2 Carlton Street, Suite 1306 Toronto ON M5B 1J3 alPHa Tel: (416) 595-0006 Association of Local Fax: (416) 595-0030 PUBLIC HEALTH E-mail: [email protected] Agencies Providing leadership in public health management July 21, 2010 Hon. Laurel Broten Minister, Children and Youth Services 14th Floor 56 Wellesley Street West Toronto, Ontario M5S 2S3 Dear Minister Broten: Re. Healthy Babies Healthy Children Program On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations of the Association of Local Public Health Agencies (alPHa) I am writing to provide you with background information regarding the Healthy Babies Healthy Children (HBHC) Program. I hope that this material will be useful to you in preparation for our meeting on July 28. The Ontario Public Health Standards make it very clear that children’s growth and development are critically important factors in health throughout the lifespan, which are in part dependent on reaching accepted milestones in their ability to learn, understand and communicate. This standard reflects the incontrovertible evidence that demonstrates the magnitude of early child development in setting the foundation for lifelong learning, behaviour and health. The Healthy Babies Healthy Children program was conceived as a means to ensure that every child (pre- natal to age six) born in Ontario that may be at vulnerable to physical, cognitive, communicative and psychosocial risk factors to healthy development could be identified, assessed and connected to the interventions that are designed to prevent associated adverse developmental outcomes. It was also designed as a means to draw existing service providers – such as child care resource centres, peer support groups, mother and infant programs, women’s shelters, counseling services, Aboriginal programs and many others – into integrated local networks that would more effectively link at-risk families to the services that meet their particular needs. This collaborative and flexible approach to promoting optimal early development in vulnerable children was met with unreserved enthusiasm within the public health community, whose stock-in-trade is early intervention to prevent adverse outcomes. The potential of the HBHC program appeared to be well recognized in its earliest years, as significant funding increases were granted by the Province between 1998 and 2002. Since that time however, overall funding of this program has stagnated, with the total amount currently provided not significantly higher than it was eight years ago. As costs have steadily increased over this period, our members have watched the slow erosion of a program that never achieved the universality that was originally intended. Ministry funding for this program has never met the actual costs of meeting the mandated standards of the program, nor have modest and sporadic increases kept pace with predictable annual cost increases. This has been an ongoing and significant concern, which has been expressed frequently to the Provincial government without a satisfactory response or resolution. Health units have managed in the meantime to continue to deliver this crucial program to the best of their abilities through local subsidies, reduction of ….. /2 Hon. Laurel Broten Page 2 of 2 July 21, 2010 services, targeting only the highest risk families, and gapping of full-time equivalents. These strategies are no longer sufficient, and some of our members are now faced with laying off experienced public health staff, thereby cutting off the stable and ongoing relationships upon which at-risk families and their children depend. We acknowledge that this is a very difficult time for the Ontario government as it seeks to tackle a formidable deficit and restore Ontario’s once enviable economy. We strongly believe that it is because of this reality and not despite it that adequate funding of programs like HBHC is essential. Investing in children is in fact a cornerstone of your Government’s Open Ontario plan to return to prosperity. Much is made of the implementation of full-day learning for 4- and 5-year olds as well as the commitment to step into the funding void left by the federal government to ensure the preservation of child care spaces. Investments in early childhood education, child care and the Ontario Child Benefit are also cited in the Plan as the “foundations of the Poverty Reduction Strategy” and “effective tools for breaking the cycle of intergenerational poverty”. These are clear demonstrations that your Government understands the long-term value of investing in children, with additional support for those living in poverty. We hope that this understanding will lead to renewed efforts to ensure that public health units can meet the standards set out in the HBHC program and that it can finally achieve its intended goals. The success of this program is predicated on the capacity to carry out a screening of all families with newborns in order to ensure that all vulnerable children can be identified and benefit from available services as early as possible. We recognize that you have been Minister of Children and Youth Services only for a short time, and would like to take this opportunity to share a selection of letters, resolutions and reports on the subject that have been submitted to the Province during the last nine years, which together paint a clear picture of the strain that the underfunded HBHC program is putting on the local public health agencies whose mandate it is to carry it out. We ask that you carefully review these materials, and understand that the chief complaint is not that a lack of resources is preventing public health units from fully delivering the program, but rather that the inability to deliver the program is having measurable and deleterious effects on tens of thousands of Ontario children. Our meeting on July 28th will give us the opportunity to discuss the next steps required to ensure that the Healthy Babies Healthy Children program receives the support that is necessary from the Province to meet its own standards and to achieve the goal of giving all of Ontario’s children the best possible start in life. Sincerely, Valerie Sterling, President Copy: Hon. Leona Dombrowsky, Minister of Education Hon. Margarett Best, Minister of Health Promotion Hon. Deb Matthews, Minister of Health and Long-Term Care Dr. Arlene King, Chief Medical Officer of Health (Ontario) Allison Stuart, Assistant Deputy Minister, Public Health Enclosures 2001 alPHa RESOLUTION NO. A01-5 TITLE: Healthy Babies, Healthy Children Program Funding SPONSOR: Association of Ontario Public Health Business Administrators WHEREAS the Province of Ontario announced in 1997 the introduction of the Healthy Babies, Healthy Children Program; and WHEREAS the Healthy Babies, Healthy Children Program is included within the Mandatory Health Programs and Services Guidelines, Family Health; and WHEREAS the Healthy Babies, Healthy Children Program addresses a vital need for early childhood development and supports future health, as described in the Mustard/McCain Early Years report; and WHEREAS the Province committed in 1997 to funding the Healthy Babies, Healthy Children Program at 100%; and WHEREAS the current funding levels for Health Units are insufficient to meet the Mandatory Programs and Services Guidelines; NOW THEREFORE BE IT RESOLVED that the Province be called upon to fully fund all Healthy Babies, Healthy Children Program direct costs, current and future, and to fully fund the indirect costs related to the operation and administration of this Mandatory Program in a manner consistent with funding formulas for other Mandatory Programs; AND FURTHER that Boards of Health not be called upon to subsidize this program. Status of Resolution: Endorsed by the alPHa membership June 12, 2001 !iF Region cf Peel REPORT WM~lllil qoll. General Committee 1M DATE: January 12, 2004 SUBJECT: HEALTHY BABIES HEALTHY CHILDREN PROGRAM FUNDING SHORTFALL FROM: Peter H. Graham, Commissioner of Health Dr. David McKeown, Medical Officer of Health RECOMMENDATION That the Regional Chair meet with the Minister of Health and Long-Term Care and the Minister of Children’s Services to request full funding to deliver the Healthy Babies Healthy Children Program in Peel at the required level of service; And further, that a copy of the report of the Commissioner of Health and the Medical Officer of Health titled, “Healthy Babies Healthy Children Program Funding Shortfall”, dated January 12, 2004 be forwarded to the Minister of Health and Long-Term Care, the Minister of Children’s Services and to local Members of Provincial Parliament. REPORT HIGHLIGHTS • Healthy Babies Healthy Children is a Province wide program, funded 100% by the Ministry of Health and Long-Term Care • Provincial allocations for Peel have not been adequate since the year 2000 • Severe under-funding has required major service modifications and reductions • Peel residents are not receiving the service to which they are entitled • 2004 projected shortfall estimated to be one million dollars • Recommend Regional Council advocate for full Provincial funding DISCUSSION 1. Background The Healthy Babies Healthy Children program (HBHC), is a Province wide, Provincially funded prevention/early intervention program designed to give children a better start in life. It was developed to ensure all Ontario families with children up to age six, have access to comprehensive universal screening, assessment, intervention and linkage to community resources needed to ensure optimal childhood development. The program was introduced in 1998. Although the program is considered 100% funded by the Province, Regional Council is reminded that the Region of Peel is responsible for funding indirect costs such as rent, human resources, etc. and in 2004 it is estimated that those costs will be $495,000. In 2000, Peel’s program was fully implemented and had approval and full funding for 87 Full Time Equivalents (FTE) of staff. Since then, the Province introduced a number of new components and although some financial increase was provided to implement them, base program funding has not kept pace with annual salary and benefit increases.