Fact Sheet for Board of Health Members Organization of Public Health in Ontario #1 of 10 fact sheets The public health system is made up of governmental, non-governmental and community agencies that operate at a local, provincial and federal level. In Ontario, 36 boards of health are responsible for the delivery of mandated public health programs and services. Two provincial ministries are responsible for different public health programs and services under the Ontario Public Health Standards and serve as key partners for boards of health. The ministries responsibilities are as follows: Ministry of Health and Long-Term Care (M OHLTC): Infectious Diseases Prevention and Control, Environmental Health and Emergency Preparedness, Chronic Diseases and Injury Prevention, Substance Misuse Prevention and Family Health. Ministry of Children and Youth Services (MCYS): Healthy Babies Healthy Children. Another key provincial partner is Public Health Ontario, which provides scientific and technical support for public health programs and services to protect and promote the health of Ontarians and reduce inequities in health. If one or mor e No responses, please call: Region of Waterloo Public Health at 519-575-4400 (TTY: 519-575-4608) No-cost check-ups, fillings, x-rays and more! Ontario has a new no-cost dent al prog ram for kids 17 years of age and unde r. Find out if your child is eligible. ontario.ca/healthysmiles 519-883-2222 t it. Your access to public health inspection results in Waterloo Region Funding The majority of mandated public health programs (as follows) have provincial cost sharing of up to 75 per cent. Health Assessment and Surveillance Chronic Diseases and Injuries Family Health Infectious Diseases Environmental Health Emergency Preparedness Currently, the Province funds up to 100 per cent of the following programs: Healthy Babies Healthy Children Infectious Diseases Control Needle Exchange Healthy Smiles Ontario Smoke-Free Ontario Enhanced Food Safety and Enhanced Water Safety Initiatives Public Health Nurses Initiatives The provincial government also funds vaccines for immunization programs and drugs for use in treatment of sexually transmitted diseases, tuberculosis and leprosy. #checkit!weinspectit. next page
Boards of health are established in one of three ways: Autonomous, and established under section 49 of the Health Protection and Promotion Act (e.g. the Eastern Ontario Health Unit) Regional Municipality (e.g. Municipal Act, 2001) By city-specific Acts (e.g. City of Toronto Act, 2006) There are five different kinds of organizational governance models for boards of health, which are established in one of the above three ways and described in the table below. Established by Governance Model Representation Citizen Representative Provincial Appointees HPPA Autonomous (22) (e.g. Middlesex- London Health Unit) Multi-municipal; distinct from municipal organization Permitted Permitted HPPA Autonomous/integrated (3) (e.g. Huron County Health Unit) One municipality only; within municipal structure Permitted Permitted Municipal Act, 2001 Regional (7) (e.g. Durham Region Health Department) Councils of regional government No No City-specific Acts Single-Tier (2) (e.g. City of Hamilton Public Health and Social Services) Councils of single-tier municipalities No No City-specific Acts Semi-Autonomous (2) (e.g. Toronto Board of Health) Single-tier council appoints members to separate board Permitted No Durham Region s Board of Health is a Regional governance model, where board of health staff operate under the administration of regional government. There are no citizen representatives and no public appointees, however, the members are directly elected within the boundaries of Durham Region. Durham Region s Board of Health is one of seven Regional boards of health in Ontario. Durham Region s Board of Health is the Council for the Regional Municipality of Durham. Regional Council is composed of 28 elected representatives for the municipalities within the Regional boundaries. Recommendations, reports and information are presented to the Board of Health via the Regional government standing committee process. The Health & Social Services Committee is the committee that deals with Board of Health matters and is a committee composed of 8 members of Council. Recommendations are forwarded from this committee directly to Council (the Board of Health) for ratification. The information contained in this fact sheet originates from the Ministry of Health and Long-Term Care s Board of Health E-Learning Module, the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members.
Roles and Responsibilities #2 of 10 fact sheets BOARD OF AND MEDICAL OFFICER OF Board of Health Under the Health Protection and Promotion Act (HPPA), Regional Council serves as Durham Region s Board of Health. The HPPA authorizes a board of health and its staff to control communicable disease and other health hazards in the community. It also mandates board of health staff to perform proactive functions in the areas of health promotion and disease prevention. All programs and services are approved by the board of health. A board of health is responsible for ensuring that the health programs and services required by the Act are provided. It may also provide other services that are necessary in the opinion of the board of health based on local needs. A board of health is accountable for ensuring that public health needs are addressed and that the board of health is meeting its objectives and priorities. The Board of Health: Establishes general policies and procedures which govern the board of health s operations. Upholds provincial legislation governing the mandate of a board of health under the HPPA and other relevant legislation. Is accountable to the community for ensuring that its health needs are addressed by the appropriate programs and ensuring that the health unit is well managed. Establishes overall objectives and priorities for the organization in its provision of health programs and services to meet the needs of the community. Appoints, by by-law, the medical officer of health and associate medical officer of health, if any, who are subsequently confirmed by the Minister of Health and Long-Term Care. next page
Medical Officer of Health The Medical Officer of Health reports to the board of health on matters related to upholding the Health Protection and Promotion Act. The Medical Officer of Health is responsible for the management of public health programs and services. Mechanisms used at Durham Region to assist Regional Council in meeting its obligation as Durham s Board of Health include regular reporting through Health & Social Services Committee of health assessment data, surveillance, program impacts and program modifications needed to improve the health of the population. The Health Department also reports annually to the Health & Social Services Committee with an annual performance report outlining key activities and statistics of the previous year. The Medical Officer of Health: Directs staff in the implementation of board of health policies and procedures. Is accountable to the board of health for day-to-day operations. Is responsible for the direct supervision and performance appraisal of senior staff and advises or assists division heads in hiring staff. Encourages and promotes the continuing education of all staff. Directs the overall provision of programs and services. Ensures the evaluation of the effectiveness of programs and services. Recommends appropriate changes and reports these findings regularly to the board. The information contained in this fact sheet originates from the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members
Ontario Public Health Standards #3 of 10 fact sheets The Ontario Public Health Standards are established by the Minister of Health and Long-Term Care as the guidelines for the provision of mandatory health programs and services, pursuant to Section 7 of the Health Protection and Promotion Act, R.S.O. 1990, c. H.7. The Standards: Establish requirements for fundamental public health programs and services, which include assessment and surveillance, health promotion and policy development, disease and injury prevention and health protection. Outline the expectations for boards of health, describing how programs are to be implemented. Set out goals and outcomes for both society and boards of health. Are broad in scope and not restrictive, and so allow boards of health to tailor the requirements and to deliver additional programs and services according to local needs. Include four principles (need, impact, capacity, and partnership and collaboration) that boards of health shall be guided by in order to ensure they assess, plan, deliver, manage and evaluate public health programs and services to meet local needs, while continuing to work towards common outcomes. Include 15 Program Standards that are grouped under five program areas. Include one Foundational Standard, which outlines specific requirements that underlie and support all Program Standards. Include requirements and protocols for each Program Standard, and guidance documents that provide information on evidence and best practices. Foundational Standard: Public health programs and services that are informed by evidence are the foundation for effective public health practice. Evidence-informed practice is responsive to the needs and emerging issues in the Health Department and uses the best available evidence to address them. Population health assessment, surveillance, research and program evaluation generate evidence that contributes to the public health knowledge base and ultimately improves public health programs and services. next page
Program Standards are grouped under the five following areas: 1. Chronic Diseases and Injuries This area focuses on programs whose collective goal is to increase length and quality of life by preventing chronic disease (e.g., through healthy eating, tobacco use reduction, promotion of physical activity, etc.), early detection of cancer and injury and substance misuse prevention. 2. Family Health This area focuses on the health of children, youth and families. Its components are child health, which focuses on healthy development through parenting and supportive environments; and reproductive health, whose focus is promoting behaviours and environments conducive to healthy pregnancies. 3. Infectious Diseases Whereas the above two areas make best use of the educational capacities of public health providers, this area deals specifically with the management of more immediate risks to health. The strategy applied here is a combination of risk assessment, surveillance, casefinding contact tracing, immunization and infection control, whose goal is to reduce or eliminate infectious diseases. The programs required by this area include Infectious Diseases Prevention and Control (e.g., in hospitals, day cares and long-term care homes); Rabies Prevention and Control; Sexual Health, Sexually Transmitted Infections and Blood-borne Infections (including HIV); Tuberculosis Prevention and Contro l; and Vaccine Preventable Diseases. 4. Environmental Health The programs in this area encompass Food Safety, Safe Water, and Health Hazard Prevention and Management. The standards seek to prevent or reduce the burden of food- and water-borne illness, injury related to recreational water use and the burden of illness created by health hazards in the physical environment. 5. Emergency Preparedness This program requires the existence of emergency response protocols to enable and ensure a consistent and effective response to public health emergencies and emergencies with public health impacts. The full PDF version of the OPHS can be found on the Ministry of Health and Long Term Care s website and the Health Department Reference Manual. 1659515
Ontario Public Health Organizational Standards #4 of 10 fact sheets The Ontario Public Health Organizational Standards (Organizational Standards) took effect in 2011 as part of accountability agreements between the Ministry of Health and Long-Term Care, the Ministry of Health Promotion and Sport 1, and boards of health. The Ministries began monitoring the implementation of the Organizational Standards in 2012. The Organizational Standards: Set expectations for local boards of health at both the governance and administrative levels. Are complementary to the Ontario Public Health Standards (OPHS) and support the principles outlined in the OPHS that guide boards of health in assessment, planning, delivery, management and evaluation of public health programs and services. Apply to all boards of health, regardless of governance model, and are a key component of the government s performance management framework for public health. Can help boards of health achieve their objectives and improve operations by clearly communicating expectations of boards of health and public health units. Can help boards of health make managerial decisions to improve the quality and effectiveness of programs and services, prioritize and allocate resources, inform managers about needed changes in operations to improve efficiency and identify required changes in policy or program directions to meet goals and objectives. Can be used as a tool for planning and operational assessment by helping boards of health stay on course toward improving outcomes, identifying gaps in training, leadership and resources, and encouraging collaboration to reach goals. Help promote organizational excellence, establish the foundation for effective and efficient program and service delivery, and contribute to a public health sector with a greater focus on performance, accountability and sustainability. Are grouped into six categories, each with its own goal/objective. Outline a varying number of requirements under each category that boards of health are accountable for implementing throughout their organizations. A summary of the categories and their goals/ objectives can be found on page two of this fact sheet. 1 Following the 2011 Ontario general election, the Ministry of Health Promotion and Sport was merged into the Ministry of Health and Long-Term Care. next page
Organizational Standards: Categories and their Goals/Objectives CATEGORY GOAL/OBJECTIVE 1 Board Structure To ensure that the structure of the board of health facilitates effective governance and respects the required partnership with municipalities, as well as the need for local flexibility in board structure. 2 Board Operations To enable boards of health to operate in a manner that promotes an efficient and effective board, effective communication, accountability and transparency, while protecting individual privacy. 3 Leadership To ensure that board of health members develop a shared vision for the organization, use a proactive, problem solving approach to establishing the organization s strategic directions and take responsibility for governing the organization to achieve their desired vision. 4 Trusteeship To ensure that board of health members have an understanding of their fiduciary roles and responsibilities, that their operations are based on the principles of openness, accountability and transparency, and that board of health decisions reflect the best interests of the public s health and protect individual privacy. 5 Community Engagement and Responsiveness To ensure that the board of health is responsive to the needs of the local communities and shows respect for the diversity of perspectives of its communities in the way it directs the administration of the board of health in planning, operating, evaluating and adapting its programs and services. 6 Management Operations To ensure that the administration of the board of health uses a proactive, problem solving approach to establishing its operational directions, demonstrates its organizational priorities and objectives through its actions on program delivery and functions in an eficient and effective manner. The full PDF version of the Organizational Standards, which includes the requirements listed under each category, can be found on the Ministry of Health and Long Term Care s website and the Health Department Reference Manual. The information contained in this fact sheet originates from the Ontario Public Health Organizational Standards document (http://www.health.gov.on.ca/en/pro/programs/publichealth/orgstandards/docs/org_stds.pdf,)
Health Protection and Promotion Act #5 of 10 fact sheets The Health Protection and Promotion Act: Is a provincial statute that gives boards of health their legal mandate and is the most important piece of legislation for boards of health. Provides for the organization and delivery of public health programs and services, the prevention of the spread of disease, and the promotion and protection of the health of the people of Ontario. Prescribes the existence, structures, governance and functions of boards of health, as well as the activities of medical officers of health and certain public health functions of the Minister. Empowers the Minister of Health and Long- Term Care to publish guidelines for the provision of mandatory programs and services. These are the Ontario Public Health Standards, which came into effect on January 1, 2009. Includes 21 regulations that govern food safety, swimming pool health and safety, rabies control, school health, board of health composition and communicable disease control. Is organized into the following 11 parts: 1. Interpretation 2. Health Programs and Services 3. Community Health Protection 4. Communicable Diseases 5. Rights of Entry and Appeals from Orders 6. Health Units and Boards of Health 7. Provincial Public Health Powers 8. Administration 9. Regulations 10. Enforcement 11. Transition Provides the legal authority to establish boards of health and specifies that there must be a board of health for each health unit. The information contained in this fact sheet originates from the Ministry of Health and Long-Term Care s Board of Health E-Learning Module and from the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members.
Legislation #6 of 10 fact sheets KEY PIECES OF LEGISLATION The following is a list of some of the key pieces of Other Acts Pertaining to Health legislation that are most significant to the work of Units as Public Bodies health units: 1. Municipal Act, 2001 1. The Health Protection and Promotion Act 2. Municipal Conlict of Interest Act 2. Emergency Management and Civil Protection Act 3. French Language Services Act 3. Fluoridation Act 4. Accessibility for Ontarians with Disabilities Act, 2005 4. Immunization of School Pupils Act All Ontario s Acts and their associated Regulations are 5. Municipal Freedom of Information posted on the Ontario government s E-Laws website at and Protection of Privacy Act http://www.e-laws.gov.on.ca/. 6. Personal Health Information Protection Act, 2004 Board of health members are encouraged to keep up to date 7. Smoke-Free Ontario Act on announced or proposed changes to legislation. 8. Day Nurseries Act 9. Safe Drinking Water Act, 2002 10. Mandatory Blood Testing Act, 2006 The information contained in this fact sheet originates from the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members.
Public Health: The Basics #7 of 10 fact sheets Public Health: Is the science and art of protecting and improving the health and well-being of people in local communities and across the country. Focuses on the health of the entire population, or on those parts of the community that may be at some level of health risk, rather than on the individual person. Uses strategies to protect and promote health, and prevent disease and injury in the population. Works with members of communities and community agencies to ensure long-term health for all. Services can reduce the need for other health care services and have the potential to limit the consequences of poor health by addressing the determinants of health and reducing risks to the population. Protects health by controlling infectious diseases through regulatory inspections and enforcement, and by preventing or reducing exposure to environmental hazards. Promotes health by educating the public on healthy lifestyles, working with community partners and advocating for public policy that promotes a healthy population. Prevents disease and injury by the surveillance of outbreaks, screening for cancer, immunization to control infectious disease, and conducting research on injury prevention. Providers include physicians, nurses, inspectors, dietitians, dental staff, health promoters and epidemiologists. Practitioners work collaboratively with other partners and sectors. Programs and services are delivered in Ontario communities by 36 boards of health. The information contained in this fact sheet originates from the Ministry of Health and Long-Term Care s Board of Health E-Learning Module and from the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members.
Determinants of Health and Priority Populations #8 of 10 fact sheets The determinants of health are the complex interactions among social, economic, physical and environmental factors and individual behaviours and conditions that influence the health of individuals and communities. Effective public health programs and services take into account the health needs of communities, which are informed by determinants of health. The determinants of health include: Income and social status Social support networks Education and literacy Employment and working conditions Social and physical environments Personal health practices and coping skills Healthy child development Biology and genetic endowment Health services Gender Culture The combined influence of the determinants of health plays a key role in determining the health status of the population as a whole. Under the Ontario Public Health Standards, boards of health are required to consider the determinants of health as they plan, deliver and evaluate public health programs and services. This includes conducting population health assessments through measuring, monitoring and reporting on the status of a population s health. Population health assessment provides the necessary information to understand the health status and needs of populations, including identification of priority populations and health inequities. Priority Populations Priority populations face inequities in health and wellness because they may have less access to things like shelter, food, a stable income, education and other circumstances that affect a community s health and well-being. Boards of health have a responsibility to tailor their programs to address the needs of priority populations. Tailoring programs and services to meet the needs of priority populations can contribute to improving overall population health outcomes. The information contained in this fact sheet originates from the Ministry of Health and Long-Term Care s Board of Health E-Learning Module
History of Public Health in Ontario #9 of 10 fact sheets The pattern of local public health services administration for Ontario was established in 1833 when the Legislature of Upper Canada passed an Act allowing local municipalities to establish boards of health to guard against the introduction of malignant, contagious and infectious disease in this province. This delegation of public health responsibility to the local level has continued to the present day. There are currently 36 boards of health in Ontario: 22 independent of local municipal government; seven regional municipalities; and seven boards of health tied in to single-tier or other municipal administration. Selected Key Milestones: 1873 The first Public Health Act was passed. 1882 The first board of health was established. 1983 The Health Protection and Promotion Act (HPPA) was proclaimed, replacing the Public Health Act. The Act was amended in 1990 making slight changes to its contents. 2004 Following SARS, the government of Ontario announces Operation Health Protection: an Action Plan to Prevent Threats to our Health and to Promote a Healthy Ontario. 2005 The Government of Ontario announces the creation of the new Ministry of Health Promotion, which will focus on programs dedicated to healthy lifestyles. 2006 The Smoke-Free Ontario Act is introduced, which bans smoking in all enclosed public places. 2006 The Government of Ontario introduces the Health System Improvements Bill (#171) that will include enabling legislation for an Ontario Agency for Health Protection and Promotion, Ontario s CDC of the North. 2007 The Ministry of Health and Long-Term Care increases its grant to boards of health to 75 per cent of the budgeted amount. 2007 The Ontario Agency for Health Protection and Promotion (Public Health Ontario) is established in Toronto. 2008 The Ontario Public Health Standards are completed in collaboration with boards of health and Ontario public health professionals. They came into effect on January 1, 2009. 2009 The Initial Report on Public Health is released by the Ministry of Health and Long-Term Care as the first step in developing an accountability framework for boards of health. The information contained in this fact sheet originates from the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members. 1659512
Conflict of Interest #10 of 10 fact sheets Durham Region s Board of Health members as elected officials must adhere to the Municipal Conflict of Interest Act.. The Act specifies the duties of local boards, including boards of health, which may have any pecuniary interest, direct or indirect, in any matter before the board. The member must disclose his or her interest in the matter and abstain from any discussion or vote pertaining to the matter. The process to follow for contravention of the Act is also specified. Under the Health Protection and Promotion Act : Boards of health are subject to conflict of interest (COI) provisions consistent with other recipients of transfer payment funding from the provincial government. Specific conflict of interest provisions are included in Transfer Payment Agreements and Accountability Agreements. Transfer Payment Agreements include a COI statement for funds received from the Province. Recipients are required to carry out the Project and use the funds without an actual, potential or perceived conflict of interest (article 6(6.1)). Conflict of Interest includes any circumstances where: a. The Recipient; or b. Any person who has the capacity to influence the Recipient s decisions, has outside commitments, relationships or financial interests that could, or could be seen to, interfere with the Recipient s objective, unbiased and impartial judgment relating to the Project and the use of the Funds (article 6(6.2)). In addition, the Recipient shall: a. Disclose to the Province, without delay, any situation that a reasonable person would interpret as either an actual, potential or perceived conflict of interest; and b. Comply with any terms and conditions that the Province may prescribe as a result of the disclosure (article 6(6.3)). The information contained in this fact sheet originates from the Ministry of Health and Long-Term Care s Board of Health E-Learning Module and from the Association of Local Public Health Agencies 2010 Orientation Manual for Board of Health Members.