A Cautionary Tale of Downloading Public Health in Ontario: What Does It Say about the Need for National Standards for More Than Doctors and Hospitals?

The 2003 SARS outbreak highlighted the importance of maintaining an adequate public health (PH) infrastructure, and cast doubt on the wisdom of basing the system locally without adequate provisions for higher-level oversight and coordination. Structurally, it highlighted the policy legacy of the 1998 Ontario decision to download full responsibility for funding PH services to municipal governments, forcing such services into budgetary competition with the "hard" services traditionally provided by local government. The federal role in PH has traditionally been minimal; PH was never included as a mandatory service in the Canada Health Act, while reform proposals have focused upon such admittedly important directions as pharmacare and home care rather than PH. Although PH has moved up the policy agenda, with a focus on pandemic preparedness, the Ontario events suggest a pressing need for setting national and provincial/territorial standards for PH, and developing mechanisms for enforcing them.