Commission on the Reform of Ontario's Public Services

With the advent of LHINs, hospitals refocused on acute care and core services, but as an
unintended result, they began pulling back on public health functions such as diabetes
counselling.
Recommendation 5-82: Replicate British Columbia’s Act Now initiative, which has been
identified by the World Health Organization (WHO) as a best practice for health promotion
and chronic disease prevention, in Ontario.
There appears to be some correlation between health outcomes and the amount provinces
spend on public health. A 2009 study by Douglas Manuel and others revealed that British
Columbia, which spends almost three times as much per capita on public health as Ontario,
is the leading province in terms of overall population health and health behaviours (including
quitting smoking, engaging in regular physical activity, choosing a healthy diet and maintaining
a healthy body weight). 68 This apparent correlation between public health spending and health
outcomes needs to be further explored through research to determine the benefit-cost ratios.
Recommendation 5-83: Have doctors address diet and exercise issues before reaching for
the prescription pad when dealing with health issues such as cardiovascular disease and
late-onset Type 2 diabetes.
Patients need to heed their doctor’s advice and make lifestyle changes when requested.
For example, the cholesterol-lowering medication Lipitor has been the biggest selling drug for
over 10 years, in some years exceeding $1 billion in sales. As Lipitor is the most-often
prescribed drug in Canada for those over age 65, this means that the ODB program is
covering a substantial cost that could be potentially alleviated, at least in part, by lifestyle
changes in Ontarians.
Recommendation 5-84: Do more to promote population health and healthy lifestyles and to
reverse the trend of childhood obesity, especially through schools.
In addition, the government should explore regulatory options for the food industry. This would
require the integration of health promotion activities with municipalities and school boards,
among others. It will be important to take a whole of government approach to population health
and include population health in planning considerations.
68 D. Manuel et al., “What Does It Take to Make a Healthy Province?” Institute for Clinical Evaluative Sciences, 2009, p. vi.
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