushed back considerably (MLHU 2011). As explained by interviewees, the City began asking to have its contribution reduced in 2009, arguing that the MLHU' s budget was increasing at a much faster rate than its own. The MLHU refused these requests until 2012, when it agreed to reduce the City' s levy by $100,000. Middlesex County' s levy, which does not appear in Table 1 (although it is accounted for in total cost-shared funding), was $1.18 million for most of the study period. The County supported the City in its efforts to reduce the municipal levy, but the City took the lead.