• What will the Ontario Agency for Health Protection and Promotion do?
• How will this agency benefit Ontarians?
• Why is the agency being created?
• Where will the agency be located?
• How will the board of directors be chosen?
• How can you call the agency arms-length if the CMOH attends board meetings?
• Will the agency be like the Centers for Disease Control and Prevention (CDC) in the U.S.?
• How will the agency work in an emergency or outbreak situation?
• Why do we need an Ontario agency in addition to the Public Health Agency of Canada?
• Were any agency models from other jurisdictions considered in creating the Ontario model? Is it a similar structure to any other jurisdiction's agencies?
• Does the government expect that the agency will prevent another SARS? If the agency was in place, would the situation have been handled differently?
• Why has the government waited to establish this organisation? Are we behind other jurisdictions in this regard?
• Will the agency play a role in determining pandemic triage?
• It has been four years since SARS. Why is the agency only being created now?
• Will the new agency hire new staff? If so, what kind of new jobs will there be?

The Ontario Agency for Health Protection and Promotion will provide scientific and technical support and advice to government, public health units and health care providers. The agency, at the direction of Ontario’s Chief Medical Officer of Health (CMOH), will also provide support in responding to health-related emergencies and outbreaks, such as SARS. The agency will provide technical and scientific assistance, rapid on-site field support (as needed), specialized communications and training, as well as standards input and practical tools from implementing best practices. As well, one of the approved core functions of the agency will be to provide laboratory services.

Ontario’s own ‘CDC of the North’ will provide research, scientific and technical support for those working to protect and support the health of Ontarians - our public health units, front-line health care workers and government.

The agency is being created to ensure that sound, scientific health knowledge and information about risks is being captured, coordinated and directed to where it is most needed. The agency will work with partners in health care, throughout the province and around the world, to aggressively detect threats and proactively identify improvements in everyday practices and emergency response. Beyond surveillance for emerging threats, the agency will disseminate clear and reliable advice based on the most up-to-date science to support heath practitioners and front-line health workers in adopting the best practices.

Several high profile reports such as the Walker SARS Expert Panel Report and Justice Campbell’s 1st and 2nd Interim SARS Reports all recommended the creation of a public health agency for Ontario. This agency will provide expertise and support for the public health system as well as strengthening Ontario’s response to health emergencies and localized outbreaks, giving timely scientific and technical advice to front-line health care workers. The agency will be an information hub of specialized expertise in areas such as infectious disease, infection prevention and control, health promotion, chronic diseases and injury prevention and environmental health. Ontario, through this agency is working to ensure that we have access to expert resources to protect the health of Ontarians.

Various options are being considered that will take into consideration the agency’s mandate to provide technical and scientific expertise and support in responding to health-related emergencies and outbreaks and the need to be closely linked and aligned with academic health science centres, universities and government.

The government will establish a screening panel of public health and governance experts to recommend a skills-based board of directors. The directors will be appointed through an order in council. A maximum of 13 members will sit on the board.

The CMOH can attend and participate in the agency’s board of directors meetings, but will not vote and is not a board member. The CMOH will sit on the Strategic Planning Committee of the board and will act through this committee as the liaison with the government in terms of helping to align the agency’s priorities with those of the provincial ministries through the Strategic Planning Committee. The chair of the board will be the official link between the board and the government and will report directly to the Minister of Health and Long-Term Care. It should also be noted that the CMOH reports directly to the legislature and files an annual report directly to it.

The agency will be arms-length from government while the CDC is part of the Department of Health and Human Services of the federal U.S. government. However, like the CDC, Ontario’s agency will provide research, scientific and technical support for those working to protect and support the health of Ontarians, our public health units and front-line health care workers.

The agency will specialize in the areas of infectious diseases, infection control and prevention, health promotion, chronic disease and injury prevention, and environmental health.

Working within the chain-of-command for emergency management, the agency will provide scientific advice and technical expertise to support and enhance emergency capability before, during and after an emergency by :

• Identifying trends, unusual occurrences, modeling of risk analysis and identification of potential health threats based on surveillance;
• Conducting research into the science of emergency management to augment best practices;
• Expanding provincial capacity in modeling related to outbreak response planning; and
• Providing field support capacity as required and when triggered by the CMOH in emergency or outbreak circumstances. The agency will work within established MOHLTC and province-wide emergency infrastructures.

Healthcare is a provincial area of responsibility and public health is shared between the province and municipalities. Responses to outbreaks will be executed at the local level or at the provincial level, where appropriate. The agency will be available to augment the local capacity and to provide best practise advice and expertise.

The Public Health Agency of Canada (PHAC) plays an important role in certain situations (liaison with international bodies, running of the Level 4 lab in Winnipeg); however it is prudent for Ontario to ensure the necessary organisational and operational capacity to manage and respond effectively within the province. The agency will work with partners in health care throughout the province, across Canada and around the world.

The need for an arms-length body that provides expert technical and scientific support to the health system and to government was identified in a number of reports (Naylor, Campbell, Walker and Haines). Other jurisdictions such as Quebec, British Columbia and the United Kingdom have similar bodies in place that are able to successfully bridge the gap between science and practice in areas of public health.

The agency will work closely and collaboratively with PHAC as well as public health agencies in other jurisdictions (e.g. BC and Quebec) to integrated activities, share resources and knowledge, co-ordinate learning and implement innovative scientific and technical advice.

It is recommended that the agency give scientific and technical advice to ministries and health care providers (public health units, hospitals, long-term care homes) who protect and promote the health of Ontarians.

Models from several jurisdictions were researched, including the UK (Health Protection Agency), USA (Centers for Disease Control and Prevention), Public Health Agency of Canada, British Columbia Centre for Disease Control (BCCDC) and Quebec's Institut national de santé publique du Québec (INSPQ). The model that the Ontario Agency for Health Protection and Promotion is most similar to is the Quebec INSPQ.

If the agency had been in place during SARS, it will have helped to identify expertise both provincially, nationally and internationally to give timely advice and tools to the government and front-line providers in dealing with the outbreak. As well, through its surveillance and epidemiological activities, the agency may be able to identify the outbreak more rapidly. As well, if the Ontario Public Health Laboratories are transferred to the agency, there will be the capacity to identify the molecular structure of emerging pathogens which is critical for early warning, treatment and infection control activities.

This is the first Ontario government to commit to modernizing the public health system in the province, which includes the establishment of a public health agency. Only two other provinces or territories in Canada (BC and Quebec) have established public health agencies. Ontario has the unique opportunity to develop expertise that will help to protect and promote the health of Ontarians, while providing an invaluable resource to the national and international public health communities.

Strategic policy will still be the responsibility of the MOHLTC. The agency will provide best practice advice, expertise and evidence-based research to help determine priorities in the case of outbreaks and emergencies. The agency could also provide front-line support to health care workers during a pandemic.

The agency is part of a much larger set of actions initiated by government to strengthen its capacity to control emergency diseases. The first priority was to address some of the major weaknesses at the local and systemic level identified by Dr. Walker, Justice Campbell and others. To that end, the government moved quickly to increase the number of infection control practitioners in Ontario hospitals, to create and hire 180 additional communicable disease positions in public health and to implement a single information system for communicable diseases across all health units in the province. These and many other measures to strengthen Ontario’s preparedness have taken place while the government worked with the Agency Implementation Task Force on detailed plans for the agency. On the basis of that solid work, the government is ready to move to the next level.

The agency will need staff to focus on specific areas of specialisation, including infectious diseases and infection prevention control, health promotion, chronic disease and injury prevention, and environmental health. Specifically, staff will need to carry out the functions of the agency including surveillance and epidemiology, research, knowledge exchange, professional development and communication.

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