Pandemic & underfunding leave questions around Peel Public Health ahead of regional dissolution
It wasn’t long ago that Peel residents would recall sitting in the large atrium at the Save Max Sports Centre or the Cassie Campbell Community Centre, on rows upon rows of chairs, six feet apart and masked, having just received their first, second, or even third dose of the COVID-19 vaccine.
As life continues to return to normal, the pandemic for the general public seems like history. But for Peel Public Health employees, who provide critical services across the region and worked tirelessly to make sure the community was protected from the COVID-19 virus, the department is still working its way back from the cascading disruptions that defined life for two years.
Their life-saving work, under challenging conditions, is now being done as Peel Public Health is uncertain about its very future. When the Region of Peel ceases to exist in 2025, the delivery of a long list of critical services will have to be carried out under a model that has yet to be determined by provincial and municipal officials.
From keeping drinking water and food safe to providing protection from disease and environmental hazards, these crucial community services will have to be delivered. The question is, how?
Bill 112, dubbed the Hazel McCallion Act, after the long-time Mississauga mayor who pushed for decades to eliminate Peel’s regional government, has caused uncertainty across Peel since its passing in June. Billions of dollars in assets have to be divided, thousands of staff will be relocated and the delivery of services without an overarching regional system of government has to be worked out in a little more than a year.
Despite Regional Chair Nando Iannicca previously claiming “there will be no service interruptions for our community”, the decision to dismantle the Region in a short time span has pushed the upper tier municipality into what staff have called an “uncertain phase” as they work to establish how they can best continue providing services with minimal disruption to the 1.5 million residents that call the three lower tier municipalities home.
Public health was first referenced in Peel during a cholera outbreak in the 1830s and the first local board of health was established in the City of Brampton in 1862. Twenty years later, a health board covering the whole province was implemented and by 1884, all municipalities were required to create their own public health unit with the responsibility to prevent and combat epidemic diseases, isolate infected persons, investigate water contamination, inspect sewage, mandate heating and ventilation of buildings, examine poisons and chemicals and compile vital statistics. Much of the initial priorities of these primitive public health units remain the same in the present day, fitting under the six categories of chronic disease and injury prevention, communicable diseases, family health, health protection, immunization services, and public health intelligence. Peel Public Health collaborates with other community organizations and services to achieve the overarching goals of practicing effective public health, enabling active living and healthy eating, promoting mental well being, reducing health-related impacts of climate change, and advancing health equity.
Stakeholders involved in the COVID-19 response
(Region of Peel)
One of the most damning challenges that Peel Public Health has faced was the onset of COVID-19. From the declaration of a global pandemic by the World Health Organization in March 2020, the healthcare sector, which was already facing an onslaught of challenges, was increasingly overburdened, taking care of an overstressed society that was failing in health. And Peel Region was hit hard.
In April 2021, Brampton had a COVID test positivity rate of almost double that of the province. As the virus swept across the Region, fueled by racism, intergenerational living, crowded long term care homes and insufficient hospital space, Peel quickly became one of the biggest COVID-19 hotspots in Ontario. As part of their pandemic response, Peel Public Health led the management of over 200,000 confirmed and probable cases of COVID-19 and over 1,700 outbreaks, as well as vaccinating 93 percent of residents. It was also one of the first health units in Canada to initiate wastewater testing for COVID-19. But while the Region grappled with controlling the spread of COVID-19, some of the other critical services that the body provides took a major hit.
As of April 1, PPH has remobilized 50 percent of programs that were shut or slowed down during the pandemic. By the end of the year the organization suspects they will be able to reestablish 70 percent. And by 2024, PPH is estimated to be running at full functionality.
But while the impact will inevitably be less severe than a deadly pandemic wiping out the Region, many of the same service disruptions could be amplified by the dissolution and the creation of three independent municipalities.
“The dissolution of Peel cannot be compared to the challenges of COVID that Peel and the world faced during those difficult years,” a spokesperson for the Region told The Pointer. “Peel is an anchor institution in the community. Peel residents, businesses and the community rely on the seamless delivery of high quality, efficient services. Everyone agrees that maintaining services is critical and that ensuring the well-being of staff who deliver and support the delivery of those services is of utmost importance.”
A report created by Regional staff for presentation to the province’s Transition Board, tasked with recommending winding down the financial operations of the Region of Peel and allocating and determining control of services, cited that employee well-being is taking a major hit across PPH from residual and emerging psychological needs from the impact of the pandemic response, and amplified by the uncertainty surrounding Bill 112.
In a staff report presented to council in June, the Region emphasized the importance of holding onto staff throughout the transition and enhancing psychological benefits for employees. In situations of emergency, the CAO authorized the extension of psychological health benefits to $2,500 in 2023 for eligible full-time employees whose current entitlements are not at this level.
But while psychological barriers are posing challenges for staff retention at PPH, the sector currently has 756 full time employees not including contracts and casual employees with 320 full time contracts being added since the pandemic, the body is also attempting to rebuild their service programs with a severe lack of funding.
The Region has been vocal about the lack of financial support its Public Health unit has received from the Ontario government, and it is not an issue that has arisen recently. As the Region of Peel continues to grow in population at unprecedented rates, topping any other Region in the Greater Toronto Area, PPH continues to get the chump change of the province.
Peel Public Health has consistently received less funding than its counterparts in other Ontario municipalities.
(Government of Ontario)
In 2013, a per capita review of all Public Health units across Ontario was complete. Peel ranked last for provincial funding, receiving only $29.83 per capita. But the decade old study took a snapshot of a funding problem that has followed a roller coaster path for the better part of three decades.
In the early 90s, Ontario maintained a 75/25 funding split, between the provincial and municipal governments, for mandatory public health programming including controlling infectious and chronic diseases, environmental health, injury prevention and family health. Under former PC premier Mike Harris, who held provincial office from 1995 to 2002, funding for public health units became the sole responsibility of municipalities. In 1998, zero percent of funding came from the province. In 1999, the funding model shifted back to 50/50.
The goal was to return to a 75/25 split in three years, an ambition that was not met when funding was capped in 2011 with only 17 Public Health units reaching this funding level split. Currently the target split is 70/30. Peel never reached this level, and 12 years later, the Region’s Public Health unit is only funded 51 percent by the province, with the remaining 49 percent coming from the municipalities. The lack of substantial financial support from the province has left the sector with a $9.9 million finding shortfall in its 2023 budget, increasing from an $8.1 million shortfall in 2022 when the funding split was 61/39. Funding has been frozen since 2018, with the exception of a minor increase in 2019. The Ontario government has since announced the restoration of $47 million in annual base funding for public health units which was the level previously provided under the 75/25 split. This year, PPH’s capital budget is $3.9 million with its 10 year capital plan reaching $15 million.
One of the most pressing projects PPH has currently underway is the implementation of a local safe consumption site to help combat the rising epidemic of opioid deaths across the Region. The crisis has claimed 682 lives across the Region since 2018, with opioid toxicity deaths increasing 68 percent between 2018 and 2021. But even that number is not representative of the problem. For every fatal overdose, there are approximately 20 to 30 non fatal ones, according to regional data.
In July 2022, Regional council unanimously approved $5.8 million over two years for the creation of an Urgent Public Health Need Site located at the Region of Peel headquarters on Peel Centre Drive in Brampton. Staff estimated the current plan would see $3.3 million allocated in the first year, including $731,000 in one time start-up fees, and $2.5 million in the second year. The majority of the costs are for staffing the site.
But with the project fully funded by the Region for two years, with hopes of more long term funding granted by the province, it is unclear how the dissolution of the Region could impact this critical service.
The Region of Peel’s first safe consumption site will be located within the Region of Peel headquarters and help to combat the growing opioid crisis in the Region.
(Alexis Wright/The Pointer)
“We are concerned about the big impact of the upcoming dissolution on the essential services provided by, funded by, and coordinated by Peel Public Health,” Jillian Watkins, executive director of Moyo Health and Community Services, the organization tasked with operating the future safe consumption site, told The Pointer in an email statement. “Peel Public Health is responsible for supporting many services that support vulnerable members of Peel Region, and any disruption to these services will have a serious negative impact on community members.”
The most likely scenario is that PPH will remain a single entity and will just detach itself from the Region. It will still receive provincial funding and will receive funding from all three independent municipalities benefitting from its services. Similar to the operation of Peel’s Children’s Aid Society (CAS), a Board of Directors would be appointed to govern the quasi-independent body. This would not be an unrealistic scenario as out of the 36 Public Health bodies across Ontario, 22 are autonomous, meaning they operate separate from the governing municipality.
The alternative would see Brampton, Caledon and Mississauga creating their own Public Health units which would cost a significant amount of time and financial resources and could lead to mismatched approaches.
“We are concerned that splitting Public Health across the three municipalities in Peel may lead to gaps in services that will negatively impact our clients and community members in the Region of Peel,” Watkins said. “If services are split up, there will be a critical need for coordination across the municipalities to prevent services from withdrawing or being reduced. This is especially important for community members who are transient and whose access to services may be impacted by jurisdictional restrictions on health care services.”
The ultimate decision on the fate of the Public Health unit will come when the Transition Board makes its recommendations to the Minister of Municipal Affairs and Housing Paul Calandra, and Premier Doug Ford, in the summer or fall of 2024.
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