BOH Orientation PowerPoint Presentation

11 January 2019

Dr. Matthew Tenenbaum, Physician Consultant


  • What is Public Health?
  • Legal Framework for Public Health
    • Health Protection & Promotion Act
    • Ontario Public Health Standards
    • Accountability Framework
    • Policies, Procedures, & Reports
  • WDGPH: Who We Are

What is Public Health?

Public health is the organized efforts of society to keep people healthy and prevent injury, illness and premature death. It is a combination of programs, services and policies that protect and promote the health of all Canadians.

-Last, J. (2001). A Dictionary of Epidemiology (4th ed.). New York: Oxford University Press.

Twelve Great Health Achievements

  • Safer and Healthier Foods
  • Control of Infectious Disease
  • Vaccination
  • Tobacco is a Health Hazard
  • Motor Vehicle Safety
  • Universal Policies (OAS, UI, Healthcare)
  • Decline in CAD and CVD
  • Healthier Babies and Mothers
  • Acting on SDOH
  • Safer Workplaces
  • Family Planning
  • Healthier Environments

The Work of Public Health

Health Protection and Promotion Act:

  • Assessment & Surveillance
  • Health Promotion & Policy Development
  • Disease & Injury Prevention
  • Health Protection
  • Emergency Management

What is Public Health?

Diagram of The Health Impact Pyramid (Frieden, 2010)

The Health Impact Pyramid (Frieden, 2010)

From bottom to top:

  • Socioeconomic Factors
  • Changing the context to make individuals’ default decision healthy
  • Long-lasting protective interventions
  • Clinical interventions
  • Counseling and education

Increaing Population Impact decreases compared to the pyramid while Increasing Individual Effort Needed increases up the pyramid.

Legal Framework for Public Health

  • Health Protection and Promotion Act
  • Other key legislation:
    • Municipal Act
    • Immunization of School Pupils Act
    • Healthy Menu Choices Act
    • Smoke Free Ontario Act
    • Skin Cancer Prevention Act (Tanning Beds)
    • Child Care and Early Years Act
    • Mandatory Blood Testing Act
    • Patients First Act
  • Ontario Public Health Standards
  • Accountability Framework

Health Protection and Promotion Act

  • Every board of health, shall superintend, provide or ensure the provision of the health programs and services required by the HPPAand the regulations (s. 4)
    • Includes ‘such additional health programs and services as are prescribed by the regulations’ (s. 5) –refers to OPHS
    • Allows Boards to provide ‘any other program or service’ if approved by contributing municipalities (s. 9)
  • Broad in scope to Tailored to local need
  • Every board of health shall appoint a full-time medical officer of health and may appoint one or more associate medical officers of health (s. 62)
  • Duties and powers of the Medical Officer of Health (s. 67)
  • Provides direction to staff relating to the delivery of public health programs and services
  • Power to issue orders, declare outbreaks, close food establishments, quarantine, etc. (s. 13, s. 22)
  • Authority limited to geography of the health unit
  • Must engage with the LHIN CEO
  • Reports directly to the Board of Health
  • Obligated municipalities in a health unit shall pay the expenses incurred by the Board of Health and the Medical Officer of Health in the performance of their functions and duties under the HPPA(s. 72)
  • Proportional contribution (failing alternate agreement)
  • Process of notice, not participation
  • The Minister may make grants for the purposes of the HPPAon such conditions as he or she considers appropriate (s. 76)
  • Provincial portion of ‘cost-shared’ base budget
  • Grants for additional programs (e.g. Healthy Smiles Ontario, 100%)
  • Some funding provided from other Ministries
  • E.g. HBHC funding provided by MCCSS (formerly MCYS)

Other Key Legislation

  • Municipal Act
  • Immunization of School Pupils Act
  • Healthy Menu Choices Act
  • Smoke Free Ontario Act
  • Skin Cancer Prevention Act (Tanning Beds)
  • Child Care and Early Years Act
  • Mandatory Blood Testing Act
  • Patients First Act

Ontario Public Health Standards

  • Provincial Standards the delivery of programs and services
    • Foundational & Program Standards
  • Public Health Accountability Framework & Organizational Requirements
  • Indicator & Transparency Frameworks

Policy Framework for Public Health Programs and Services

Goal To improve and protect the health and well-being of the population of Ontario and reduce health inequalities
Population Health Outcomes
  • Improved health and quality of life
  • Reduced morbidity and premature mortality
  • Reduced health inequity among population groups
Domains Social Determinants of Health Healthy Behaviours Healthy Communities Population Health Assessment
Objectives To reduce the negative impact of social determinants that contribute to health inequities To increase knowledge and opportunities that lead to healthy behaviours To increase policies, partnerships and practices that create safe, supportive and healthy environments To increase the use of population health information to guide the planning and delivery of programs and services in an integrated health system

Program & Foundational Standards

  • Population Health Assessment
  • Health Equity
  • Effective Public Health Practice
  • Emergency Management
    • Chronic Disease Prevention & Wellbeing
    • Food Safety
    • Healthy Environments
    • Healthy Growth & Development
    • Immunization
    • Infectious & Communicable Diseases Prevention & Control
    • Safe Water
    • School Health
    • Substance Use & Injury Prevention

Accountability Framework

The Accountability Framework is composed of four Domains:

Domain Delivery of Programs and Services Fiduciary Requirements Good Governance and Management Practices Public Health Practice
Objectives of Domains Boards of health will be held accountable for the delivery of public health programs and services and achieving program outcomes in accordance with ministry published standards, protocols, and guidelines. Boards of health will be held accountable for using ministry funding effeciently for its intended purpose. Boards of health will be held accountable for executing good governance practives to ensure effective functioning of boards of health and management of public health units. Boards of health will be held accountable for achieving a high standard and quality of practive in the delivery of public health programs and services.

Organizational Requirements incorporate one or more of the following functions:

Requirements for Boards of Health:

  • Monitoring and reporting
  • Continuous quality improvement
  • Performance improvement
  • Financial management
  • Compliance

The Accountability Framework is supported by:

  • Accountability Documents:
    • Organizational Requirements: Set out requirements against which boards of health will be held accountable across all four domains
    • Ministry-Board of Health Accountability Agreement: Establishes key operational and funding requirements for boards of health
  • Planning Documents:
    • Board of Health Strategic Plan: Sets out the 3 to 5 year local vision, priorities and strategic directions for the board of health.
    • Board of Health Annual Service Plan and Budget Submission: Outlines how the board of health will operationalize the strategic directions and priorities in its strategic plan in accordance with the Standards
  • Reporting Documents:
    • Performance Reports: Boards of health provide to the ministry regular performance reports (programmatic and financial) on program achievements, finances, and local challenges/issues in meeting outcomes.
    • Annual Report: Boards of health provide to the ministry a report after year-end on the affairs and operations, including how they are performing on requirements (programmatic and financial), delivering quality public health programs and services, practicing good governance, and complying with various legistative requirements.

Policies, Procedures, & Reports

  • Set of policies and procedures developed for and available to the Board of Health on Dilitrust
  • WDGPH provides reports to the Board to align with reporting requirements
  • Annual report schedule developed for the Board

WDG Public Health: Who We Are

  • One of 35 local public health agencies in Ontario
  • Responsible for health of 284,461 residents of Wellington County, Dufferin County, and the City of Guelph
  • Vision: Everyone has the opportunity for health and wellbeing.

Our Local Public Health System

Local Public Health system includes:

  • Wellington-Dufferin-Guelph Public Health
  • Ontario Ministry of Health and Long-Term Care
  • Ontario Waterloo Wellington Local Health Integration Network
  • Ontario Central West Local Health Integration Network
  • Community Partners
  • Public Health Ontario

WDGPH Senior Leadership

  • Dr. Nicola Mercer, Medical Officer of Health
  • Dr. Matthew Tenenbaum, Ass. Medical Officer of Health
  • Chris Beveridge, Director, Health Protection
  • David Kingma, Director, Administrative Services
  • Rita Isley, Director, Community Health & Wellness
  • Andrea Roberts, Director, Family Health
  • Kyle Wilson, Director, Information Systems

WDGPH Board Members

  • Allan Alls Municipal Appointee, County of Wellington
  • Christine Billings Municipal Appointee, City of Guelph
  • George Bridge Municipal Appointee, County of Wellington
  • Guy Gardhouse Municipal Appointee, County of Dufferin
  • Rodrigo Goller Municipal Appointee, City of Guelph
  • June Hofland Municipal Appointee, City of Guelph
  • Nancy MacDonald Provincial Appointee, County of Wellington
  • Ralph Manktelow Citizen Appointee, County of Dufferin
  • Lambert Otten Provincial Appointee, County of Wellington
  • Chris White Municipal Appointee, County of Wellington
  • There are currently five vacant positions on the Board of Health for provincial appointees