Opinion-Policy Nexus

No one has ever claimed that Canada is a breeze to govern. We have too few people spread too thinly over too much territory, too many overlapping layers of government, too many politicians scuffling over jurisdiction – and over cash. Not to mention a constitutional division of powers written in and for the age of the horse and buggy. 

The deficiencies become apparent in a time like this, when the nation is in grip of a pandemic, when we need all of the politicians and their assorted bits and pieces of administrative machinery to be on the same page, not flying off in all directions.

Ontario offers an extreme example. Trouble starts at the top with a premier who came to office with no experience in provincial politics, a chip on his shoulder, and a disinclination to take advice from experts who know what they are talking about. He assembled the weakest Ontario cabinet in a generation, surrounding himself with ministers so dependent on his favour that fear to venture an independent thought.

Political leadership at Queen’s Park is just the tip of the trouble that made Ontario’s handling of the first wave of COVID-19 so disastrous – especially for those in long-term care homes – followed by its failure to prepare for the second wave, and, in recent weeks, the confusion created by a blizzard of mixed messages about vaccinations.

Some communities (for example, Kingston and Guelph) were well into arm-jabbing while others were still struggling to organize websites where seniors could to apply to be wait-listed for a shot (Cambridge, next door to Guelph, being among the laggards). 

Health policy for the province is set at Queen’s Park. But the actual delivery of health care is the responsibility of a ramshackle structure of no fewer than 34 local and regional boards of health – the theory being that health services can be best provided by agencies close to the people who use the services. But 34 boards, each going its own way! To do a job that could be done by five or six. That’s assuming the job could not be done more efficiently and successfully by one province-wide agency with no boards of health at all.

There is no provincial template for the 34 boards in terms of size, membership, priorities, financial resources, spending per capita, or managerial competence. Each board appoints a medical officer of health who must be a medical doctor. Some MOH’s are also trained public health administrators; most are not. Some would be hard-pressed to manage their way out of a paper bag; administration is just not their field.

Some boards include representatives of the provincial government; others do not. The Toronto Board of Health has 13 members – six city councillors, six citizens who successfully applied to city council to represent the public, and one member chosen by the local boards of education. Waterloo Region is quite different; its board of health has 16 members, one elected by voters in each of the region’s 16 municipalities; its staff works for the regional government administration, not for the board itself. 

As one insider observes, the raison d’etre of a board of health is to prevent and fight disease. The problem with having members who are local councillors, or are individuals chosen by the council, is that they are inclined to be more concerned with keeping property taxes down than with fighting disease. As a general proposition, boards that have a medical officer with training in public health administration and boards that receive adequate funding from their local council are doing the best job of controlling COVID and getting those jabs into arms.

In the beginning, the province provided 75 per cent of the base funding for boards of health. The Mike Harris government reduced it to 50/50 province-municipality. Critics fear the Ford government will chop the ratio further, to 25/75 province-municipality.

In an ideal province, two things would happen: those 34 boards would be scrapped, and the provincial government would take over the delivery of health care and 100 per cent of its financing. I wouldn’t count either from Doug Ford.

My Mistake: Last week, I wrote that the CEO of the Public Sector Pension Investment Board, a crown corporation, is appointed by the federal cabinet. Wrong! The CEO is appointed by the PSPIB board of directors. The board’s members are appointed by the cabinet. 

Cambridge resident Geoffrey Stevens, an author and former Ottawa columnist and managing editor of the Globe and Mail, retired last month from teaching political science at the University of Guelph. His column appears Mondays. He welcomes comments at [email protected].


Monday, March 8, 2021 - 09:15