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Editorials on Sexual Health Programs & Hospital Restructuring

Two editorials are offered in this first issue of the Ontario Health Promotion Email Bulletin, with the hope that they provoke thought and commentary, response and reaction, within Ontario's health promotion community and beyond.

A. Ontario Hospital Services Restructuring Commission - a critical commentary

Much has been written recently about Ontario's Hospital Services Restructuring Commission, and its recommendations on hospital closings and other changes. A recent column by Michele Landsberg, titled "Patients to pay painful price for restructuring plans" appeared in the Toronto Sunday Star on April 27, 1997, takes a critical view of the composition of the Commission.

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B. Provincial funding for Sexual Health?

Why the Province must continue full funding for Sexual Health

By the Sexual Health Network of Ontario, P.O. Box 602, Postal Station Q, Toronto, Ont. M4T 2N4

Provincial funding for sexual health makes economic and social sense.

Ontario's teen birth rate has been reduced by nearly 25%, since a Conservative government established 100% funding for sexual

health programs in 1975. Since then Ontario has experienced a net savings of $25 million per year by preventing approximately 21,600 unintended pregnancies (Orton, M.J. (1996), Inequitable Access to Resources for Prevention of Adolescent Pregnancy as a Social and Ethical Issue, Early Parenting Conference, Ryerson Polytechnical University, Toronto, May 1996.)

Because the savings accrue to the province, municipalities have minimal financial incentive to preserve this funding. These cost-effective services must be funded provincially to ensure their survival. The cost is approximately 1/10th of 1 percent of the Ontario health budget; only 19.2 million (0.1%) for sexual health and 8.3 million (0.05%) for AIDS prevention (Based on 1996/97 budget. Health budget calculated at 17.8 billion.). This can be absorbed provincially without erosion of health services.

The sexual health program provides specialized services to people who are often least able to advocate for themselves, for example,

teenagers and immigrant women. These individuals often require complex follow-up and experience reduced access to other services. In most regions, family physicians would be unable to absorb the clients from sexual health clinics. As well, physician-offered services don't begin to include the range of provincially-funded educational and health promotion programs. Now, for instance, telephone support services provide inexpensive education and counselling that reduce the number of more costly doctor visits. Sexual health programs provide education to teachers, social workers, daycare staff, parents and employee health counsellors -- all of whom positively influence the health of others, including helping teens reduce the chances of becoming pregnant.

These programs are socially important and save money. For every government dollar spent on family planning, an average of $4.40 is saved by averting short-term expenditures for medical and nutritional services and welfare (Forrest, J.D. & Singh, S. (1990). Public sector savings resulting from expenditures for contraceptive services, Family Planning Perspectives, 22:6-15.). Preventing sexually transmitted diseases is also much cheaper than treating them. In Canada, the estimated annual cost of treating gonorrhea is $54 million and treating chlamydia and its sequelae costs $89 million (Health Canada (1996), Canada Communicable Disease Report, supplement: Notifiable Diseases Annual Summary, Ottawa.).

Unlike the rest of public health, no municipal funding has supported sexual health programs. Municipalities won't be economically

encouraged to absorb these programs because they won't bear the resulting increase in medical costs if programs are cut. Because they're about sex, these health services are vocally opposed by a small minority of citizens; this makes them quite vulnerable municipally where constituents are more likely to know their political representatives. Especially in jeopardy are independently-run community programs such as SERENA, a natural family planning organization; Immigrant Women's Health Centre, which provides service in 14 languages; Hassle Free Clinic, a key provider of anonymous HIV tests; and Planned Parenthoods, including Ontario's oldest birth control clinic.

Continued financial commitment to sexual health programs is consistent with the Province's support for community health services.

The Province must safeguard the existence of sexual health programs by maintaining 100% provincial funding.


A full copy of the article on Ontario Hospital Services Restructuring has been put online by Robyn Kalda at for the Friends of Women's College Hospital

The editorial message about sexual health programs was posted on the Citizens for Local Democracy web-site in the Health Services restructuring area. You can find it at: