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 front lines of Ontario’s COVID-19 pandemic response.

Municipal services also play an important role in the health care system, population health and the social determinants of health. Given municipalities’ significant contributions, AMO 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 involved in community health decisions  and municipalities need to be treated as funding government partner, not as stakeholders, in planning how to deliver services that meet the needs of local communities.

AMO’s analysis of municipal Financial Information Returns found that in 2018 (the latest year in which all municipalities have submitted data) 80% of municipal operating expenditures contribute in some way to the social determinants of health. These are the conditions in which people are born, grow, live, work and age that determine their overall well-being. In 2018, more than $40 billion in operating funds directly or indirectly contributed to the social determinants of health. These include municipal services like social housing and emergency services, as well as parks and recreation, waste management, and child care. All significantly impact population health in Ontario.

Municipal governments also fund direct health care services. Currently, capital funding for new hospitals is shared between the province and municipal governments at 90% and 10% respectively. Municipal governments often go over and above the required 10% to cover additional costs like the purchase of diagnostic equipment. 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 by other orders of government. Although an overwhelming majority of municipal operating spending impacts the social determinants of health, municipal governments are not treated as decision-makers in health planning.

Furthermore, municipal integration with Ontario Health Teams and other health care decision-making in the province is inconsistent. AMO submitted recommendations to the Ministry of Health that would improve and standardize the relationship between municipalities, District Social Service Administration Boards (DSSABs), and Ontario Health Teams. This includes mandatory municipal representation on both planning and governance tables. Questions also remain about how funding arrangements will work in Ontario Health Teams for services like  long-term care.

Municipal governments have stepped in to fill the gaps when needed, especially in serving the most vulnerable and marginalized members of our communities. To meet community needs, many municipal governments fund above their required cost-share and provide additional health care services using property tax revenue. This is not appropriate as health care is a provincial responsibility.

Municipal governments and DSSABs are committed to working in partnership with the province to improve health outcomes for all Ontario residents and seek further provincial commitment to addressing health at the population level in partnership with local governments. As front line service providers, municipalities have a wealth of information to share that can inform broader health policy.

Municipalities and DSSABs 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 requires a well-planned, efficiently operated, and adequately funded health system. Residents increasingly look 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 refer to a specific group of social and economic factors within the broader factors that impact health and well-being. 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, 2SLGBTQQIA+, and Black Canadians.

AMO’s policy development and advocacy is guided by the Health Canada definition of the social determinants of health. These factors 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.


Michael Jacek
Senior Advisor