HALDIMAND—For over 20 years, Haldimand County residents’ tax levies helped pay for the decisions made by the Haldimand Norfolk Board of Health, even though that body has been solely comprised of Norfolk County Council.
However, a December 2, 2024 announcement that the Ministry of Health and Long-Term Care has approved the voluntary merger of the Haldimand Norfolk Health Unit (HNHU) and the Brant County Health Unit (BCHU) means that will be changing.
In a press release from Haldimand County, Mayor Shelley Ann Bentley said she was pleased with the news.
“The opportunity to have a direct voice in shaping public health-related decisions is long overdue. I am hopeful that by bringing in diverse perspectives and strengthening partnerships across the region we’ll see more responsive, impactful public health services for our residents,” she said.
The new organization will be called Grand Erie Public Health (GEPH) and will serve the counties of Haldimand, Norfolk, and Brant, and the city of Brantford.
According to a news release issued by Haldimand Norfolk Health and Social Services (HNSS) – the umbrella organization HNHU operates under – “the full integration of the two health units into a single new entity is expected to take place gradually throughout 2025,” starting on January 1.
Additionally it noted, “The delivery of programs and services for the public, in both communities, will remain the same. Programs and services will remain available across all of Brantford-Brant and Haldimand-Norfolk regions at current operating locations.”
HNSS addresses things like housing programs, administration of Ontario Works, childcare fee subsidies, and other social services, with health units offering supports (including information, programs, etc.) to residents for a wide range of health-related items, including immunizations, cancer prevention, natal care, addictions, etc.
The merger is only in relation to the health unit.
“All social services, housing, homeless prevention, and children’s services would remain across Haldimand and Norfolk and under the one service manager (Norfolk County),” said Sarah Page, General Manager of HNSS, in an interview with The Press prior to the announcement that the Ministry had approved the merger.
To understand why the health units are being combined, it’s important to look at how we got here in the first place.
Haldimand and Norfolk counties were once the Regional Municipality of Haldimand-Norfolk. While the region was dissolved in 2001, the two newly minted counties continued to share some municipal items, including their social services. At the same time the regional government was being dissolved, “a whole bunch of provincial downloading happened,” said Page.
Since Norfolk had the larger population, it was designated by the province as the Consolidated Municipal Services Manager (CMSM), meaning it served as the funding source and has been responsible for the delivery of all mandated services. Also, Norfolk’s Council exclusively has comprised the Board of Health.
Page noted there were concerns over the years “that Haldimand doesn’t have a voice on the Board of Health”, but that they couldn’t “snap our fingers and change (it)” at the local level. Over the years, steps were taken to make it “as equitable as we can.”
One approach was with the formation of the Haldimand Norfolk Health and Social Services Advisory Committee, a body comprised of an even split of councillors from both counties, which looks at matters related to HNHU.
“I’m really conscientious about when we go to (the advisory committee); I listen to what they say, and I pass that on to the board,” Page said.
But ultimately, the advisory committee’s recommendations for the Board of Health are not binding.
Page and her associates would also make sure to go before Haldimand Council to present reports on key issues when they came up, to make sure all members were getting the information firsthand.
Despite these efforts, Page said “it’s got to be frustrating” for Haldimand residents. She added, “It’s a lack of control, and it is publicly funded.”
Many of HNHU’s programs have been primarily funded by the province, but municipal levies are also part of the equation.
Generally speaking, public health funding is to be split between the province and the municipality 75/25. However, things like the actual cost to implement a program or a decision at the municipal level to expand a program would shift that ratio.
“We have a huge geographic region, so when we’re running things like prenatal classes and things like that, we don’t just want to run them in Simcoe,” Page said, noting offering programs and services across the two counties increases accessibility, especially considering the limited public transit.
“Sometimes you have to take people’s healthcare to them,” Page said. “That’s always been one of our guiding principles.… Sometimes that costs more than the province has given us.”
Ultimately in Haldimand and Norfolk, the funding ratio for the health unit has been closer to 71% paid by the province, and the remaining 29% is covered by the two counties.
The municipal contributions have been split based on the counties’ respective number of households; about 59% in Norfolk, 41% in Haldimand.
According to the County’s news release about the merger, HNHU’s 2024 operating budget is $3.4 million, with Haldimand contributing $1.4 million.
“While Haldimand is grateful that the Board has considered its position on many issues over the years, the merger is an important step in allowing Haldimand to have a dedicated voice at the table with respect to a service of this financial magnitude, allowing Haldimand to better advocate for resident needs when it comes to making important public health-related decisions,” the news release stated.
This process has been in the works since 2023, when the province put out the option for voluntary health unit mergers, indicating that the Ministry would fully fund the costs associated with the approved mergers, Page said.
She said the ministry has also indicated that the point of this is not to cut funding or services, and “has pledged, if there is a merger, no front-line staff losses.”
Page noted the increasing importantance for Haldimand to get a voice on the Board of Health considering population growth in the last few years, especially when compared to Norfolk.
“We’re getting to the point where, I would assume in the next five years or so, we’ll be pretty close to equal populations,” she said, adding that Haldimand is growing at a faster rate than Norfolk.
More than just having Haldimand representatives on the Board of Health, Page said the hope is to move to an autonomous corporation.
“Most public health units are autonomous and outside of an actual municipal governance structure,” Page said, noting that for the past two decades, Norfolk’s elected officials – regardless of whether or not they had any relevant experience or knowledge of the healthcare system – have been asked to “make decisions for the broader population on health outcomes.”
Page noted that Boards of Health may be asked by health experts to make decisions that are in direct contrast to the wishes of residents – which happened in many communities around the world during the Covid-19 pandemic.
“There are certain issues that politically you might say no to, but as the Board of Health, you probably should be saying yes to,” she noted.
Page added that by having private citizens on the Board of Health, it might make things more accessible for residents wanting to give feedback; they might feel more comfortable approaching another individual from their community, rather than an elected official of a larger government body.
Getting feedback from the community is important for a health unit, but can be an ongoing challenge, Page added.
“(We) send out surveys, things like that (and) we might get 200 people to answer, which is 200 people’s opinion, but statistically, it’s not something that you could base decisions on.”