Municipal Implications

Municipal governments and District Social Service Administrative Boards play important roles in the health care system: co-funding it, delivering services, and employing professionals of vital services such as public health, land ambulance, and long-term care homes. These services have been, and continue to be, on the frontlines of Ontario’s COVID-19 pandemic response. AMO is committed to highlighting the important role municipal services play in the health care system, population health, and the social determinants of health, and to advocating for greater municipal involvement in health planning.

In an analysis of municipal Financial Information Returns, AMO found that in 2018 (the latest year in which all municipalities have submitted data) 90% of municipal operating expenditures contribute in some way to the social determinants of health. In 2018, this represented $42.5 billion in operating funds that directly or indirectly contributed to the social determinants of health. Some municipal services like housing provision are direct contributors, while other services like firefighting are indirect contributors. Whether direct or indirect, these contributions significantly impact population health in Ontario.

Municipal governments also fund direct health services. Currently, capital funding for new hospitals is shared between the Province and municipal governments at 90% and 10% respectively. Municipal governments often contribute beyond the required 10% to cover additional costs. This is a major challenge for municipal governments, particularly rural, small urban, and northern municipalities. In these less affluent jurisdictions, municipal governments struggle to raise sufficient funds to provide their communities with desperately needed hospitals. This creates significant inequities in access to health care across the province. In 2018, municipal governments contributed $2.23 billion in combined operating and capital costs for health services.

Despite this, municipal governments are not currently recognized as significant contributors to population health in Ontario or included appropriately in health and health care planning at other levels of government. Furthermore, municipal integration with Ontario Health Teams and other health care decision-making in the province is inconsistent. AMO recently submitted recommendations to the Ministry of Health that would improve and standardize the relationship between municipalities and Ontario Health Teams.

Municipal governments have stepped in to fill the gaps when needed, especially in providing services to the most vulnerable in our communities. Many municipal governments fund above their required cost-share to address community needs. The overwhelming majority of municipal operating spending impacts the social determinants of health, but municipal governments are not treated as decision-makers in health planning. 

Health care is the Province’s jurisdiction and responsibility.  However, as AMO has demonstrated, municipalities make significant financial contributions to population health in Ontario, and municipal governments seek a comprehensive approach to health planning that both addresses upstream health factors and respects municipalities’ decision-making authority. As service providers, municipal governments must be at the table where health decisions are made, and municipalities need to be treated as funding governments, not as stakeholders, in planning how to deliver services that meet the needs of local communities.

Municipal governments are committed to working in partnership with the Province to improve health outcomes for all Ontario residents. Municipal governments seek a further provincial commitment to addressing health at the population level in partnership with local governments. As frontline service providers, municipalities have a wealth of information to share that can inform broader health policy. Municipalities seek to work in partnership with Ontario Health and share municipal insights with the Province to help Ontario Health develop a clear picture of municipal contributions to the social determinants of health. AMO advocates that the Province should work with municipal governments and other relevant agencies to adopt a “health in all policies” approach that will address the social determinants of health and improve population health and reduce health inequities by coordinating across Ministries and orders of government.


Health care consistently ranks as a major concern for Canadians, and Ontario is no exception. As the COVID-19 global pandemic made clear, a strong health care system is critical in preparing for emergencies of this scale and responding effectively to keep people safe. People expect and deserve to have fair access to high quality health care. This can only be achieved by a system that is well planned, efficiently operated, and adequately funded. Residents are increasingly looking to their local municipal councils to represent the community’s concerns about health care provided by institutions, health care professionals, and the Province.

The social determinants of health (SDOH) refer to a specific group of social and economic factors within the broader determinants of health. These relate to an individual’s place in society, such as income, education or employment. Experiences of discrimination, racism, and historical trauma are important determinants of health for certain groups such as Indigenous Peoples, LGBTQ+, and Black Canadians. The Government of Canada defines the determinants of health as:


  • income and social status
  • employment and working status
  • education and literacy
  • childhood experiences
  • physical environments
  • social supports and coping skills
  • healthy behaviours
  • access to health services
  • biology and genetic endowment
  • gender
  • culture
  • race/racism


AMO uses this Health Canada definition in policy development and advocacy.   The social determinants of health have strong effects upon the health of Canadians – stronger even than the effects of individual behaviours like diet, physical activity, and tobacco and alcohol use.

Municipal governments and the provincial government can work to achieve fair access to high quality and cost-effective health care for all Ontarians. Municipal governments are co-funders of health services and well positioned on the ground to provide meaningful input into health care planning and local operations. For more information, please see AMO’s discussion papers on the municipal role in health care, “Partners for a Healthy Ontario,” and its accompanying document, “A Compendium of Municipal Health Activities and Recommendations“.  These papers discuss how to improve outcomes for people and communities through changes to funding, governance, and delivery.


Michael Jacek
Senior Advisor