One public health unit to serve nearly half of Ontario, if government plan proceeds

The Ontario government is beginning tolay out its plan to collapse the province's 35 public health units into 10 regional entities, news which concerns the two chief medical officers serving the northwest of the province, from the Manitoba border, to Hudson Bay and along the north shore of Lake Superior.

Under the proposal, the Thunder Bay District Health Unit (TBDHU) which oversees about 146,000 residentsspread across an estimated 230,000 square kilometres would be combined with the Northwestern Health Unit (NWHU), which oversees more than 82,000 people, spread across more than 171,000 square kilometres.

At this point, "not much" is known about how one regional entity, which would serve an area equivalent to more than two-fifths of the province, is expected to operate, said Dr. Janet DeMille, the chief medical officer and CEO of TBDHU, adding the government has said it plans to hold "consultations."

'Community-driven approaches' work best

"We have not heard about the consultation process or any further guidelines about what the ministry might be looking for," she said, notingthe government has said it wants these changes to start coming into effect in April 2020.

Her primary concern is that the new, larger entity won't have the flexibility to address individual community concerns.

"What goes on in the city of Thunder Bay versus what goes on in Manitouwadge or Kenora or Sioux Lookout, these are very different situations and the way one would want to deal with it is actually often by community-driven approaches," she said.

"Public health very much focuses on, and works through relationships at the ground level," agreed her counterpart, Dr. Kit Young Hoon, the chief medical officer and the CEO fo the NWHU.

Concerned about 'risks versus benefits' of merging

"The programming needs to be responsive to local needs, to engage local partners and agencies and strengthen the local community and that's best done when we have staff that live in the community, understand the community and can build those relationships," she said.

Young Hoon said the two northwestern health units already work closely together and are both lean and efficient organizations.

She doesn't believe the government will save much money by somehow consolidating them.

"Our concern is there's going to be a fair bit of disruption, that it could potentially impact services, we're concerned about the risks versus benefits with this change."

'If we do our job well, nothing happens'

DeMille said the vital role that public health plays in society, through such activities as vaccination programs, water and food inspections, and sex education and prenatal clinics, is often overlooked.

"If we do our job well, nothing happens. We prevent things from happening," she said. "You can't measure what you've prevented, and I think it is hard for people, including the government to understand the breadth of what we do in public health."