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Milestones and History
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History of Public Health Units in Ontario

The pattern of local public health services administration for Ontario was established in 1833 when the Legislature of Upper Canada passed an Act allowing local municipalities "to establish Boards of Health to guard against the introduction of malignant, contagious and infectious disease in this province.” This delegation of public health responsibility to the local level established 150 years ago has persisted to the present day. There are currently 36 health units in Ontario: 22 independent of local municipal government; 7 regional health departments; and 7 health units tied in to single-tier or other municipal administration.

Important Public Health Milestones


The first Public Health Act was passed.


The first board of health was established.


A more comprehensive Public Health Act was prepared by Dr. Peter H. Bryce. This Act established the position of the Secretary of the Board of Health (now called the medical officer of health) and the relationship with the board of health. Within two years of passage, 400 boards of health were in operation.


The Public Health Act was amended so that health units could be established on a county basis.


The first county-wide health unit was established with a grant from the Rockefeller Foundation. It included the four eastern counties of Stormont, Dundas, Glengarry, and Prescott. At this time, Ontario had 800 local boards of health and 700 medical officers of health, most of whom were part-time.


The Public Health Act was amended so that provincial grants could be provided to municipalities for the establishment of health units. Six health units were in place by the end of 1945.


Twenty-five county and 12 municipal health units were in place which served two thirds of the population of Ontario.


Fifty-four boards of health were in place, which served 95 percent of the population.


The Public Health Act was amended so that organized municipalities were required to provide full-time public health services. The District health unit concept was introduced based on the collective experience of operating health units in Ontario. Economies of scale concepts were introduced which suggested optimum population sizes (100,000) for health unit catchment areas. The province encouraged health units to regroup on a multi-county basis to become more efficient.


The Health Protection and Promotion Act (HPPA) was proclaimed, replacing the Public Health Act. The Act was amended in 1990 making slight changes to its contents.


The HPPA was revised as part of Bill 152, the Services Improvement Act. Current edition of the Mandatory Health Programs and Services Guidelines published.


The former Metropolitan Toronto was amalgamated into a single City of Toronto. Six former public health departments in the boroughs of East York, Etobicoke, North York, Scarborough, York and the city of Toronto merged into a single entity, i.e. Toronto Public Health. This amalgamation reduced the total number of public health units in Ontario from 42 to 37.


The government of Ontario announces Operation Health Protection: an Action Plan to Prevent Threats to our Health and to Promote a Healthy Ontario.


The government of Ontario announces the creation of the new Ministry of Health Promotion, which will focus on programs dedicated to healthy lifestyles


Following recommendations by assessor Graham Scott, the Muskoka-Parry Sound Board of Health was dissolved and merged with two other health units (the then-Simcoe County District Health Unit and then-North Bay District Health Unit). This action reduced the overall number of public health units in Ontario from 37 to 36.


The Smoke-Free Ontario Act is introduced, which bans smoking in all enclosed public places


The government of Ontario introduces the Health System Improvements Bill (#171) that will include enabling legislation for an Ontario Agency for Health Protection and Promotion, Ontario’s "CDC of the North”.


The Ontario Agency for Health Protection and Promotion is established in Toronto.


The Ontario Government announces public funding for the Human papillomavirus (HPV) vaccine.


The Ontario Public Health Standards are completed in collaboration with boards of health and Ontario public health professionals. They came into effect on January 1, 2009.


The Initial Report on Public Health is released by the Ministry of Health and Long-Term Care as the first step in developing an accountability framework for boards of health.


The Ontario Agency for Health Protection and Promotion changes its operational name to Public Health Ontario.


The Ministry of Health and Long-Term Care releases its Ontario Public Health Organizational Standards for boards of health in February 2011. It also introduces Accountability Agreements between government and boards of health.


The Ontario Government announces publicly funding the Rotavirus vaccine.


The former Ontario Ministry of Health Promotion and Sport dissolves. Its health promotion programs and activities are transferred to the newly created Health Promotion Division within the Ministry of Health and Long-Term Care.