Ontario Public Health Standards

Introduction to the Standards

The Ontario Public Health Standards are published as the guidelines for the provision of mandatory health programs and services by the Minister of Health and Long-Term Care, pursuant to Section 7 of the Health Protection and Promotion Act, R.S.O. 1990, c. H.7.

Purpose

The Ontario Public Health Standards establish requirements for fundamental public health programs and services, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The Ontario Public Health Standards outline the expectations for boards of health, which are responsible for providing public health programs and services that contribute to the physical, mental, and emotional health and well-being of all Ontarians. Boards of health are responsible for the assessment, planning, delivery, management, and evaluation of a variety of public health programs and services that address multiple health needs, as well as the contexts in which these needs occur.

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Scope and Accountability

This document specifies only those programs and services that all boards of health shall provide and is not intended to encompass the total potential scope of public health programming in Ontario.

The scope of these standards includes a broad range of population-based activities designed to promote the health of the population as a whole, and with community partners to reduce health inequities. The concepts of population health and health promotion are embedded in the Ontario Public Health Standards.

The Ontario Public Health Standards identify requirements that should result in specified outcomes and goals.1 Boards of health shall tailor programs and services to meet local needs and work towards the achievement of those specified outcomes and goals.

Many of the standards are supported by specific protocols (or other documents referred to in these standards) that further specify how to operationalize some of the requirements. Boards of health are accountable for implementing the standards including those protocols that are incorporated into the standards.

The achievement of overall goals and societal outcomes depends on achievements by boards of health along with those of many other organizations, governmental bodies, and community partners across the province. Societal outcomes and goals help to qualify the collective contribution towards broader health and societal aspirations. Measurement at these levels will meet provincial reporting requirements while assisting boards of health in planning and organizing programs and services in relation to other community partners.

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Determinants of Health

The health of individuals and communities is significantly influenced by complex interactions between social and economic factors, the physical environment, and individual behaviours and conditions. These factors are referred to as the determinants of health, and together they play a key role in determining the health status of the population as a whole. Determinants of health include the following:

  • Income and social status;
  • Social support networks;
  • Education and literacy;
  • Employment/working conditions;
  • Social and physical environments;
  • Personal health practices and coping skills;
  • Healthy child development;
  • Biology and genetic endowment;
  • Health services;
  • Gender;
  • Culture; and
  • Language.

Addressing determinants of health and reducing health inequities are fundamental to the work of public health in Ontario. Effective public health programs and services consider the impact of the determinants of health on the achievement of intended health outcomes.

A key component of the requirements outlined in the Ontario Public Health Standards is to identify and work with local priority populations. Priority populations are identified by surveillance, epidemiological, or other research studies and are those populations that are at risk and for whom public health interventions may be reasonably considered to have a substantial impact at the population level.

The Ontario Public Health Standards incorporate and address the determinants of health throughout, and include a broad range of population-based activities designed to promote the health of the population and reduce health inequities by working with community partners.

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Public Health in Ontario

Public health programs and services are an essential part of the health system, and they share with other services the common vision of a system that helps people stay healthy, delivers good care when people get sick, and will be there for people's children and grandchildren. The primary focus of public health is the health and well-being of the whole population through the promotion and protection of health and the prevention of illness.

The preventive nature of public health means that the public is often unaware of public health interventions. However, the work of public health is important to the overall promotion of a healthier population, reducing the demand on the health care system, and responding to threats to the health of the public. Public health is responsible for many major improvements in the population's health through initiatives such as childhood vaccinations, the control of infectious disease, safe food handling, reproductive health, the prevention of chronic diseases (e.g., through tobacco control), and the prevention of injury. These efforts complement the work of much of the health care system, which focuses predominantly on the treatment of individual illness and disability.

The public health system is an extensive collection of governmental, non-governmental, and community organizations operating at the local, provincial, and federal levels with varying roles, perspectives, and linkages. In Ontario, boards of health have historically been an integral part of the formal health system, with responsibility for the delivery of local public health programs and services. This responsibility is carried out in collaboration with other organizations in the health system and in partnership with others in local communities. The locus of responsibility and accountability of program delivery for boards of health is local, not provincial or federal.

At the time of writing, Ontarians are served by a system of 36 local boards of health that collectively cover the entire province and are individually responsible for serving the population within their geographic borders. Just over two-thirds of Ontario's boards of health are autonomous bodies created to provide local public health services. Municipal councils act as the board of health for the remainder. Specifically there are:

  • 22 autonomous boards that operate separately from the administrative structure of their municipalities;
  • 4 autonomous boards that are integrated into municipal structures;
  • 4 boards that are councils of single tier municipalities; and
  • 6 boards that are councils of regional municipalities.

All boards of health have the same responsibilities in terms of delivering public health programs and services within their communities.

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Legislative Mandate for Ontario's Boards of Health

Ontario's Health Protection and Promotion Act (HPPA) provides the legislative mandate for boards of health. This section provides an overview of the HPPA.

The guiding purpose of the HPPA is to:

…provide for the organization and delivery of public health programs and services, the prevention of the spread of disease and the promotion and protection of the health of the people of Ontario. (R.S.O. 1990, c. H.7, s.2)

The HPPA is divided into 11 Parts with 111 Sections, summarized2 below:

Part I: Interpretation

  • Provides a definition of terms used in the HPPA and sets out the purpose of the HPPA.

Part II: Health Programs and Services

  • Sets out the duties of boards of health with regard to the provision of mandatory health programs and services (including the application of these programs and services to school pupils).
  • Includes the provision of safe drinking water by small drinking-water systems.
  • Sets out the Minister of Health and Long-Term Care's authority to publish guidelines for the provision of mandatory health programs and services.

Part III: Community Health Protection

  • Sets out the duties of public health officials with regard to health hazards (including the issuance of written orders and the provision of direction with regard to investigating or mitigating health hazards).
  • Sets out the legislative requirements for the operation and maintenance of food premises.
  • Sets out the power of the medical officer of health to vary prescribed regulatory requirements relating to small drinking water systems on a temporary basis, and to specify alternative requirements that will apply in their stead.

Part IV: Communicable Diseases

  • Sets out the duties of a medical officer of health with regard to communicable diseases, including the issuance of written orders (i.e., Section 22 orders).
  • Includes orders to address communicable diseases outbreaks.
  • Sets out the duty to report reportable diseases (for physicians, practitioners, hospital administrators, school principals, etc.).
  • Sets out requirements with regard to immunization.

Part V: Rights of Entry and Appeals from Orders

  • Describes the right of entry, powers of inspection, and appeals from orders.

Part VI: Health Units and Boards of Health

  • Sets out the requirements for the composition of boards of health.
  • Sets out the process for boards of health to enter into agreements with the council of a band on reserve.
  • Sets out the duties of boards of health.
  • Sets out the manner of appointment of medical officers of health (and of associate medical officers of health).
  • Sets out the requirements for boards of health to address medical officer of health vacancies (including vacancies due to inability to act or due to absences).
  • Sets out the requirement for payment by obligated municipalities.

Part VI.1: Provincial Public Health Powers

  • Sets out the actions that the Chief Medical Officer of Health may take where there exists or there may exist an immediate risk to the health of persons anywhere in Ontario.
  • Authorizes the Minister of Health and Long-Term Care, on certification by the Chief Medical Officer of Health that an immediate risk to human health exists, to procure, acquire, or seize medication and supplies that are essential for safeguarding human health when regular supply and procurement processes are insufficient to address the risk.
  • Authorizes the Chief Medical Officer of Health, where there is an immediate and serious risk to the health of persons, to make orders to health information custodians (defined in the Personal Health Information Protection Act) to provide information.
  • Authorizes the Chief Medical Officer of Health to issue directives concerning precautions and procedures to health care providers or health care entities.
  • Authorizes the Chief Medical Officer of Health to collect, retain, and use pre-existing laboratory specimens to investigate, eliminate, or reduce the risk to health.

Part VII: Administration

  • Provides for the Minister of Health and Long-Term Care to make investigations respecting the causes of disease or mortality.
  • Provides for the appointment of the Chief Medical Officer of Health.
  • Provides for the appointment of assessors.
  • Provides for the Minister of Health and Long-Term Care to issue direction to boards of health and powers to ensure that the direction is carried out.
  • Provides for the agency known as the Northern Ontario Public Health Service.
  • Provides for protection from personal liability for certain persons in certain circumstances.

Part VIII: Regulations

  • Provides for the Lieutenant Governor in Council and the Minister of Health and Long-Term Care to make regulations relating to the various parts of the HPPA.

Part IX: Enforcement

  • Sets out offences under the HPPA.

Part X: Transition

  • Sets out the parameters for transition from the old Public Health Act to the HPPA.

More specifically, authority for the establishment of boards of health is provided under Part VI, Section 49, of the HPPA. The HPPA specifies that there shall be a board of health for each health unit. A health unit is defined in the HPPA, in part, as the "…area of jurisdiction of the board of health" (s.1).

The HPPA also provides the mandate for the duties of boards of health. Boards of health have many statutory responsibilities, including the following:

  • Superintend, provide, or ensure the provision of health programs and services in specified areas (s.5);
  • Provide health programs and services as prescribed by regulations to the pupils attending schools within the health unit (s.6);
  • Superintend and ensure the carrying out of HPPA Parts II, III, and IV and the regulations relating to those parts in the health unit served by the board of health (s.61);
  • Appoint a full-time medical officer of health (s.62);
  • Hire staff as necessary to carry out the functions of the board (s.71); and
  • Give annually to each obligated municipality a written (budget) notice (s.72(5)).

Section 50 of the HPPA allows a board of health to enter into an agreement with the council of the band on a reserve within the health unit. Under such an agreement, the board of health would provide health programs and services to the members of the band, and the council of the band would accept the responsibilities of a municipal council within the health unit.

Under Section 62 of the HPPA, each board of health is required to appoint a full-time medical officer of health. Section 64 states that no person is eligible for appointment as a medical officer of health unless he or she is a physician and possesses the qualifications and requirements prescribed by the regulations for the position, and the Minister of Health and Long-Term Care approves the proposed appointment.

A medical officer of health:

  • Is responsible to the board for the management of the public health programs and services;
  • Directs staff of the board of health (who are responsible to the medical officer of health) if their duties relate to the delivery of public health programs or services;
  • Has authority that is limited to the health unit served by the board of health; and
  • Is entitled to attend each meeting of the board and its committees (except as relates to the performance and remuneration of the medical officer of health).

Under Section 71 of the HPPA, boards of health are also required to engage the services of qualified staff to carry out the functions of the board of health, including the duties of the board of health with respect to mandatory health programs and services.

In addition to the qualifications for the position of medical officer of health, R.R.O. 1990, Regulation 566 under the HPPA (Qualifications of Boards of Health Staff) outlines the educational and experiential qualifications for the following classifications of board of health staff:

  • Business administrator;
  • Public health dentist;
  • Dental hygienist;
  • Public health inspector;
  • Public health nurse; and
  • Public health nutritionist.

The HPPA and its associated regulations do not currently outline the required qualifications for other classifications of board of health staff, including but not limited to epidemiologists, health promoters, toxicologists, program evaluators, data analysts, librarians, communications specialists, etc.

As mandated by Section 72 of the HPPA, obligated municipalities shall pay the expenses of the board of health and the medical officer of health. Boards of health are required to provide a written notice on an annual basis to each obligated municipality to specify the amount required from the municipality to defray the expenses of the board, the medical officer of health, and the provision of public health programs and services.

The Minister of Health and Long-Term Care may make grants for the purposes of the HPPA on such conditions as he or she considers appropriate.

In 2008 the provincial/municipal cost-share relationship for public health programs and services is 75 per cent/25 per cent.

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Statutory Basis for the Ontario Public Health Standards

Section 5 of the HPPA specifies that boards of health must provide or ensure the provision of a minimum level of public health programs and services in specified areas as follows:

  • Community sanitation and the prevention or elimination of health hazards;
  • Provision of safe drinking water by small drinking-water systems;
  • Control of infectious and reportable disease, including providing immunization services to children and adults;
  • Health promotion, health protection, and disease and injury prevention;
  • Family health;
  • Collection and analysis of epidemiologic data;
  • Such additional health programs and services as prescribed by regulations; and
  • Home care services that are insured services under the Health Insurance Act including services to the acutely ill and the chronically ill.

Section 7 of the HPPA grants authority to the Minister of Health and Long-Term Care to "publish guidelines for the provision of mandatory health programs and services, and every board of health shall comply with the published guidelines" (R.S.O. 1990, c. H.7, s.7(1)), thereby establishing the legal authority for the Ontario Public Health Standards.

Where there is a reference to the HPPA within the Ontario Public Health Standards, the reference is deemed to include the HPPA and its regulations.

At the time of writing, all of the standards are administered by the Ministry of Health and Long-Term Care. The Ministry of Children and Youth Services is responsible for the administration of the Healthy Babies Healthy Children components of the Family Health standards.

Boards of health may deliver additional programs and services in response to local needs identified within their communities, as acknowledged in Section 9 of the HPPA.

Furthermore, boards of health should bear in mind that in keeping with the French Language Services Act, services in French should be made available to French-speaking Ontarians located in designated areas.

Boards of health need to be knowledgeable about their duties and responsibilities as specified in other applicable Ontario laws, including but not limited to, the Building Code Act, the Child Care and Early Years Act, the Employment Standards Act, the Immunization of School Pupils Act, the Occupational Health and Safety Act, the Personal Health Information Protection Act, and the Smoke-Free Ontario Act.

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Format

The Ontario Public Health Standards specify the requirements to be carried out by each board of health. The Ontario Public Health Standards document is organized as follows:

Foundations

  • Four Principles, which are Need, Impact, Capacity, and Partnership and Collaboration. The principles underpin the Foundational and Program Standards and are meant to be used by boards of health to guide the assessment, planning, delivery, management, and evaluation of public health programs and services.
  • One Foundational Standard, which consists of four specific areas:
    • Population Health Assessment;
    • Surveillance;
    • Research and Knowledge Exchange; and
    • Program Evaluation.

The Foundational Standard outlines specific requirements that underlie and support all Program Standards. Population health assessment and surveillance requirements are included in a general manner in the Foundational Standard and more specifically in each Program Standard.

Program Standards

  • Program Standards (grouped under five program areas), which address Chronic Diseases and Injuries, Family Health, Infectious Diseases, Environmental Health, and Emergency Preparedness. Specific requirements are articulated for each of the Program Standards. Boards of health shall assess, plan, deliver, manage, and evaluate programs and services in each of those Program Standards and coordinate across the Program Standards.

The relationship between the Principles, the Foundational Standard, and the Program Standards is depicted in Figure 1.

Figure 1: Ontario Public Health Standards: Relationship between the Principles, the Foundational Standard, and the Program Standards [PDF]

Both the Foundational Standard and the Program Standards articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices. Societal outcomes result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. The standards also outline the requirements that boards of health must implement to achieve the stated results. The intent of these concepts is outlined in Figure 2.

Figure 2: Components of each standard [PDF]


1 Refer to Format section for a definition.
2 The summary is not comprehensive; refer to the HPPA for a complete list of provisions.

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