History of Public Health in Ontario

Health units have been an integral part of the health care delivery system of this province for over 60 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

1873	The first Public Health Act was passed.
1882	The first board of health was established.
1884	A more comprehensive Public Health Act was prepared by Dr. Peter B. Bryce. 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.
1912	Public Health Act was amended so that health units could be established on a county basis.
1934	The first county-wide 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 who were part-time.
1945	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.
1950	25 county and 12 municipal health units were in place which served two thirds of the population of Ontario.
1965	54 boards of health were in place, which served 95% of the population.
1967	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.
1983	The Health Protection and Promotion Act was proclaimed.
1997	The Health Protection and Promotion Act was revised as part of Bill 152, the Services Improvement Act.
1998	Municipalities in Ontario assume 100% funding of public health services.
1999	Cost shared funding for public health is re-introduced across the province. Municipalities are required to pay the expenses incurred by the Board and the Medical Officer of Health. The Minister of Health may make grants as considered appropriate. Between 1999 and 2004, the provincial grant has covered 50 per cent of the cost of public health programming in Simcoe County.
1998	The board of health for East York, North York, City of Toronto, Scarborough and Etobicoke were dissolved and the Board of Health for the City of Toronto Health Unit was Established in January 1, 1998 reducing the number of public health units in Ontario to 37.
2004	The Ministry of Children and Youth Services is crated brining together programs for children,young people and their families under one Ministry. The Ministry assumes funding responsibility for the Healthy Babies Health Children Program.
2004	In response to recommendations from a number of provincial and federal reports emerging as a result of the SARS outbreak in Ontario, the province announced new provincial funding for public health and changes to the funding formula for public health programs and services. These initiatives were designed to enhance the total funding available for public health in order to improve local public health capacity. The following schedule of stepped increases to the provincial share of public health funding was introduced: January 1, 2005 – 55% province, 45% municipalities January 1, 2006 – 65% province, 35% municipalities January 1, 2007 – 75% province, 25% municipalities
2005	On March 3, 2005, regulation amendments were filed under the Health Protection and Promotion Act (HPPA) to support the merger of the Muskoka-Parry Sound Health Unit with the Simcoe County District Health Unit and with the North Bay & District Health Unit effective April 1, 2005 reducing the total number of health units in Ontario to 36.
2005	The Ministry of Health Promotion is announced in the summer of 2005. The Ministry portfolio is dedicated to promoting healthy living and illness prevention.