Toronto's top doctor worried province could reduce public health funding

Toronto's top doctor is warning one-time funding that prevented a cut to public health by the Ford government runs out at the end of this year, while the province insists the cash flow to health units will remain the same. 

Dr. Eileen de Villa made the comments at this week's Toronto Board of Health meeting in response to questions about provincial funding commitments. In 2019, the province attempted to change the way it funds health units across Ontario, shifting its cost-sharing arrangement with municipalities from a 75 per cent - 25 per cent split to a 70-30 formula.

At that time, the change was projected to cost public health units $200 million a year in provincial funding, and sparked a fiery backlash from city politicians. Ford's government eventually retreated from the plan.

But de Villa said when the province announced its changes in 2019, they've continued funding at the 75-25 split, but have provided an annual five per cent top-up that brings the ratio back to 70-30. 

De Villa said that top up expires at the end of 2023, and the province has not confirmed stable funding beyond that.

"It has been made clear to us that it is one-time [funding] so I don't know what the provincial government's plan is at this point in time," she said.

"What I can tell you is what we have been told is we're getting that mitigation funding for 2023 … thereafter, we have yet to hear."

Province backed down after fight over funding cut

In 2019, former mayor John Tory and then Board of Health chair Joe Cressy waged a public fight against the province's proposed cuts. Tory accused the Ford government of unilaterally moving ahead with the in-year budget cuts without consultation.

"Toronto is being singled out for more discriminatory treatment, in other words, harsher cuts than anywhere else in the province," Tory said at the time. Cressy pegged the potential loss of funding to Toronto Public Health at $86 million that year.

The province later reversed course on the plan but de Villa told CBC Toronto this week there are concerns about any potential change in funding across the province's public health units.

She could not say what a change in the formula would now cost those units, but believes the impact would have grown.

"In the last few years costs in general have gone up," she said. "So what it costs to deliver service, the same services, we did five years ago is going to be different today."

Like the broader health-care system, as health units emerge from the height of the pandemic they're catching up on delayed services and programs, she said.

"Any shift in the ratio does make it more challenging for us," she said. "We need to continue the COVID response and do the catch-up on the non-COVID work that had to be delayed or deferred."

But a spokesperson for Ontario Health Minister Sylvia Jones said the funding plans for health units have not changed.

"There are no plans to change the cost-sharing ratios and our government will continue to invest in public health," Hannah Jensen said in a statement.

Health units ask for stable funding in Ontario budget

De Villa's comments come weeks ahead of the release of Ontario's provincial budget as the association that represents the province's local public health units pushes for stable funding. In a pre-budget submission last week, the Association of Local Public Health Agencies (alPHa) asked the province to immediately revert back to the 75-25 cost-sharing formula permanently..

"Changing the funding formula for public health will result in no net savings for the Ontario taxpayer but cause disproportionate hardship for Ontario's municipalities," alPHa's president Trudy Sachowski wrote. 

She also noted there is an "over-reliance" on mitigation and one-time funding to pay for ongoing and predictable costs.

"It creates unnecessary uncertainty in the budget planning process and carries significant enough financial risk that it can result in the curtailment of important services," she added.

Councillors concerned about 'unstable funding'

Board of Health Chair Chris Moise said he's concerned that the province has not moved away from the one-time funding allocation and could still be contemplating cuts. Now is the time to invest in public health, he said.

"We don't know what the funding will look like and we're still in the pandemic," Moise said.

"We still need to do testing and make sure that ... our communities are safe … so we need steady and reliable funding for those things that are happening."

The board may need to push back and ask for more clarity from the province on the cost-sharing formula, said Moise, adding that the situation makes him feel "a bit of anxiety."

"We actually spend the money at public health, and then we get reimbursed by the province," he said. "The province at any one moment in time can say, 'We're not going to fund you.'"

Coun. Gord Perks, who is a member of Toronto's Board of Health, said he is concerned that Ontario's budget will contain cuts to public health. Throughout the COVID-19 pandemic, public health proved itself to be a life-saving service in the city, he said.

"Many of us on council are deeply concerned about the ongoing attack from the province on the funding and also the legal authority of public health departments in the province of Ontario," he said.

"We just went through a period where, by the skin of their teeth, public health provided incredible service to Torontonians. Now is not the time to be reversing that, we need to be reinstating the base programs."

Deputy Mayor Jennifer McKelvie said Wednesday that working with the province to secure funds for health care and COVID-19 support is a top priority. Ontario confirmed to the Office of the Mayor on Friday that it has processed a transfer payment of $235 million to the city to help address its pandemic shortfall.

"I look forward to continuing discussions with our provincial partners, with the Chair of the Board of Health, Councillor Chris Moise, and with our Medical Officer of Health, Dr. Eileen de Villa to ensure our city has the funding needed to plan for the future," McKelvie said in a statement.