Ontario government’s public health restructuring plan poses threat to community health, nurses warn
Public health nurses in Ontario and the union that represents them are concerned about the future of their services and the health of the people they serve. Their concerns stem from the Ontario government’s plans to move from the current 35 local public health units to 10 larger, regional units and to shift more of the share of public health funding from the province to municipalities.
The full impact of the restructuring plan remains uncertain; the government has provided few details and did not consult with groups such as the Ontario Nurses’ Association (ONA) before announcing the changes in the April budget.
“The province did not seek the advice of the people who work on the front lines of public health before announcing this centralization plan, and the process is problematic,” says Vicki McKenna, RN, president of ONA, which represents 2,500 nurses and other health-care professionals delivering services in 31 of the current 35 units.
“Our biggest concern, however, is what will happen to vital programs and services,” McKenna says. “Our public health nurses are critical to the health of communities, especially for those most vulnerable populations who often have no other access to health care.”
Melanie Holjak is a public health nurse delivering services under the Healthy Babies, Healthy Children program in the Haldimand-Norfolk Health Unit. In this role, she offers breastfeeding support to all new mothers in the community and extra supports to new parents facing economic or social risks that could affect a child’s healthy development.
Holjak is concerned that the creation of regional units in larger cities could mean programming tailored to local needs will be reduced or eliminated. “Every community is unique and has different health issues and needs,” she says. “I fear that we will lose services and programs developed in response to locally identified needs.”
Holjak works primarily in rural areas, visiting people in their homes because transportation options are limited. She also provides supports to a Mennonite population. “Our local family home visitors and public health nurses have the knowledge to reduce language barriers and consider cultural differences. These issues in our rural communities may not be relevant or relatable to those in urban city centres.”
Shelley Aretz is another public health nurse who sees an uncertain future for her work in the Street Nursing program with the Thunder Bay District Health Unit. Aretz focuses on harm reduction and testing to help prevent the spread of infectious diseases such as HIV, Hepatitis C and tuberculosis among vulnerable populations. The people she serves includes those who are homeless or precariously housed, people who inject drugs and workers in the sex trade.
Part of her job is tracking down people who have been tested for an infectious disease in a hospital emergency room (ER) who have left before learning their results. “Many have no permanent address, and when the hospital informs us the person tested positive, we have to find them to let them know and refer them for care, and then find their contacts in case they’ve given the infection to someone else,” says Aretz.
“We go to homeless shelters, rooming houses, soup kitchens and other locations to try to find people with often life-threatening infections and get them treated,” she adds.
“Reducing these services could threaten the health of many community members by curtailing our ability to slow the spread of infectious diseases.”
Aretz says her health unit has already announced it is eliminating four frontline public health nurse positions.
The provincial government has said it hopes to save around $200 million with its public health amalgamation. ONA says it is not realistic to expect that can be done without cutting services and programs, which are already stretched to meet demands.
“Public health nurses are feeling very pressured, and programs have never been so overloaded because of rising needs due to poverty, the opioid crisis and other issues,” says McKenna.
“Because of the uncertainty about future funding, some public health units aren’t filling vacancies, and the people left behind have to take on more and more,” she says.
According to McKenna, the province’s stated goal of saving money in public health is “a false economy.”
“Hospital emergency rooms are already well over capacity, and when people can’t get care or support in their community, they often end up in the ER. Public health is about health promotion and disease prevention, and if you don’t invest in it properly, you end up with more people with serious illnesses and push up costs in the acute-care system.”