Toronto Public Health says 'very difficult decisions' could lie ahead amid uncertainty around funding

Toronto Public Health (TPH) is raising concerns that possible provincial changes to its funding formula could have a dramatic impact on some of the services it delivers.

In a presentation at the TPH budget committee this week, staff said a number of programs would be at risk if the province follows through on a previous plan to slash its share of funding for public health units.

Until 2018, the province shared costs with Ontario’s public health units in a 75-25 per cent split.

The proposed funding model for public health units in the 2019 budget reduced the provincial share to 70 per cent, with the goal of reducing it further to 60-40 in the following year and 50-50 the year after that.

However because of the COVID-19 pandemic, the province held its share at 70 per cent over the past few years and provided “mitigation funding” which kept support at 2018 levels.

However it’s not clear whether that will continue as the province emerges from the pandemic, once again raising the prospect that public health funding could be cut dramatically.

The health unit said Monday that it could be short by $49 million next year if the province proceeds with a new funding formula. 

If that happens, the programs at highest risk of cuts include the harm reduction program with Shelter, Support and Housing, which is fully funded by the city, as well as a safe injection program for people trying to get off opioids, and various capital projects.

But various other programs which are paid for through provincial mitigation funding would also be at risk.

At a Toronto Public Health Board meeting earlier this month, Finance and Administration Director Althea Hutchinson that “there would be some very difficult decisions that would be need to be made”  if the funding model changes.

“I would characterize it as more than devastating,” Hutchinson said when asked about the impact if the province proceeds with the original plan, which would eventually see an estimated $100 million in provincial funding cut from the TPH budget.

In an email to CP24.com Thursday, a spokesperson for Health Minister Sylvia Jones said there is no plan to change the formula, but did not clarify how long that policy will hold.

“There are no plans to change the cost-sharing ratios and the dollar amount that flows to public health units reflects a 75-25 cost sharing ratio,” the email read.

“Yesterday the Minister met with the Association of Local Public Health Agencies (ALPHA), including (Toronto’s medical officer of health) Dr. Eileen De Villa. In that meeting the Minister reassured ALPHA and Dr. De Villa there will be no changes to the cost-sharing ratio and that our government will continue to invest in public health.”

However Toronto Public Health told CP24.com in an email Thursday that they have not received any communication confirming the funding formula for 2024 so far.

In an interview, Coun. Chris Moise, who chairs the TPH Board, said the comments from Jones’ office give him “little to no confidence” in terms of what will happen to the health unit’s funding next year.

In fact the city has not yet received confirmation of the provincial funding formula for 2023, though staff are not expecting any dramatic changes for this year.

“We’re in the month of what, July? It’s just nuts,” Moise said.

Jones’ office did not clarify when asked explicitly whether the formula will remain unchanged for 2024.

Moise said the affected programs would be wide-ranging, and because TPH is mostly a service-based organization, funding cuts would amount to layoffs.

“I think it’s important to really zone in as to what it is we're talking about here; We’re talking about cutting staff, frontline staff in public health that do the heavy lifting every day. There'll be less of them,” he said.

He also pointed out that Ontario recently received billions of dollars in additional federal funding through a new health accord with the provinces.  

Speaking at the Jan. 5 TPH Board meeting, de Villa said it's important to recognize public health as an "investment" in the health of the population.

“It is an investment in prevention that actually saves money down the road, particularly, yes, in health care. But the savings are not just about health. We see them in virtually every sector of society,” de Villa said. “The challenge of course with prevention is it's really hard to explain the value of what didn't happen, right? And that, I think, is the challenge that has always existed for us as public health; very hard to sell the value of what didn't happen.”

During the pandemic, TPH was highly visible as one of the key agencies monitoring the outbreak, providing advice to the public and facilitating a widespread vaccination campaign. However the agency’s day-to-day work includes dental programs, sexual health programs, food safety, and chronic disease and injury prevention.

The TPH budget committee voted Monday to recommend that the board ask the province to “provide sufficient and sustainable funding for Toronto Public Health to meet Toronto’s population health needs, taking into account such things like inflationary pressures and the demands resulting from the COVID-19 pandemic” as well as the pandemic’s impact on other issues like immunization and mental health.