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Initial Report on Public Health
Report Contents


We are very pleased to provide you with the Ministry of Health and Long-Term Care's (MOHLTC) Initial Report on Public Health in Ontario.

The Public Health Division, in partnership with the Ministry of Health Promotion (MHP) and the Ministry of Children and Youth Services (MCYS), has made significant strides to renew public health in Ontario and build a public health sector with a greater focus on performance, accountability and sustainability. Some of our recent achievements towards this goal include delivering the new Ontario Public Health Standards, producing the Ontario Health Plan for an Influenza Pandemic, and now, releasing a public report that reflects the state of public health in Ontario. This report demonstrates our commitment to a public health sector that is accountable to the people of Ontario.

The indicators provided in this report are intended to contribute to our understanding of public health in Ontario as a system, at both the provincial and local levels. As we move towards implementing a performance management system in public health, we have an increased need for information that can be used to ensure the public's health is protected, to inform decisions on where improvements are required, to ensure that appropriate governance is in place and to help promote organizational excellence.

This initial report is intended to provide a snapshot of the current state of public health in Ontario. Over time, with the continued involvement of public health professionals in the sector, different indicators will need to be identified and developed. There is significant expertise related to performance management already available within our sector, and within the health care sector, and we will be relying on these resources to assist in developing the tools and processes required to operate a useful, efficient and effective performance management system at the provincial level.

The work of the Capacity Review Committee (2006) gave us an important conceptual framework for performance management. The work to implement this vision is now well underway, and this report is the first tangible product that begins to articulate that vision.

We hope you find the report informative and, most importantly, useful. We would like to take this opportunity to thank the members of the Performance Management Working Group who provided advice that shaped the development of this report. Their knowledge and wisdom have contributed substantially to the quality of this product.

Allison J. Stuart
Assistant Deputy Minister (A)
Public Health Division
Ministry of Health and Long-Term Care
Arlene S. King, MD, MHSc, FRCPC
Chief Medical Officer of Health (effective June 15, 2009)
David C. Williams, MD, MHSc, FRCPC
Chief Medical Officer of Health (A) (until June 15, 2009)
Associate Chief Medical Officer of Health,
Health Protection


Producing this report involved the commitment of a diverse group of individuals, each of whom contributed their time and advice to ensure that the final product was representative of public health in Ontario at both the local and provincial levels. The ministry acknowledges and thanks the many individuals who contributed to this report including:

  • The members of the Performance Management Working Group (PMWG) in 2007-2008 i who advised on the development of this report:
    • Dr. Kathleen Dooling, Community Medicine Resident, University of Toronto
    • Dr. Vera Etches, Medical Officer of Health (A), Sudbury & District Health Unit
    • Dr. Charles Gardner, Medical Officer of Health, Simcoe-Muskoka District Health Unit/ 2007-08 COMOH Chair
    • Ms. Dawne Kamino, Director, Controllership & Resources Management Branch, Ministry of Health and Long-Term Care
    • Dr. Jeff Kwong, Scientist, Institute for Clinical Evaluative Sciences
    • Dr. Robert Kyle, Commissioner & Medical Officer of Health, Durham Region Health Department
    • Dr. Jack Lee, Senior Strategic Advisor, Ministry of Health Promotion
    • Dr. Doug Manuel, Senior Scientist, Institute for Clinical Evaluative Sciences (co-chair December, 2007 - May, 2008)
    • Dr. Rosana Pellizzari, Associate Medical Officer of Health, Toronto Public Health (co-chair from May, 2008)
    • Ms. Katharine Robertson-Palmer, Coordinator, Education and Research, Ottawa Public Health
    • Ms. Julie Stratton, Manager, Epidemiology, Peel Regional Health Unit/APHEO
    • Ms. Brenda Tipper, Health System Strategy Division, Ministry of Health and Long-Term Care
    • Ms. Monika Turner, Director, Public Health Standards Branch, Ministry of Health and Long-Term Care (co-chair)
    • Dr. Erica Weir, Associate Medical Officer of Health, York Regional Health Unit
    • Ms. Jackie Wood, Manager, Corporate Services, Ministry of Health Promotion
  • Staff in public health units across the province, who contributed by completing the survey of boards of health on governance and management issues, providing case studies, and verifying the indicator methodology and data that appear in the report.
  • Members of the Association of Public Health Business Administrators who assisted in developing the survey tool that was used to gather governance, organizational practices and financial data.
  • The Institute for Clinical Evaluative Sciences (ICES) and Peel Public Health, which provided data analysis and advice.
  • Members of the Association of Public Health Epidemiologists in Ontario (APHEO) who provided technical advice on indicator methodology and development:
    • Ms. Deborah Carr
    • Ms. Sherri Deamond
    • Mr. Foyez Haque
    • Ms. Joanna Oliver
    • Ms. Suzanne Sinclair
  • Staff within the Ministry of Health Promotion and the Ministry of Children and Youth Services, who contributed to the indicator narratives and conducted data analysis.
  • Staff within the Ministry of Health and Long-Term Care, who advised on the development of this report throughout 2008-09 within the following branches: ii
    • Communications and Information Branch
    • Controllership and Resources Management Branch
    • Emergency Management Branch
    • Environmental Health Branch
    • Health Analytics Branch
    • Infectious Diseases Branch
    • Legal Services Branch
    • Strategic Alignment Branch
  • Staff of the Strategic Policy and Implementation Branch, ii who provided research and editorial support in the development of this report:
    • Ms. Allison McArthur
    • Ms. Beata Pach
  • Staff of the Public Health Standards Branch, ii who acted as secretariat to the PMWG and guided this document through the development process, including:
    • Mr. David Moore
    • Mr. Hassan Parvin
    • Ms. Paulina Salamo
    • Ms. Sylvia Shedden
    • Ms. Joanne Thanos
    • Ms. Lisa Vankay
    • Ms. Tricia Willis
Section I: Introduction

In A Dictionary of Public Health, John Last 1 defines public health as:

"an organized activity of society to promote, protect, improve, and when necessary, restore the health of individuals, specified groups, or the entire population. ... The term "public health" can describe a concept, a social institution, a set of scientific and professional disciplines and technologies, and a form of practice. ... It is a way of thinking, a set of disciplines, an institution of society, and a manner of practice".

On a daily basis, Ontario's public health sector contributes to keeping Ontarians healthy and safe through health protection, disease prevention and management, and health promotion activities. The essential day-to-day work of the public health sector often goes unnoticed as many potential health threats or conditions are contained or averted by routine prevention, health protection, health promotion, as well as surveillance and management activities carried out by public health organizations across Ontario.

Some of the great accomplishments of public health in the twentieth century include the virtual elimination of polio in Canada, the pasteurization of milk, the disinfection and fluoridation of drinking water, and the identification and prevention of tobacco-related illness. These examples demonstrate the contribution that public health has made to protect the health of the population.

A strong public health sector is vital to a healthy and safe Ontario population and yet we tend not to think about it except in times of crisis. The anonymity of the public health sector disappeared quickly with the gastroenteritis outbreaks in Walkerton in 2000 and the Severe Acute Respiratory Syndrome (SARS) crisis in 2003. These two events revealed serious weaknesses in the province's public health sector at the time.

Key reports that resulted from the Walkerton incident (the O'Connor Reports 2, 3) and SARS (the Walker, 4, 5 Naylor, 6 and Campbell 7, 8, 9 reports) provided a range of recommendations for renewal of public health in Canada and specifically in Ontario. In response, the government of Ontario announced Operation Health Protection 10 in 2004. The Operation Health Protection (OHP) action plan focused on revitalizing the public health sector, preventing future health threats, and promoting a healthy Ontario. The plan also included a commitment to produce an annual Ontario public health performance report.

Ontario has made significant progress delivering on the commitments made in the OHP. Ontario's continued commitment to build a strong, flexible, and responsive public health sector has been demonstrated through initiatives such as:

  • amending the Health Protection and Promotion Act (HPPA) 11 to modernize the legislation
  • creating the Ontario Agency for Health Protection and Promotion
  • increasing provincial funding to public health units
  • developing new standards for public health, which strengthen public health sector accountability

Another outcome of OHP was the establishment of the Capacity Review Committee (CRC). The committee was tasked with making recommendations to government on long-term strategies to revitalize public health in Ontario. The committee delivered its final report in 2006, which included a recommendation to adopt a comprehensive public health performance management system. 12 Public reporting was seen as an important tool within this system to demonstrate accountability and measure performance.

Ontario has responded to the need to improve performance management in public health by initiating work on the development of a public health performance management system. This system is intended to enable the public health sector to demonstrate its achievements in terms of improvements in both outcomes and services over time.

The introduction of the new performance management system is intended to move Ontario away from focusing primarily on compliance with processes, towards an emphasis on tracking outcomes. As the performance management system continues to be developed, improved measures of outcomes will follow.

This initial report provides a snapshot of Ontario's public health sector. It provides an overview of the scope of public health and profiles the local operational context of public health program and service delivery. It is a first step in understanding the current work of public health and will inform the discussion as Ontario moves towards a performance management system for public health.

This report also serves an important purpose in raising awareness of the vital role public health plays in protecting the health of Ontarians and in contributing to the provincial health system as a whole.

Towards Performance Management

Ontario's efforts to introduce a performance management framework for public health are being informed by the Performance Management Working Group (PMWG).

Formed in 2007, PMWG members come from diverse backgrounds and include members of the Council of Ontario Medical Officers of Health (COMOH), the Association of Public Health Epidemiologists in Ontario (APHEO), Public Health Research, Education and Development (PHRED) Program, the Association of Local Public Health Agencies (alPHa), and local public health units.

The group also includes representatives from the Ministry of Health and Long-Term Care, the Ministry of Health Promotion and the Ministry of Children and Youth Services - the three ministries that share responsibility for providing funding and policy direction to public health units. The group's advice has informed the development of this report as well as continuing to address the larger performance management framework for public health.

Section II: Overview of the Public Health Sector
Scope of Public Health

The World Health Organization (WHO) defines public health as "a social and political concept aimed at improving health, prolonging life and improving the quality of life among whole populations through health promotion, disease prevention and other forms of health intervention." 13 The WHO notes a distinction between the traditional model of public health and an emerging concept of public health, which emphasizes:

  • a significantly different understanding of how lifestyles and living conditions (social, economic and physical environments) determine health status
  • the need to mobilize resources and make sound investments in policies, programs and services which create, maintain and protect health

The public health sector has contributed to improving the health of Ontarians through initiatives such as childhood immunizations, the control of infectious diseases, supporting parenting/early childhood development, addressing oral health, ensuring safe water, education and inspections related to safe food handling, the promotion of healthy sexuality, reproductive and child health, the prevention of injury, and the prevention of chronic diseases through initiatives such as tobacco control and promotion of healthy eating.

Public health also contributes to the health of Ontarians by complementing the work of other parts of the health care system. Through its work in addressing the determinants of health and reducing health risks to the population, public health contributes to reducing the need for other health care services and limiting the consequences of poor health including:

  • the need for acute medical care
  • long-term consequences of illness and injury, including the severity and incidence of diseases and disability
  • reduced income or loss of employment
  • premature mortality

The public health system consists of governmental, non-governmental, and community organizations operating at the local, provincial, and federal levels. However, the prime responsibility for program delivery in Ontario lies with local boards of health, which comprise the public health sector. Provincial and federal level organizations play an important role in setting policy, providing funding, issuing directives about specific programs, services and situations, as well as coordination across jurisdictions.

There are exceptions to this indirect support of the provincial and federal governments, such as the work of the Canadian Food Inspection Agency, which has the authority to take direct action at the community level when necessary to protect the food supply. In addition, First Nations Band Councils and the federal government have the responsibility for much of the delivery of public health programs on reserves. In Ontario, the role of the provincial government is to:

  • establish overall strategic direction and provincial priorities for public health
  • develop legislation, regulations, standards, policies, and directives to support those strategic directions
  • monitor and report on the performance of the public health sector and the health of Ontarians with regard to public health issues
  • establish funding models and levels of funding for public health service delivery
  • ensure that ministry, public health sector and health care system strategic directions and expectations are met

Ontarians are served by 36 local boards of health that collectively cover the entire province and are individually responsible for serving the population within their geographic borders. Approximately two-thirds of Ontario's boards of health are autonomous bodies created to provide public health services in their jurisdictions. For the remainder, municipal or regional councils act as the board of health.

All boards of health in Ontario and their staff:

  • have the same statutory responsibilities under the HPPA for delivering public health programs and services within their communities
  • must comply with over fifty acts and regulations
  • must deliver the same core set of services according to the Ontario Public Health Standards 14 (OPHS); local service delivery models vary based on community need, geography and other local factors
  • deliver other optional programming, with funding from a variety of sources, to address local community needs and priorities

Within this document, the term "board of health" has the meaning assigned to it in Section 1 of the HPPA, and refers to either the legal entities that provide public health programs and services within a specific geographic region or to the governing body of the organization, depending on the context. The term "public health unit" is used to refer to the staff complement of the organization who deliver the programs and services, which is usually headed by a medical officer of health or by a shared leadership model of a medical officer of health and a chief executive officer.

Legislative Framework for Public Health

Ontario's HPPA provides the legislative mandate for boards of health. 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." 11

Part II, Section 5 of the HPPA specifies that boards of health must provide or ensure the provision of specific public health programs and services. The OPHS are published by the Minister of Health and Long-Term Care under his/her authority in Section 7 of the HPPA and specify the minimum mandatory programs and services with which all boards of health must comply.

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 living 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
  • language

Public health works to address the determinants of health as the underlying causes of health inequities. This approach is reinforced in the OPHS, which require the following types of activities by public health units:

  • identification of priority populations
  • adapting programs and service delivery to meet locally identified priority needs
  • assessment and sharing information of health inequities
  • raising awareness with community decision makers and partners

These actions will foster more comprehensive solutions that will help improve the immediate and long-term health of Ontarians. The OPHS incorporate and address the determinants of health, and identify a broad range of population-based activities designed to promote health and reduce health inequities by working with community partners.

Public Health Programs and Services in Ontario

In addition to delivering programs and services to meet local contexts and situations, the scope of public health programs and services, as articulated in the OPHS, encompasses:

Chronic Diseases and Injuries: Chronic Disease Prevention
Prevention of Injury and Substance Misuse
Family Health: Reproductive Health
Child Health
Infectious Diseases: Infectious Diseases Prevention and Control
Rabies Prevention and Control
Tuberculosis Prevention and Control
Sexual Health, Sexually Transmitted Infections,
        and Blood-borne infections (including HIV)
Vaccine Preventable Diseases
Environmental Health: Food Safety
Safe Water
Health Hazard Prevention and Management
Emergency Preparedness: Public Health Emergency Preparedness
Section III: Performance of the Public Health Sector
Report Development

The process of developing this report began with careful consideration of how public reporting contributes to performance management. Meeting the longer term objective of publishing provincial performance reports reflective of the public health mandate will require time and resources to develop new measures of program outcomes and to address data collection issues.

While this report is not intended as a performance report, it does provide a status update on a range of indicators related to public health practice. Over time, as new data sources and indicators are developed, these basic indicators may be replaced by more appropriate measures. The development of this report was informed by the decision to avoid trying to directly link the indicators to the standards in the OPHS, which were released during the report's development. This decision was made because it was seen as inappropriate to begin to publicly report on local public health performance until public health units have had time to adapt to the new standards and begin measuring their impact at the outcome level. These outcome level measures will need to be identified and developed as this public health performance management work continues.

In presenting the scope of public health in Ontario at both the provincial and local levels, an important consideration was to use reliable data that could be presented at the health unit level. The selection of indicators, therefore, was contingent upon the availability of reliable and comprehensive data. During the indicator selection process a wide range of indicators, other than those presented, were considered for inclusion but were not selected for a variety of reasons, including unavailability of consistent and reliable data.

To guide the selection of indicators for the report, several different frameworks, or approaches to performance management indicator reporting were evaluated by the PMWG, including:

  • balanced scorecard approach
  • strategy mapping approach
  • attributes of a high performing system

Through discussion and research on the use of these frameworks in other sectors and other jurisdictions, it was determined that each of these approaches has merits and limitations when applied to the public health sector in Ontario.

Balanced Scorecard Approach
The Balanced Scorecard, as developed by ICES for public health, identifies four quadrants: 1) Health Determinants and Status, 2) Community Engagement, 3) Resources and Services, 4) Integration and Responsiveness for the reporting of information on a system or organization. 16

Several public health units have used the Balanced Scorecard approach for local public reporting in the recent past. However, the lack of consistent and available data for all health units for two of the four quadrants (Community Engagement, and Integration and Responsiveness) would compromise the usefulness of this tool for provincial reporting at this time.

Strategy Mapping Approach
A strategy mapping approach was explored as a framework to guide measurement of performance in public health. This approach was helpful in understanding the strategic components of public health, but was found to be too high level for use as a framework for this report.
Attributes of a High Performing System
Determining the "attributes of a high performing system" that could be used in relation to the public health sector was approached by first researching the performance dimensions used in other jurisdictions and in other health care sector reports. Through discussion with the PMWG, the following five key dimensions were identified as appropriate for capturing the key aspects of Ontario's public health sector.
  1. Effectiveness
  2. Capacity
  3. Equitable
  4. Community Partnership
  5. Effectively Governed and Managed

Each of these approaches provides an organized way of presenting performance information. The PMWG determined that any one of these performance reporting approaches could be used as part of the process for selecting potential indicators. In fact, an exercise was completed which showed that the indicators that were available for use at this time could be mapped into all of the above frameworks. This shows that the different frameworks have significant conceptual overlap, and any one of them could be used to assess public health performance.

As the report development process continued, it was determined that focussing on performance reporting at this time was inappropriate, due mainly to the lack of performance related indicators and consistent data to support them, and because of the early stage of development of the new approach to performance management within the public health sector.

While the work of developing the report and the selection of indicators was informed by the earlier work on performance reporting frameworks, a decision was made to not use any specific reporting framework for this report.

Development of Indicators

Indicators used in existing reports on public health and population health were considered as part of the context for informing Ontario's public health reporting. These existing reports included:

  • Q Monitor: 2008 Report on Ontario's Health System (Ontario Health Quality Council) 17
  • Ontario Health System Scorecard 2007/08 (Ministry of Health and Long-Term Care) 18
  • Healthy Canadians: A Federal Report on Comparable Health Indicators 2006 (Health Canada) 19
  • Report on the State of Public Health in Canada 2008 (Public Health Agency of Canada) 20
  • Developing a Balanced Scorecard for Public Health (Institute for Clinical Evaluative Sciences) 16
  • Towards Outcome Measurement (Public Health Research Education and Development Program) 21

Many public health units have also produced and will continue to produce, local health status reports or performance reports, which may contain similar or related indicators with more analysis and interpretation on the impact of these measures within their communities.

The indicators presented in this report are intended to complement and enhance our understanding of the scope and impact of public health across Ontario, whereas many other health reports focus on information about the impact of the health care system or the health of the general population.

A modified Delphi process was employed to select indicators for this report, using a number of rationales, including:

  • strategic priority for public health
  • provides sector-level information
  • provides local-level information
  • the ability of public health to influence outcomes in this area
  • whether the indicator relates to multiple program areas

Selection criteria that were used to determine the final set of indicators required that each indicator be:

  • relevant, feasible, and scientifically sound
  • supported by currently available data that could be reported at the health unit level
  • part of a set which reflects the scope of public health practice
  • meaningful in describing the scope of public health at both the provincial and local levels

This report will allow local public health officials and other stakeholders to consider how a board of health is currently providing programs and services alongside of its peers. But this is only a starting point which also requires an understanding of local context and conditions, which must be taken into account. It is expected that public reporting will evolve as performance management in public health develops, consistent with the OPHS and Protocols, and that this will drive the development of better indicators and new data sources.

Section V: Moving Towards Performance Reporting


Developing a Performance Management Culture

As a first product of the new approach to performance management in public health, it is hoped that this report will serve as a catalyst for a cultural shift within the sector. Such a shift involves moving away from an exclusive focus on measuring compliance and reporting on processes, and moving towards measuring outcomes and looking for ways to improve practices.

This shift in focus does not diminish the importance of tracking processes or delivering on program requirements. Performance management is far more than simply meeting minimum standards. Under the new performance management system, organizations within the public health system will need to work together to:

  • identify current achievement levels
  • explore ways to achieve more with the same resources
  • use a continuous quality improvement approach to support change

As the performance management system matures, it is assumed that provincial level public reporting on all requirements and outcomes would be inappropriate and unmanageable. However, boards of health are responsible for ensuring that they are fulfilling and managing all requirements as a necessary part of their responsibilities for effective governance and management.

Moving forward, it will be necessary to balance provincial reporting on key high-level outcomes of primary importance to protecting and improving the public's health and the need to have enough information available to identify sectoral pressure points in order to be able to intervene when it is in the public's interest to do so.

Future Indicators

Through the process of developing this initial report it became clear that the kinds of indicators that directly measure performance of public health programs and services are not currently available. While Ontario's work in this area is building on the work of other jurisdictions, a review of the literature shows that it takes time; there are no ready made answers or systems that can be adopted quickly or without customization.

Developing these future indicators will be an iterative process as information needs are clarified and defined over time. The consensus-building phase of indicator selection and the more technical phases of indicator definition and development will require a significant investment of time and effort to properly consider the issues, the implications, and possible alternatives. It will also require engagement with public health professionals to develop a consensus that the right things are being measured, in the right ways, for the right purpose.

Once appropriate measures are identified as priorities for development, it will also be necessary to develop or modify data collection mechanisms and procedures for ensuring consistency in data collection.

Over time, it is anticipated that the indicators included in this report may be amended, or replaced in order to include a focus on sector-level risk assessment measures. Currently, measures that assess the strengths and weaknesses of public health have not been agreed upon, have not been clearly developed and defined and therefore are not likely to be supported by existing data sources.

Requirements for a Performance Management System

Developing an effective public health performance management system will require substantial infrastructure which will take time to design and implement. It is anticipated that much of this change will happen within the context of existing local and provincial resources.

The infrastructure required to support a performance management approach features:

  • valid and reliable indicators
  • accurate and reliable baseline data for each indicator
  • a robust data-collection system
  • policy on the use of targets
  • knowledge about how program activities change outcomes
  • consideration of local conditions, constraints, and program/organizational capacity to change outcomes
  • organizational capacity to manage data, interpret results, and undertake actions to support operational changes

Some of the tasks required to support implementation of this vision include:

  • reaching consensus on which indicators to develop that will report on program outcomes and allow the assessment of risks to the public
  • designing and validating the identified indicators
  • developing and implementing corresponding data-collection tools
  • developing and implementing new accountability mechanisms that clarify roles, responsibilities, and reporting requirements
  • developing and implementing supports and incentives for improving practices

The ministry, with its sister ministries (MHP and MCYS) and the advice of the Performance Management Working Group, is currently planning how best to accomplish these important tasks.

Implementation Challenges

Experience with performance management in other systems and jurisdictions has highlighted certain common implementation challenges. In Ontario, these challenges include the following:

  • The individuals and organizations within the sector already have an existing set of relationships, areas of expertise, and ownership for data systems, processes, and tools, all of which are likely to be impacted by the implementation process.
  • Success ultimately requires changes in attitudes and behaviours. This will require the use of change-management strategies at all levels of the sector.
  • Current participants have different levels of experience and expertise in understanding and using performance management approaches. Some public health units are farther ahead than the ministry; others are newer to the ideas and process changes required for performance management. To fully engage staff at all levels, implementation will have to be concrete and practical. If the individuals within the sector do not share an understanding of accountability or performance management, the system will face strategy dilution which will undermine the implementation's effectiveness.
  • This new approach to performance management is occurring at the same time as the Ontario Agency for Health Protection and Promotion is becoming active and all parties are in the process of establishing new relationships and determining appropriate linkages and roles.
  • The significance of the issues faced in developing the day-to-day processes for working with data and ensuring data quality and integrity cannot be underestimated. The importance of using data to drive program delivery is emphasized in the Foundational Standard of the OPHS, and public health units are already working on ways to integrate these requirements into their processes.
Implementation Opportunities

Along with the challenges, there are opportunities to be leveraged, including:

  • The substantial capacity and performance management expertise already at work within the Ontario public health sector. This can be marshalled to support the implementation of performance management at the sector level.
  • The fact that many public health units and other stakeholders already are implementing compatible performance management practices at the local level. This presents the opportunity to learn from each other and benefit from our collective experience.
  • As the Ontario Agency for Health Protection and Promotion becomes more operational, new capacity in such areas as assessing evidence, exchanging knowledge, collecting and analyzing data, and carrying out professional development activities will become available just as that additional capacity is needed.
  • Performance management is about working smarter, not harder. The principles of performance management support working smarter by collecting data once for multiple uses and restricting collection to only the data that will be used to inform decisions. These principles will need to inform our work in order for everyone in the sector to see the benefits.

The ministry, in collaboration with MHP and MCYS, is pleased to be offering this report on public health in Ontario as an initial step towards implementing a new approach to performance management.

In the process of developing this report, with the advice of the Performance Management Working Group and others, experience has been gained as to the iterative decision making processes that are a vital and necessary part of developing this new performance management approach. Moving from a compliance framework to a performance management framework does not necessarily require new resources; what is most fundamental is a shift in thinking and in organizational culture to support continuous quality improvement.

The intended outcome of the performance management framework is to emphasize improvements through informed decision making, appropriate accountability, and sustainability of the Ontario public health system. Reaching this outcome will require that the ministries involved in public health continue to engage with organizations in Ontario's public health sector as well as those in the broader health care sector. Partnerships and collaborative efforts are a vital aspect of supporting a strong, flexible, and responsive public health system that is able to demonstrate improvements and achievements over time.

i It should be noted that some members changed positions during the course of the production of the report. However this list accurately reflects the PMWG membership and roles during the period of the report's development.
ii Note that the Public Health Division underwent a restructuring that coincided with the publication of this report. The branch names shown here reflect the branches as they were known during the period of the report's development.
1 Last JM, editor. A dictionary of public health. New York: Oxford University Press; 2006.
2 O'Connor DR. Part one: report of the Walkerton Inquiry: the events of May 2000 and related issues. Toronto, ON: Queen's Printer for Ontario; 2002. Retrieved April 23, 2009 from: http://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton/part1/.
3 O'Connor DR. Part two: report of the Walkerton Inquiry: a strategy for safe drinking water. Toronto, ON: Queen's Printer for Ontario; 2003. Retrieved April 23, 2009 from: http://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton/part2/.
4 Expert Panel on SARS and Infectious Disease Control, Walker D. For the public's health: a plan of action. Final report of the Ontario Expert Panel on SARS and Infectious Disease Control. Toronto, ON: Queen's Printer for Ontario; 2004. Retrieved April 23, 2009 from: http://www.health.gov.on.ca/english/public/pub/ministry_reports/walker04/
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6 National Advisory Committee on SARS and Public Health, Naylor D. Learning from SARS: the renewal of public health in Canada. Ottawa, ON: Health Canada; 2003. Retrieved April 23, 2009 from: http://www.phac-aspc.gc.ca/publicat/sars-sras/pdf/sars-e.pdf.
7 SARS Commission, Campbell A. Spring of fear: final report. Toronto, ON: Queen's Printer for Ontario; 2006. Retrieved April 23, 2009 from: http://www.health.gov.on.ca/english/public/pub/ministry_reports/campbell06/online_rep/
8 SARS Commission, Campbell A. The SARS Commission second interim report: SARS and public health legislation. Toronto, ON: Queen's Printer for Ontario; 2005. Retrieved April 23, 2009 from: http://www.health.gov.on.ca/english/public/pub/ministry_reports/campbell05/
9 SARS Commission, Campbell A. The SARS Commission interim report: SARS and public health in Ontario. Toronto, ON: Queen's Printer for Ontario; 2004. Retrieved April 23, 2009 from: http://www.health.gov.on.ca/english/public/pub/ministry_reports/campbell04/
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11 Health Protection and Promotion Act, R.S.O. 1990, c. H7. Retrieved April 14, 2009 from: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e.htm.
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20 The Chief Public Health Officer's report on the state of public health in Canada 2008: addressing health inequalities. Ottawa, ON: Her Majesty the Queen in Right of Canada; 2008. Retrieved April 14, 2009 from: http://www.phac-aspc.gc.ca/publicat/2008/
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