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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. 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.


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


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, replacing the Mandatory Health Programs and Services Guidelines.


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


 The Patients First Act includes a clause that formalizes engagement between the local Medical Officer of Health and LHIN CEOs on issues related to local health system planning, funding and service delivery.

2018  The Elgin-St.Thomas and Oxford County Public Health Units formally merge on May 1 as the Oxford - Elgin - St. Thomas Public Health Unit, which is branded as Southwestern Public Health.




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