Public health units have been an integral part of the health care delivery system of this province for over 50 years. While 1945 is often thought of as the year of the inception of health units in Ontario, this was simply an important milestone.
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, established 150 years ago has persisted to the present day.
Important milestones in public health
The first Public Health Act was passed.
The first board of health was established.
A more comprehensive Public Health Act was prepared by Dr. Peter H. Bryce, the first part-time secretary and chief medical officer of health until 1904. This Act established the position of the medical officer of health and the relationship with the board of health. Within two years of passage, 400 boards of health were in operation.
Public Health Act was amended so that health units could be established on a county-basis.
The first countywide health unit was established with a grant from the Rockefeller Foundation. It included the four eastern counties of Stormont, Dundas, Glengarry, and Prescott. At this time, Ontario had 800 local boards of health and 700 medical officers of health, most of whom were part-time.
The Public Health Act was amended so that provincial grants could be provided to municipalities for the establishment of health units. Six health units were in place by the end of 1945.
25 county and 12 municipal health units were in place that served two thirds of the population of Ontario.
54 boards of health were in place, which served 95% of the population.
The Public Health Act was amended so that organized municipalities were required to provide full-time public health services. The District health unit concept was introduced based on the collective experience of operating health units in Ontario. Economies of scale concepts were introduced which suggested optimum population sizes for health unit catchment areas. The province encouraged health units to regroup on a multi-county basis to become more efficient.
The Health Protection and Promotion Act was proclaimed.
The Health Protection and Promotion Act was revised as part of Bill 152, the Services Improvement Act. The Mandatory Programs and Services Guidelines were implemented in December.
Municipalities in Ontario assume 100% funding of public health services. Presently there are 37 health units in place: 27 county-district health units; 9 regional health departments and 1 single municipality (Toronto).
For further information on public health units in Ontario and their locations visit the web site of the Association of Local Public Health Agencies at www.alphaweb.org.
History of the Sudbury & District Health Unit
In the early 1940’s, Provincial Department of Health policy directed that the formation of health units be proceeded with in Ontario, in order that public health services then available in towns and cities be provided to rural areas. At that time the Sudbury area was considered as an excellent one in which to form a health unit.
However, local opposition developed and the health unit did not come into being. Instead, the City of Sudbury Health Department was strengthened and a full time public health service developed in the city only. From time to time, interest was somewhat reawakened in the Health Unit with recommendations from various health-oriented groups, but no concerted effort toward the formation of a health unit in the district took place until 1955. At that time the Sudbury and District Municipal Society investigated the health unit proposals.
A committee, headed by Anthony Falzetta, Reeve of Drury, Denison and Graham, and Chairman of the Sudbury Municipal Association, strongly recommended to their membership that the formation of a health unit would result in vastly improved public health services to the rural areas and in the provision of funds from provincial sources to the City of Sudbury, which at that time paid the entire cost from local tax sources.
The municipalities of Drury, Denison and Graham, Waters, Dowling and Sudbury signed an agreement to establish the Health Unit and it came into being on September 1, 1956. The office was located at 50 Cedar Street, Sudbury, Ontario.
Sudbury & District Health Unit Milestones
On September 10 the first meeting of the Sudbury and District Board of Health was held. Dr. J.B. Cook was the Medical Officer of Health with an annual salary of $12,000.00. Dr. Ford Dixon was elected Chairman and Mr. A. Falzetta the Vice-chairman. Miss L. Johns was appointed Secretary, Miss Florence Tomlinson the Supervisor of Nursing and Miss R. Desjardins Senior Public Health Nurse. Wm. A. McDonald was the Senior Sanitary Inspector and J. Sandul the Sanitary Inspector. Dr. A.B. Sutherland was the Public Health Dentist. As an aside, the public health nurses doing work in the City were required to utilize taxi services. The main interest of the City of Sudbury at that time was to take advantage of the 25% grant Statistics & Health made available to health units from provincial sources. The interest of the townships was to receive public health service previously lacking, aided by 50% funding from provincial sources. The total population was 56,833, of whom 6,467 lived in the unorganized territories. The Health Unit employed a staff of 10. Their mandate was to provide and administer the tuberculosis control program and the venereal disease program. In October the immunization clinics for pre-school and school children for diphtheria, whooping cough, tetanus and smallpox were started in Waters, Drury, Denison, and Graham Townships. They were still waiting to receive polio vaccine. It is recorded that as of November 14, 1956, 3,363 children received polio vaccine and this has increased steadily ever since. Each year, at local request, additional municipalities applied for the health services. At no time were these municipalities actively sought out, but they examined the Health Unit program and applied for membership.
In July the population had increased to 114,738. The Health Unit employed:
- 23 full time and 4 part time Public Health Nurses
- 2 registered nurses
- 5 inspectors
- 9 full time and 1 part time clerical, and
- 5 certified nurses’ assistants.
A further change in Provincial Department of Health policy dictated the active promotion of expansion of health unit boundaries, with the announcement that district health units serving more than one district would be subsidized to 75% of the costs, if all municipalities in the district were served. Thus, the Sudbury and District Health Unit was expanded to serve all of Sudbury District – all of Manitoulin District – the Township of Elliot Lake and four unorganized townships In Algoma – two unorganized townships in Parry Sound and two unorganized townships in Nipissing effective January 1, 1968 – a total area of 22,000 sq. miles.
In November the acute Home Care program was established. They offered services to people living in the City of Sudbury and within an approximate radius of 50 miles. These services, which were purchased from available community agencies, consisted of nursing care, physiotherapy, speech therapy, homemakers as well as arrangements for x-ray and laboratory tests, medical equipment and medications.
The population served was 213,000 persons with a budget of $1,700,000.00.
Under the then Medical Officer of Health, G.F. Mills, the first composite annual report was prepared and was prepared annually thereafter.
The Ministry of Health distributed the document “Mandatory Programs and Services Guidelines” to all health units, for immediate implementation. As well the Sudbury & District Health Unit acquired a new Associate Medical Officer of Health – Dr. Alan Northan, who, during his tenure, would make smoking a high profile, health-related issue for the health unit.
In July, under the direction of Dr. R.J. Bolton, the health unit employed 507 full and part time staff in public health, Homemaking and Home Care. The area covered 49,561-sq. km. with a population of 186,000. The 1990 budget was $7.5 million for public health and almost $7 million for Home Care.Some major events that occurred in 1990 were the implementation of the Dental Coach Program; rabies clinics were conducted because of the high incidence of animal rabies; the health unit received its first accreditation award of one year and discussions were initiated on Long Term Care Redirection.
The Clean-Up Week promotion was discontinued. In May of the same year there were 70 confirmed cases of measles reported with more than 4,000 children re-vaccinated.
The population served by the health unit was 180,607. The number of staff employed in 1992 was 201 full-time and 418 part-time staff, including the Home Care program. New initiatives in 1992 were the beginning of the Anonymous HIV testing service with the implementation of a 1-800 line and a proposal presented and approved for the sponsoring of a Needle Exchange/Risk Reduction Program. In February of 1992 the health unit received their three-year Accreditation Award (later to be extended to four years). In that same year the Association of Allied Health Professionals union was certified for therapy and other staff in the Home Care Program.
This was the year the Integrated Homemaker Program and the Quick Response Programs were initiated as part of Home Care services.
The strategies for the immunization of 3,000 Grade 7 students for Hepatitis B were developed; a cost-recovery user fee was implemented for the Travel Clinic and sewage system inspections. The newest program for the planning and development of enforcement activities as they related to the Tobacco Control Act, Bill 119 came into being that same year.
In June and as a result of new legislation the new Community Care Access Centre assimilated the Home Care Program along with the Placement Coordination Services. The health unit was then reduced to 125 staff to provide the programs and services defined by the Ministry of Health.
This was a year of major restructuring by the legislature. A new Services Improvement Act was implemented which changed the funding formula from a 75%(province): 25% (municipalities) cost-share to a 100% download to the municipalities except for a few programs the Ministry of Health agreed to continue to fund such as the Genetics, Immunization and the Healthy Babies Healthy Children programs. This became effective January 1, 1998. As part of that restructuring process, the Ministry of Health developed a new set of Mandatory Health Program & Services Guidelines, which were released in December 1997. This resulted in a restructuring of the programs and services within the Sudbury & District Health Unit.
This saw a reversal of the funding formula by the province in 1998 that had been downloaded 100% to the municipalities and was now uploading 50% of the funding back to the Ministry of Health retroactive to January. They still continued to fund 100% of the Genetics, Immunization, Healthy Babies Healthy children Program and the Unorganized Territories Grants. The Public Health Research, Education and Development Program (PHRED) was recognized as a permanent program in six Ontario health units, of which Sudbury is one.
The Sudbury & District Health Unit once again received a four-year accreditation award as well as the Seal of Excellence from the Ontario council on Community Health Accreditation for 10 continuous years of accreditation status. This year also marked the retirement of Dr. Robin Bolton after 15 years of service and the induction of Dr. Penny Sutcliffe, the new Medical Officer of Health.
The Sudbury & District Health Unit received a four-year accreditation award and Seal of Excellence from the Ontario Council on Community Health Accreditation. The Sudbury & District Health Unit is the first health unit in the province to receive this award under the new guidelines established for public health accreditation. The accreditation award recognizes excellence in service to the public and in partnership development with community agencies, professional associations and local, regional and provincial governments.
The Health Unit was awarded unconditional accreditation by the Ontario Council on Community Health Accreditation. This is the highest level of award and signifies a high level of compliance with the OCCHA standards. This earned the Health Unit a three-year award.
An analysis by the Health Unit reveals important untapped opportunity for health in the City of Greater Sudbury. A first-for-Sudbury study found significant differences in health for those living in the City’s most deprived areas compared with its least deprived areas. The findings are contained in a report, Opportunity for All: The Path to Health Equity, which highlights the startling differences between the most deprived and the least deprived areas of the City. Some of the most dramatic differences include:
- a rate of emergency department visits that is 3.9 times higher for mental health episodes
- an infant mortality rate that is 2.4 times higher
- an obesity rate that is twice as high
Past and present Medical Officers of Health and Associate Medical Officers of Health
The Sudbury & District Health Unit has been led by the following Medical Officers of Health and Associate Medical Officers of Health since the inception of the Sudbury & District Board of Health:
|Penny A. Sutcliffe, MD, MHSc, FRCPC||August 21, 2000 to present|
|Ariella Zbar, MD, CCFP, MPH, MBA||August 8, 2016 to present as Associate Medical Officer of Health|
|Na-Koshie Lamptey, MD, MPH, CCFP, FRCPC||September 7, 2010 to August 16, 2013 as Associate Medical Officer of Health|
|Vera G. Etches, MD, CCFP, MHSc, FRCPC||September 6, 2005 to January 23, 2009 as Associate Medical Officer of Health|
|Robin J. Bolton, MD, MHSc, FRCP(C)||January 2, 1985 to October 10, 1985 as Associate MOH. October 10, 1985 to July 31, 2000 as MOH.|
|Allan A. Northan, MD, MHSc, FRCP(C)||January 1, 1989 to August 4, 1993 as Associate Medical Officer of Health|
|Brian J. Lynch, MD, DPH||June 1, 1981 to October 11, 1985|
|Franklin G. Mills, MD, DPH, FRSH||October 3, 1977 to September 30, 1980|
|John B. Cook, MD, DPH||September 19, 1945 to March 31, 1978|
This item was last modified on June 22, 2018