- Kimberly Doering (BC) & Char Strain (Ontario)
In Ontario, the Ministry of Health sets the strategic directions for the provincial health system. This includes both health care and public health; in order to achieve these strategic directions the Ministry of Health enforces legislation, regulations, policies and guidelines (Public Health Ontario, 2021). The Health Protection and Promotion Act (HPPA) set out by the Ministry of Health, informs the structure, governance and functions of local health units. This legislation guides the delivery of programs and services at the local level. The purpose of the Act includes the prevention of the spread of disease and promotion of health of citizens of Ontario (Association of Public Health Units, 2015). The Ontario Public Health Standards (OPHS) are provincial standards that also focus local planning and implementation of public health services, based on the unique health and social needs of each health unit region. The provincial Minister of Health publishes the standards and each local health unit must comply with them (Association of Public Health Units, 2015). The standards set out the minimum expectations for delivery of public health programs by each public health unit within the province. According to the Association of Public Health Units (2015) the introduction of the Ontario Public Health Standards provided health units a stronger focus on the social determinants of health; the standards include a variety of population-based activities to promote health while reducing inequity. Several Guidelines, which are topic-specific documents that provide direction to health units on how to address certain standards, are outlined by the Ministry of Health. These include the Relationships with Indigenous Communities and the Health Equity Guidelines of 2018 (Ministry of Health and Long Term Care, 2018).
The OPHS outlines that each health unit must engage in ongoing population health assessments that includes the collection, monitoring and interpretation of data on the health status of local populations including the social determinants of health. These ongoing assessments are then used to plan local programming that addresses public health needs. Additional legislation that supports public health include; the Child Care and Early Years Act, and the Safe Drinking Water Act, each health unit is required to have a signed Health Funding and Accountability Agreement between their Board of Health and the Ministry of Health that sets out performance and financial expectations (Association of Public Health Units 2015). Each public health unit within the province has a Strategic Plan that highlights priority indicators and populations for disease prevention, protection and health promotion, including addressing the social determinants of health.
Not unlike Ontario, the Ministry of Health also sets the strategic direction for the province of British Columbia (BC). The Ministry of Health maintains the overall responsibility for ensuring British Columbians has timely and equitable access to quality health care services. The delivery of these health care services is provided by the provinces regional five regional health authorities (Ministry of Health, 2020). BC also has a sixth heath authority, the Provincial Health Services Authority (PHSA) that holds responsibility for provincial clinical policy, clinical services and information management. PHSA in essence ensures the coordination of health services at the provincial level. The Ministry of Health also partners with the First Nations Health Authority which looks after the planning, management and delivery of health services to the First Nations communities in BC in partnership with the Canadian government (2020). The Population and Public Health division of the Ministry is responsible for improving the overall health and wellness of the population of BC and focuses on health promotion, disease prevention, and reducing health inequities (Province of British Columbia, n.d.).
In 2013, the Ministry of Health published BC’s Guiding Framework for Public Health entitled PROMOTE, PROTECT, PREVENT: Our Health Begins here, which was later updated in 2017. This document aims to improve the overall health of British Columbians by setting a long-term vision, creating a collaborative process to determine health priorities and supporting a Public Health approach to addressing health equity.
The Northwestern Health Unit 2017-2020 Strategic Plan identifies the following priority groups and Social Determinants of Health:
1. Indigenous Populations: Colonialism, inadequate housing, poverty, lower levels of education, inadequate access to health and social services. Promote health equity for Indigenous populations (First Nation, Metis and Inuit) to improve health outcomes.
2. Children and Youth: Health status early in life is a determinant of health across the lifespan; maximize health and opportunities of children and youth in Northwestern Ontario.
3. Seniors: Fastest growing population in Northwestern Ontario, maximize quality of life while reducing health care costs.
4. Vulnerable Populations: Includes those who are marginalized, oppressed, criminalized, and disproportionately affected negatively by the social determinants of health, LGBTQ2S+ and minorities (Northwestern Health Unit, 2017).
Specific goals and objectives of the Northwestern Health Unit include improving health equity by completing health status and surveillance reports stratified by socioeconomic and demographic variables and Increase environments that support healthy choices by supporting engagement in healthy public policy work (Northwestern Health Unit, 2017).
BC is said to be one of the healthiest provinces with the highest life expectancy in the country (Setting Priorities the B.C. Health System, 2014). However, there is still discrepancy between those living in the northern portion of the province and between aboriginal people and non-aboriginal people in the province (Setting Priorities the B.C. Health System, 2014). In BC, those most impacted by health inequities are Aboriginal peoples, the working poor, people with mental illness and addictions, new immigrants and those who are homeless (Pauly et al, 2013).
BC’s Guiding Framework for Public Health (2017) outlines seven measurable goals in relation to the determinants of health:
i) Health Living and Healthy Communities
ii) Maternal, Child and Family Health
iii) Positive Mental Health and Prevention of Substance Harms
iv) Communicable Disease Prevention
v) Injury Prevention
vi) Environmental Health
vii) Public Health Emergency Management
Like Ontario, BC’s Population and Public Health division has also committed to health surveillance whereby it collects, analyzes and disseminates heath data to inform future decision making, policy creation and public health priorities (BC’s Guiding Framework for Public Health, 2017).
References:
British Columbia:
BC’s Guiding Framework for Public Health 2017 Update. (2013). Retrieved February 15, 2021, from
For the Public - Province of British Columbia. (n.d.). Retrieved February 15, 2021, from
Ministry of Health. (2019/20). 2019/20 Annual Service Plan Report. Retrieved February 15, 2021,
from https://www.bcbudget.gov.bc.ca/Annual_Reports/2019_2020/pdf/ministry/hlth.pdf
Pauly, B., Macdonald, M., Hancock, T., Martin, W., & Perkin, K. (2013). Reducing health inequities:
The contribution of core public health services in BC. BMC Public Health, 13(1), 550.
Setting Priorities for the B.C. Health System. (February 2014). Retrieved February 15, 2021, from
Ontario:
Association of Local Public Health Agencies. (2018). 2018 Orientation manual for boards of health.
Child Care and Early Years Act, S.O. 2014, c. 11, Sched. 1 (2014).
Health Protection and Promotion Act R.S.O. 1990, c. H.7 (1990).
Ministry of Health and Long-Term Care. (2018). Board of health and local health integration network
guidelines 2018. Population and Public Health Division. Ontario
Ministry of Health and Long-Term Care. (2018). Health equity guidelines 2018. Population and
Public Health Division. Ontario.
Ministry of Health and Long-Term Care. (2018). Protecting and promoting the health of Ontarians.
Ontario public health standards: Requirements for programs, services and accountability. Ontario.
Ministry of Health and Long-Term Care. (2018). Relationships with Indigenous communities
guidelines 2018. Population and Public Health Division. Ontario. http://health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Relationship_with_Indigenous_Communities_Guideline_en.pdf
Northwestern Health Unit. (2017). 2017-2020 Strategic plan: Creating healthy communities moving
Public Health Ontario. (2020). Ontario Public Health System: Public health history. Agency for
Health Protection and Promotion. Ontario. https://www.publichealthontario.ca/en/about/blog/2020/ontario-public-health-system
Safe Drinking Water Act, S.O. 2002, c. 32 (2002). https://www.ontario.ca/laws/statute/02s32
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