APHEO Annual Meeting

1. APHEO Annual Meeting October 15, 2007 Presentation by George Pasut Acting Chief Medical Officer of Health Public Health Division Ministry of Health and Long-Term Care

2. Overview Public Health Renewal • Ontario Agency for Health Protection and Promotion • Recommendations from the Capacity Review Committee • New Ontario Public Health Standards Ministry Transition • New role for ministry • Role of Local Health Integration Networks • Role of Public Health Division • Changes and priorities

3. Public Health Mandate As set out in the Health Protection and Promotion Act • Provide for the organization and delivery of public health programs and services. • Prevent the spread of disease. • Promote and protect the health of the people of Ontario. Key areas of focus • Emphasizing aggregates vs. individuals (communities, sub-populations, cohorts). • Helping people remain well vs. finding and treating those who are sick. • Building community partnerships. • Attending to broader environmental factors (social, economic, environmental) that affect health. • Helping 36 local boards of health implement mandatory programs by providing professional, technical and financial resources.

4. Local Public Health Units Medical Officer of Health • Oversees the provision of public health programs and services within his or her health unit. • Directs boards of health on the delivery of public health programs and services. Programs and services • Community sanitation • Control of infectious diseases • Health promotion, health protection and disease and injury prevention • Family health • Epidemiologic data (collection and analysis) • Additional health programs and services prescribed by regulations

5. Map of Health Units

6. Chief Medical Officer of Health • Develops public health programs and services that promote and protect the health of the people of Ontario. • Appointed by the Lieutenant Governor in Council. • Holds office for a five-year term; may be reappointed for further terms. • Must have license to practice medicine from the College of Physicians and Surgeons and a Fellowship in Community Medicine or equivalent. • Leads Public Health Division • Current CMOH and ADM are acting. • Recruitment is underway for a CMOH. • A special all-party committee of the legislature is leading recruitment process, consistent with recent amendments to the Health Protection and Promotion Act.

7. Public Health Division • Comprises eight branches and 220 staff members, including physicians, nurses and epidemiologists. • Works closely with numerous ministries, including Health Promotion, Children and Youth Services, Environment, Municipal Affairs and Housing and Community and Social Services • Liaises regularly with federal government (Public Health Agency of Canada and the Canadian Food Inspection Agency) and other provinces and territories.

8. Public Health Division - Management Structure

9. Public Health Renewal Guiding principle • A health care system that helps people stay healthy, delivers good care when they need it and will be there for their children and grandchildren. Major components • Ontario Agency for Health Protection and Promotion • Initiatives arising from Capacity Review Committee recommendations, including • Ontario Public Health Standards

10. Ontario Agency for Health Protection and Promotion Background • Numerous reports recommended public health agency: • Naylor Report (Oct. ’03), Walker Interim Report (Dec. ’03), Campbell reports (Apr. ’04, Dec. ’04), Walker SARS Expert Panel Report (Apr. ’04), Haines Report (July ’04), Walker Legionnaire’s Report (Dec. ’05), CMOH 2005 Annual Report. Agency Implementation Task Force • Established in January 2005 to advise on design, development and implementation. Health Systems Improvements Act • Includes the Ontario Agency for Health Protection and Promotion Act. • Received Royal Assent in June 2007, legally establishing the agency.

11. Purpose • Provide scientific and technical advice and support to the health care system and the Ontario government. • Develop, disseminate and advance public health knowledge, best practices and research. • Inform and contribute to policy development. • Develop, collect, use, analyse and disclose data. • Undertake, promote and co-ordinate public health research. • Provide education and professional development. • Establish, operate and maintain laboratory centres. • Serve as a model for bridging infection control and occupational health and safety. • Undertake research related to evaluation modes of transmission of febrile respiratory illness and the risk to health workers. • Provide advice and support in emergencies as directed by the CMOH.

12. Role of CMOH • CMOH is not a formal member of the board. • Can attend board meetings as observer and participate or send delegate. • Must be given notice of meetings. • Board cannot unreasonably limit CMOH’s participation. • CMOH or delegate will sit on board’s strategic planning committee. • CMOH may issue directives for scientific and technical support as well as operational support in an emergency or outbreak. • Minister must consult with CMOH before issuing directives to the agency.

13. Status and Next Steps Status • Board members appointed: David Walker (chairman), Michael Christian, Richard Masse, Vivek Goel, Liana Nolan, Judith Tompkins, Terry Sullivan. • Work initiated on office support, human resources, finance, capital and insurance. Next Steps • Conduct international search for CEO; target start date for CEO is early 2008. • Establish secretariat to support start-up organization until CEO is on board. • Finalize memorandum of understanding, conflict-of-interest guidelines and first bylaws. • Prepare Ontario Public Health Laboratories for transfer to the agency (2008-2009).

14. Board and CEO in place (focus on start-up operations) Year 1 (07/08) Senior leadership in place and staff recruitment underway; capacity for resources in infectious diseases and response in emergency and exigent circumstances; anticipated transfer of Ontario Public Health Laboratories Year 2 (08/09) Scientific and technical expertise in all areas of specialization Year 3 (09/10) Key Milestones

15. Capacity Review Committee • Received in May 2006. • Made 50 recommendations in seven areas: • Quality governance • Stronger public health units • Revitalized public health work force • Stable and predictable funding • Demonstrated accountability and performance measurement • Research and knowledge exchange • Strategic partnerships • Objective: to improve function and configuration of public health system.

16. Key Recommendations • Replace existing Mandatory Health Programs and Services Guidelines with program standards. • Incorporate organizational-level standards, including effective human resources management, board of health functioning, financial management and research and knowledge exchange. • Develop valid, reliable and meaningful performance measures to accompany program standards. • Develop new approach to accountability – a performance management system.

17. Government Response to Date • Ontario Public Health Standards and supporting protocols to replace mandatory guidelines • Collaborative approaches to performance management • Several initiatives to increase human resource capacity (HealthForceOntario) • Support to Queen’s University’s School of Public Health • Ongoing review of remaining recommendations

18. Ontario Public Health Standards Background Technical review committee • Guided development of new standards (Sept. 2006 to April 2007). • Comprised representatives from public health units, academia, the Association of Municipalities of Ontario and ministries of Health and Long-Term Care, Health Promotion and Children and Youth Services. Program standards development teams (10) • Developed initial drafts of standards for committee’s consideration. • Comprised representatives from local boards of health and government. Inter-ministry committee • Provided platform for information exchange across government and general advice to technical review committee. • Included representatives from ministries of Environment, Labour, Municipal Affairs and Housing and Agriculture, Food and Rural Affairs.

19. Overview: Development Ministers Acting CMOH Inter-ministry Committee (15 members) Technical Review Committee Program Standards Development Teams (10) Expert Advice Report Advise Technical Support Proposed Standards

20. Key Approach and Directions • Move toward standards that are measurable and linked with specific performance measures for increased accountability. • Integrate standards into overall performance management system for public health. • Incorporate technical revisions to reflect new science, evidence and best practices in public health. • Balance need for provincial standardization of program functions with need to offer local flexibility. • Establish ongoing review, enhancement and support processes so that standards continually evolve. Revised standards were to fit within fiscal envelope for mandatory programs.

21. Results to Date • Proposed standards • Are more coherently organized within and across programs. • Offer greater standardization across programs in areas of surveillance and assessment, health promotion, disease prevention and health protection. • Provide local flexibility by basing delivery of programs and services on local needs as identified by surveillance activities. • Link board of health activities (requirements) to outcomes for measurement purposes. • Build on Capacity Review Committee’s recommendations on role of research and knowledge exchange in supporting evidence-informed and effective public health practice. • Process involved extensive consultation with stakeholders. • Government has approved in principle. • Supporting protocols are being developed.

22. Proposed Structure and Format Introductory section • Outline purpose, scope and accountability, statutory basis and format for proposed standards. Foundations • Principles – encompass need, impact, capacity and partnership and collaboration. • Foundational standard – addresses population health assessment, surveillance, research and knowledge exchange and program evaluation. Program standards (13) • Address chronic diseases and injuries, family health, infectious diseases, environmental health and emergency preparedness.

23. Overview: Proposed Structure and Format

24. Timelines Early 2008 Release of Standards (including protocols) Spring 2008 Training & Implementation APRIL 30 Submission to A/CMOH MAY/ JUNE MHP, MCYS & MOHLTC Review JUNE/ JULY Ministers’ Approval in Principle SUMMER/ FALL Develop supporting materials* WINTER Dec Ministers’ Final Approval Performance Management Framework Protocols Protocol development teams will support revisions and drafting; boards of health will participate. Implementation resource manual will support boards of health with implementation. Communication and training strategy will support roll-out.

25. Ministry Transition Ministry – steward of health care system • Strengthen accountability frameworks and mechanisms. • Establish strategic directions and provincial priorities. • Develop legislation, regulations, standards, policies and directives. • Monitor and report on the performance of the health care system. • Plan and establish funding models and levels of funding for the health system.

26. Ministry Transition (cont.) Local Integrated Health Networks • Fund, plan and integrate health services at the local level.

27. Ministry Transition (cont.) Public Health Division • Focus on operational responsibilities and implementing program-based policy initiatives. • Foster good communication with LHINs and integrate efforts when programs overlap. Photo credit: Centres for Disease Control and Prevention

28. Division’s Current Priorities • Food safety legislation • Transfer of Small Drinking Water Systems to MOHLTC from MOE • HPV vaccination program • Infection control • N95 masks • Alignment of provincial health emergency response with federal and municipal levels • Capacity Review Committee (ongoing review of recommendations) • Ontario Public Health Standards (protocols and roll-out) • Recruitment strategies for public health field, including MOHs • Public health portal • Integrated Public Health Information System • Public health inspection systems

29. Questions and Answers