By Bruce Reeve, CC BY-SA 2.0, Link

May 27, 2018; Global News and Ottawa Citizen

Writing about the Ontario budget over a month ago, we noted that controversies about alcohol, marijuana, and other curious talking points were still generating headlines a full two weeks after the budget was read into the legislature. Six weeks later, no one is talking about booze, gambling, or combat sports; the headlines are a lot less fun and a lot more serious—for the Ford government and for the citizens of Ontario.

As details (and speculations based on missing details) about changes to public health spending continue in a drip-drip-drip pattern of daily media coverage, a growing list of influential voices are speaking out in defense of various programs, from school lunches to restaurant inspectors. Premier Doug Ford initially addressed some of these concerns in ways that many, including many of his own supporters, viewed as dismissive, such as when he equated public health expenditures with “folks that go into restaurants and put the little stickers on saying it’s safe to eat here.”

It’s this perception that the Ford government either doesn’t understand the implications of its own spending changes or just isn’t concerned about the impact they might have on vulnerable people that seems to be fueling growing negative public sentiment, as well as drawing out some ghosts of Ontario politics past.

On Thursday, ten former Ontario health ministers representing all three major political parties sent a letter to Health Minister Christine Elliott, urging the governing Progressive Conservative (PC) party to rethink planned cuts to public health funding, claiming that work such as preventing outbreaks of disease or ensuring safe water are being put at risk.

“If you do not want to see another Walkerton and SARS, you don’t cut public health,” said former Liberal Health Minster Helena Jaczek, one of the ten signatories, at a press conference at Queen’s Park in front of the provincial legislature building Thursday morning. Jaczek was referencing the seven deaths in 2000 in the town of Walkerton (from an E. coli outbreak in drinking water) and 44 deaths Canada-wide in 2003 from the spread of severe acute respiratory syndrome.

“Traditionally, ministers of health have avoided commenting on the policies of their successors,” wrote the six Liberals, three New Democrats, and one Progressive Conservative (Dennis Timbrell, who served in the health portfolio under Premier Bill Davis from 1977–1982) “Health has been seen as a nonpartisan issue—something we all support. This attack on public health has prompted us to break our silence.”

Over the weekend, it appeared that these voices and other pressures, including Toronto Mayor John Tory and his door-to-door campaign had the Ford government doing a weekend rethink.

In a surprise announcement Monday morning, Ford stood with Municipal Affairs Minister Steven Clark to announce that the Ontario government is reversing retroactive cuts to municipal budgets.

“Our municipal leaders share the fact that we are in a fiscal hole and we all need to work together,” Clark said. “The announcement today to maintain pre-budget funding levels for land ambulance, public health and child care services, gives us that opportunity to have good consultations and suggestions about how collectively we can find those savings.”

Mayor Tory struck a conciliatory tone stating “This must be done in a prudent, collaborative manner that does not impact the vital services that people in Toronto rely on each and every day. This can only be done if we work together.”

Regular folks seem to have a lot to say too. Perhaps it is the cumulative effect of multiple controversies that generated such interest at a time of year when citizens are usually focused on tomato plants, backyard barbecues, and booking campsites for the summer. Here’s a short list with some of what has many Ontarians hot under the collar:

Elliott, not a newcomer to health issues, says the cost-sharing changes are being phased in over three years, and for many municipalities, they’re not huge changes. “That is something that I’m sure if they concentrate on the priorities of public health that they will be able to find those savings.” Despite Monday’s rollback of planned cuts, Ford still spoke of the ease with which municipalities should be able to “save a few pennies” per citizen. But the public seems to be growing increasingly skeptical about the “find the money” approach to fiscal responsibility.

Two recent polls indicate a dramatic change in approval for a government elected to a majority less than a year ago, with over 40 percent of the popular vote. An Environics poll noted a whopping 75 percent of Ontarians felt Ford’s government was “on the wrong track” and this included 37 percent of 2018 of PC voters. A poll by Mainstreet found just 19.9 percent of Ontarians have a favorable opinion of Ford, while 73.4 percent have a negative opinion of the premier.

If the nonprofit community seems less than vocal in these conversations, it is likely because budget details for many sectors have yet to emerge, and it’s difficult to speak out against changes that are based on guesswork. The Ontario Nonprofit Network is continuing its efforts to unbundle emerging budget information, with the latest Expenditure Updates as a step towards further understanding of what budget announcements will mean on the ground.

Some are not waiting on the details: they are doing the math and putting forward their own estimates and assertions about the impact of expenditure reductions. This includes Children’s Aid Society (CAS) branches and the Ontario Association of Children’s Aid Societies, who say they are still reeling from cuts made under the previous Liberal government. Their own estimate of 2019 budget impact is a $24 million cut by the PCs and a realistic threat of being unable to meet the basic standards for protecting children within their mandate (these expected changes are not included in Monday’s rollback).

In response to the CAS, Finance Minister Vic Fedeli mimicked Ford’s offer to Ottawa’s mayor about how to deal with cutbacks, telling CBC News that if any provincially funded agency is having trouble finding efficiencies, his staff will be available to help them. Whether this is intentionally tongue-in-cheek or not, this offer is unlikely to draw nonprofits into a meaningful conversation.

The Ontario Medical Association, not known for partisan advocacy, has taken a practical approach to the public health controversy, noting that the Ford government can best achieve its goals of cost savings by investing more, not less, in the types of programs and services currently under threat.

“The true proof of the value of public health is demonstrated by the absence of negative health outcomes or harmful health behaviors—when people do not develop diabetes, or never start smoking,” said Dr. Michael Finkelstein, Chair, Section of Public Health Physicians. “The paradox of public health is that when it works, the benefits are largely invisible. Counting the number of children contracting measles is easy; counting those who didn’t get measles because they were vaccinated is more difficult but may be more valuable.”

And therein lies the traditional disconnect between government policy and nonprofit service delivery to communities—while everyone agrees that tax dollars need to deliver “results,” there is not always an easy straight line to understanding how systems, programs, and services affect people.

And so, while the Ford government has certainly been confrontational about the value of various social investments, this is also a wakeup call to the many nonprofits who deliver these services. A “this too shall pass” attitude is not the answer. It is not enough to simply do important work and do it well—the public has to know why it is important and, to the greatest degree possible, have access to the evidence that demonstrates a better quality of life for all.

How to “report on impact” is always part of the NPQ dialogue. For an example, see this article from February by Elizabeth Castillo, “Counting What Counts: Why Social Accounting MATTERS.”—Keenan Wellar