The Agenda with Steve Paikin (Audio) - Do Municipalities Have the Fiscal Supports They Need?

Episode Date: September 10, 2024

Municipalities provide many services that people use. But increasing pressures have made it fiscally challenging for them to deliver these services. To explore what can be done to get Ontario's prosperity back on track, Daniel Tisch, the President and CEO of the Ontario Chamber of Commerce; Cameron Love, the President and CEO of The Ottawa Hospital; and Nishan Duraiappah, the Chief of Police for Peel Regional Police join Nam Kiwanuka. See omnystudio.com/listener for privacy information.

Municipalities provide a lot of services we all use, but increasing pressures have made it physically challenging for them to deliver these services, which affect health care, businesses and public safety. To explore what can be done to get Ontario's prosperity back on track, we welcome the President and CEO of the Ontario Chamber of Commerce. Cameron Love, the President and CEO of the Ottawa Hospital. And Nishan Duryapa, the Chief of Police for Peel Regional Police. Please put your hands together for these three. Welcome. Thank you. Thank you.

Thank you. We've got about 45 minutes for this conversation, and we've got lots to get to. But I wanted to start off by checking into your worlds. Cameron, if you can get us started, can you give us a sense of how things are within the hospital sector? Yeah, so I mean, we still have we still have our challenges within health care within the hospital sector.

And I think it's really more of a discussion around capacity and wait time. We're pretty fortunate in Ontario, actually, we're fortunate in Canada, that the healthcare system as it's structured within hospitals, the quality of care and the ability to deliver care is really strong. Like we function exceptionally well. Our challenge is the time and access. And that is really a capacity discussion. I want to just interject because fortunate, I'm not sure if that's the word that a lot of people would use to describe public health care in this province across the country. Yeah, it's a fair comment. I think, I mean, you can compare a lot to other countries, but if I look, and this isn't an issue just that's cropped up in the last year and a half or post the pandemic,

it has been building probably for about a better part of a decade or two. And so when we look at things like access to emergency care, access to surgical care, once you're in the care that's provided is excellent. The whole focus of what we're trying to do is to reshape and remodel health care to improve access. So whether you need surgery, whether you need an emergency department, whether you need a patient bed, whether you need access to long term care, it's how do you remodel that to build greater capacity to improve access? And that is probably the biggest issue, the biggest concern is access in this province to healthcare and the time it takes to get to it. And Chief, how is this impacting your sector? So if you look at the dynamics in public safety or particularly in policing the police sector, post George Floyd in the last three or four years, I would

dare to say that public safety is a number one concern for almost every municipality, small, rural, urban. And the narrative has really switched around. So the challenges that we're facing are how do you do that in a way that evolves with the changing dynamics and pressures and the confluence of issues that are not necessarily crime related but social disorder related that ends up on the doorsteps of emergency first responders on a day-to-day basis, which is one of the critical discussions that Cameron and I have had and obviously Daniel too in the business

community is there is an interwoven dependency on each other to mitigate some of these issues. I'm glad you brought that point up because your sectors may seem very different but they're actually rely on each other to create healthy communities. And Daniel, you've written a report on the economic outlook for the business sector. And one of the key findings was that confidence in the economy has dropped to a record low. Why is confidence so low? Well, in some ways, it's not surprising when you look at businesses and what they've

been through, especially small businesses in the last few years, right? I mean, coming out of the pandemic, they emerged with major disruptions in their supply chains, major disruptions in their customer traffic coming into their establishments, especially at the local level, high debt loads, a mental health crisis that small businesses are not prepared to deal with, and continuing concerns

around the broader environment, you know, the stuff we were just literally talking about healthcare in the community, housing in the community, safety in the community, you know, connecting connecting as well to the addictions and substance use crisis. We did a report on that earlier this year. So when you add it all up, yeah, I mean, it's pretty grim. You're like, so just to give you a perspective, at the height of the pandemic,

business confidence in Ontario's economic outlook was 29%. This year, it's 13. Small business 12. Businesses and health and social services or health and social service providers, just 8%. Now, there's one bit of good news. And the good news is that when you ask them, are you confident in Ontario's economic outlook, they say no. If you say, are you confident in yourself and in your own business, they say yes. Forty-eight percent say, I'm confident in my own outlook, so that's a massive difference.

And a majority actually believe they're going to grow this year. And so in some ways, I think as public policymakers, folks in this room, the challenge that you have and we have together is to get businesses to invest on and act in their belief in themselves. I think you kind of touched a little bit on how businesses are impacted by people who are experiencing homelessness. But I wanted to get a better understanding of how those challenges at the municipal level affect each of your sectors.

And Cameron, if you could start us off, please. Yeah, so unfortunately, since the pandemic, we've seen significant challenges with homelessness. And we've had this issue in the past, but it's really grown. And if I look at it from the hospital sector, I think in the absence of having strong collaboration with municipalities to build strength in terms of a system to support that population, in the absence of that,

what tends to happen is everybody comes to the Emerge department. And quite honestly, the Emerge department is the last place where you want to support people that need that type of care. And it's not one element of care they required. It could be mental health, it could be addictions, it could be social aspects of care, it could be eye diseases, infectious diseases, it's a whole gamut of things.

And so I think part of what we've been trying to work very closely with this municipality in Ottawa, and I think many are doing this across the provinces, it really needs a system approach. There's not one thing that helps manage this population and helps them get back to a better place. And we had, as I said, we've seen significant growth. And again, part of its capacity, but part of it is it's not just about a hospital. It's how do you take resources within a hospital, whether it's specialists or nurses or whatever, how do you partner with other community agencies to wrap an umbrella of services around to support that community?

So instead of operating in silos, you kind of collaborate. And I think we've had pretty good success with that in Ottawa, inner city health, the mission, the municipality, the hospitals have rallied around it. But I think we're seeing growth and we're seeing, unfortunately, a greater instance of that. And we've got to wrap more resource, more capacity around it. Because coming to a hospital should not be the only place. If they do, we care for them.

But the care they require is a lot more comprehensive. It tends to be needed in the community. And so what we tend to do is we treat them for one specific in a hospital. We discharge in the community, but then if the support's not there, it becomes a vicious circle. And I imagine, too, that takes away resources from people who are in the ER for medical

emergencies. And Chief? We see, obviously, you know, the first line of sight to somebody that's sleeping in an, you know, off-ramp turnaround in a green space, The initial calls often come to us. But I know in Peel Region and I have some of our team from Peel Region here have done a remarkable job of providing the off ramps and options for people. But precarious housing and homelessness is interwoven with so many other issues that we see, whether it be addictions, mental health. And so, you know, the pressures for first responders to Cameron's point is, you know,

is a police officer or a paramedic the right person to be responding to somebody that has those demands? Unfortunately, we're the 24‑7 go‑to for these issues. And it often is on the doorstep of first responders. The ability, especially if we think about encampments, small or large, that many municipalities are feeling is, you know, it's on the heels of all the issues that we're seeing and nationally that are conflated with geopolitical issues. But is a police officer the right person to ask somebody to move into, you know, secure housing or an off ramp or to a hotel option? Probably not. But we have matured in our way that we are working with social service agencies or municipalities to find off ramps and connection to services. So that is a big change that we've

seen as opposed to being like the big stick that is waived at people that are homeless. And just to jump in, I mean, I totally agree with what my colleagues have just said. And how we need a systems wide approach. And too often often part of the challenge that you know, we have 150 local chambers of commerce and boards of trade within our network within our Ontario Chamber Network. And business is too often left out of this

conversation, right? You know, even yesterday, we heard very compelling speeches from a number of political leaders talking about this issue, and saying correctly, that municipalities are the front are on the front lines and which is a very challenging place to be, right? Because municipalities don't have the funding to execute those responsibilities properly. But business is also on the front lines.

Local business is on the front lines. And so they're investing more in security on their premises. They're investing in surveillance. They're investing in training on their premises, they're investing in surveillance, they're investing in training for their staff for situations that really the staff shouldn't have to be dealing with. And of course as a result of all this there's a loss of customers and there's a loss of talent. So we've got to work together on this because I think that there's no one size fits all solution. We know it's

integrated with the availability of fits all solution. We know it's integrated with the availability of mental health services. We know it's integrated with the concurrent building of homes, which is a big priority. And finally, we see all orders of government working together on that, which is incredibly healthy. But we need business to be part of that conversation. You mentioned the word frontline because I think part of living in a community, there are many different people within that community. And I think the goal for everybody here

is to try to figure out how everybody can thrive in those communities. And I guess when you were meaning with frontline, is if you're a small business and there's someone experiencing a mental crisis, it's really difficult to have the expectation for that business to be able to handle that in a... Absolutely, absolutely.

And it's interesting because I took over this job in January and a lot of people were surprised that the Ontario Chamber of Commerce is putting out a report on housing, right? And we're putting out a report on the substance use and addictions crisis. And that's because social issues are business issues, right? They affect the health of our communities. And if you ask business leaders across Ontario, small business in particular, what they're most worried about, it was interesting. My friend Sabine Matheson was, yesterday gave us some results from the survey of CAOs, right? And one thing she said was a few years before the pandemic, their

big worry was money. Now it's people. And the interesting thing is you ask businesses, business leaders, it's exactly the same answer. So number one is the workforce. How do I, you know, find the right people? How do I attract them? How do I retain them? How do I develop them and re-skill them, right? That's number one. Then you have regulation and kind of business competitiveness as a secondary issue. And then you start getting into social issues, the availability of housing, the availability of healthcare, right? Efficient transportation and alleviating congestion in big urban areas in

particular. And so these community issues really matter to Ontario businesses, and we need to ensure that we've got really strong collaboration, as I know we do, between our local chambers across and boards of trade across the province and all of you. Well, we've been told that municipalities don't have enough resources. Is this a chronic issue?

Is this something that's recent? Cameron? Enough resources in municipalities? Yeah, I think the short answer would be yes. But to expand on that, I think there's two sides to this. There is always a need, and we've grown tremendously as regions and systems, and the demand and the population growth is greater than ever. And so by default, as populations grow in the healthcare environment, as the

incidence of disease grows, you have to grow capacity, which means you've got to invest in it. It's the same thing for police, it's the same thing for ambulance, it's the same thing for fire, it's the same thing for municipalities because you build more capacity, you need more buildings, you need more housing, et cetera. So there's an element that there definitely needs to be funding that's put into it. I think the other thing that goes hand in hand with that, and I can only speak specifically to healthcare, what we can't do is to leave the system the same and keep putting money into it. There is a need to shift and change the system. You look across healthcare across the entire world, call call it the top 10 countries,

not one of them has stayed stable in terms of the model of what they've implemented, because as they've invested, they've changed the way models run, they make them more efficient, they drive value, but they improve access. And that's what we need to continue doing within healthcare. I think it's the same probably within municipalities, as we think about how we managed to your previous question,

the homeless population, what worked 10 years ago is not going to work 10 years going forward. And so we've got to reorganize ourselves to some extent while you invest. And what worked, well, and even I agree with you, and to go even further, what worked, how old is Canada, 160-something years? What worked 160 years ago doesn't work today. We still are dealing with a 19th century governance structure fundamentally for municipalities being creatures of the province. And there's this very frustrating dance which I know is frustrating to everybody here and to business

people watching it's frustrating as well. It's that, you know, there's a dance whereby municipalities every year go cap and hand to the government and say we need this, we need that, and the government looks at it with good intentions. You know, I don't want to suggest anyone's not, you know, having the very best of intentions. But it's all about solving short term problems and filling holes in this year's budget rather than fixing the system for the next generation. And it's interesting

because I think we'll have an election at some point, you know, in the next year or two years, we don't know. The opposition parties will be talking about change and the government will be talking about continuity but also legacy, right? What's their legacy going to be? And I think there's an opportunity for all parties to get behind this idea, which we've heard about here at AMO, of a social and economic prosperity review, which we as an Ontario Chamber certainly support. And I think that it would be very constructive and in everyone's

interest. This should not be a partisan issue. This should be a long-term issue about the competitiveness of our province and the prosperity of our province. I was doing a panel yesterday on women's leadership and one of the panelists mentioned that one of the concerns too is that when there is a change of government, then there's a change of priorities. And some of these funding issues, they have to be continued. You mentioned population growth. I'm going to come back to that in a little second but I wanted to get your insights on is it funding that is the issue or the improper allocation of money towards various sectors? Well, listen, I think it's not a zero sum game of, for example, you know, there's nowhere in Ontario where they said, hey, the police got here too fast

when I called them. That does not happen. So I'm just using that as an illustration. The wait times are too short in the hospital. So there are wait times for ambulances that are too long, right? There are in all sectors, I think, there's a need for improvement. I do agree that systems need to change without a doubt. And the growth of particularly where I am in the GTA, the growth of population adds

so much urban pressures to us that without a doubt if you want to keep a community safe, it costs. But there is a need for, to Cameron's point, for systems to change. I think if you took the chamber out of his title, health care out of his title, and policing out of mine, we'd be all saying the same thing. It's the definition of insanity, doing the same thing over and over again except expecting a different outcome. Without a doubt, we know in policing, and I can speak on behalf of my colleagues,

that the shift in the model of how we serve the public has to change, but it's not without the absence of the need for investment. Otherwise you're compromising public safety, right? Well, your sector is a sector that is known to have received a bump in its funding. Is funding enough to ensure that you can do your jobs? Well, let me say this.

Anywhere in Ontario, if you take the data for any of your municipal police agencies, 80% of the time a police officer is spending on the road is for non-criminal activity. It's mental health, addictions, precarious housing, food insecurity, older adult isolation, youth related issues. Do any of those sound like a police related issue? Minister Tobolo and I have chatted before, the only legislated person that can take somebody to a hospital in crisis is a police officer. And does that make sense? There are times where we need to be there. I only say that because other

systems do need to be strengthened to alleviate the pressures on things like policing, fire paramedics or ER rooms so we can get back to doing what we're supposed to be doing. So it's interesting to say that because you essentially are saying what communities were calling for the police to be defunded are saying. They're saying take some of the money that's going to the police and give it to other sectors in order for them to help people in need. So how do you balance those two things? So I've explained this many times in my region, is that to turn the tap down on public safety

and turn the tap on on something else immediately is impractical. You know, the reality is people are still waiting on 911 for response, for calls. So that space needs to exist. But do I believe that other systems need to be strengthened so that there's less overreliance on people like police officers or paramedics or firefighters? 100%. And I'm a full advocate for pro public health approach to public safety. If you took policing out of justice system and you put it with the health care system, can I tell you we would have a way better impact on people's needs in the community and be far more aligned? We'd be

upstream versus being reactionary. So does it sound like I'm working my way out of a job? Kind of. But it's because we are spending our time, you know, who hasn't had somebody's vehicle stolen and car jacking? Violent crimes are on the increase nationally. Versus standing at a 7-11 for somebody who is sleeping in a vestibule and trying to get them to a social service entity for help versus responding to your house for an emergency. There's a different space that we should be in. And I'm with Cameron, Gary Kent, my CEO from the region appeal and his amazing team are

here. We talk about strengthening other systems so that we can get back to business. I think 100% that's the way to go. We've got 20 minutes left and I've only gone into the first five questions. And I want to talk about the opioid crisis, but I'll bring that up in a minute. I wanted to catch up on something that you said, Cameron, regarding population growth. Population of Ottawa has reached more than a million. How would something like that population growth impact a hospital?

Significantly, because there's two pieces to that. It's not just population growth, it's the age of the population. The highest demographic growth is typically 65 and 70 and over. Unfortunately, as you start hitting your 70s and 80s the incidence of disease and the risk of healthcare issues climbs. So what we see, I have a couple of answers to this one with what Nish just said. And to your comment around are the allocations right, it's a tough question but here's what I tell you is that everybody talks

about we need an allocation move from one group to another without an expectation that we're going to change the way the system works. And if I couple that to health care, what I'll tell you today is on any given day, 30% of the people that are admitted in our hospital and probably all the hospitals in Eastern Ontario are waiting for placement in the community. So should we just pick up all the money from the hospital and transfer it to the community? You can do that as an allocation, but you're not going to improve the system without changing the way the community system works and the hospital

system. Part of this is if we can come up with a longer-term plan where you're going to restructure healthcare, not what you do in the hospital versus what you do in the community, but what you do for populations, then you start to move the barometer of where people need to be cared for. You can get greater value because you provide more cost effective care in the community than you can in a hospital. But you've got to fundamentally change the system and change is the hard piece because not everybody agrees. And so as you do that, what helps then is it takes the burden off of emergency departments, it changes what the police can do, it changes what the ambulance can do. So moving allocations is not the, to me, is not the formula.

Coming up with a plan on how we're going to remodel that allows you to invest in the right areas that gets you money out and allows a change is what we have to do. But it doesn't happen in three months. I'm going to come through with Daniel, but who would do that? Well I think what you need really comes down to leaders within the industry. You need governments in line, you need municipalities in aligned, and you need industry leaders, whether it's chiefs of police or CEOs of hospitals, but a willingness to change.

What you can't do is expect everybody to keep everything the same and just keep pumping money into it. You've got to change the way it's organized. Yeah, just to jump in on that, it's not, again, we're in agreement here. It's not just about moving money around. It's not just about even necessarily the amount of money, right? It's about predictability. It's about growth. And I think it's about responsibilities, right?

And I think those are the three things that we need to look at, right? So business is all about predictability, right? And there's a real threat to municipalities. If municipalities continue to be as reliant as they are on non-residential sources of revenue, in effect business taxes, right? There's a threat to our ability to grow housing as fast as we want if municipalities continue to need to rely so heavily on development charges. But we understand why they do, right? Why they have to do both. Because they are being at, they don't have predictability. They don't have the revenue sources that grow with the economy. Reliance on the property tax is not realistic and property tax reassessment is long overdue,

which is another problem. And then there's a matter of responsibilities. Municipalities are being asked to look at mental health, to look after addictions, to look after asylum seekers, to contribute to ambulance costs and hospital building costs. And it's just not sustainable. I mean, just as a business proposition, it's not sustainable. So we have to work together on how we can structurally change the system so that it works for all of us. And if we do, the good news is, you know, businesses will be attracted to places that all of a sudden are more competitive. We'll get more investment, we'll get more jobs, we'll get healthier, stronger communities. This next question, it's a point of overlap in all of your sectors, the opioid crisis. And Chief, I wanted to start with you.

Region of Peel has one of the fastest growing cities in Canada, Brampton, and one of the largest cities in Canada, Mississauga. How is that affecting the lives of healthcare staff, police, services, and business owners? But I wanted to ask you how that's impacting how you all do your job. So, you know, in Peel Region, I know my regional chair, Nando Unica is here and he says it way better than I do, but the population is going to grow in the next six to seven years by 500,000 or more. I'm looking at my regional team. So the reality is things like the opioid crisis are a significant issue for us. I think the way policing sees it is, you know, if you provide people opportunities and off ramps

and services, we will still be serving them and meeting them at the curbside. We'll still be taking them to ER rooms. Ontario has an opportunity in our view in policing is to model probably the best holistic approach to responding to opioids. It's not through one singular solution. Multi-sector investment, you know, we can learn from other provinces but Ontario where we have one of the second highest rates of overdoses is a significant issue. And it's often for me it's often conflated with other criminal activity and other issues which, you know, mask the underlying issues. So, hitting root causes and finding multi-sector responses to things like substance use or the opioid crisis is the way to go. And it's not one particular solution. I wholeheartedly

believe it has to be a multifaceted plan and a priority for this province for sure. And of course, at the heart of the opioid crisis are people, the individuals who are impacted by it, their families, their neighbors, their communities. As in the healthcare sector, how is it impacting you, Cameron? Yeah, it's a big impact. At FaceValue, you can say that, obviously, we see anybody that Nish's

team or other police bring or other families bring, they come to the emergency department. And so there's the obvious, how do you deal with the acute instance of some type of overdose related issue? To me, that is, it's a piece you do, we want to avoid, we want to eliminate, but it's a practical reality. What's interesting is that's not where the problem is. The problem is, is how do you get most of these patients that we're seeing that are coming in and I completely agree with what Mish said.

There's either a history of mental health, there's a history of some type of social distress, there's lots of other factors. It could be unemployment, homelessness, bad social situations, family related matters. Part of what we've been focused on is what you really want is if the hospital has specialists that are able to deal with the acute treatment, and we have social workers, and we have nurses, how do you take that and couple that with what public health is doing plus organizations in the community where we have wrap umbrellas of services long before they need to come to the eMERGE and death store? And that's the reality. We have to

get further upstream. But again, what it means is don't wait for everybody to come to the Emerge and Death Store. And that's the reality. We have to get further upstream. But again, what it means is, don't wait for everybody to come to hospital. How does the hospital play a role in partnering with these community partners to build a stronger system? And I really think that a lot of the underpinning to this, and this to me is, we talk about opioids, we talk about toxic drugs, et cetera. The underpinning to a lot of this is the growth and incidence of mental health disease by a long shot. And I think that is the area of focus that we have to focus on. It is not acute heart attacks, it is mental health, which is a much tougher thing to manage from a healthcare perspective, but absolutely critical that partners rally around the population to support it because it's not one

thing that they need help with. Yeah, very much agree. And I mean, it's like we had the pandemic, and then we had the eco-pandemic. The eco-pandemic was all about mental health, right? And they ask any employer in the province, they all, you know, I hear the same stories or very similar stories, right, about the fact that a large company, a large business,

will have, you know, strong HR department, they'll have an employee assistance program, but a small local employer often will not. And they don't have the capability to deal with these things. Now, layer on to that, as I already said, the added challenge with, you know, if we have this absolutely horrific human tragedy, which is also a social and economic tragedy, of having business and local commerce disrupted by the opioid crisis

and staff having to deal with circumstances that they're not prepared to do, right? And so it's been really hard for businesses. And one thing that I think we see too much is we see too much focus on ideology and not enough on evidence. And so what we've said is, look, there's no one right answer here, right? You know, we think we all know that, right? This is very complex, sophisticated. There's a there's a balance of values here. There's there's community safety as one value. There is harm reduction as another value.

There's treatment and getting people well as another. And you can't just rest the strategy on any one thing. You've got to look at everything. You've got to do a little bit of everything. Perhaps we need to get in better balance in these different domains. But in the end, we have to look at what is going to work and let the evidence drive the prescription. It seems to be a very complicated issue. With it again, people are in dire need of assistance, but as you said, it's a social, economical, we're talking about money now. And Cameron, earlier this year, Belleville's mayor,

Neil Ellis, issued an urgent plea for the provincial and federal governments to step up. Do you think upper levels of government are doing enough? Well, that's not an easy question. Are they doing enough? I think they're headed in the right direction and doing, making some investments, making some changes. I do think, coupled to what my two colleagues have said, I think where there needs to be more effort is not just funding, it's also policy change and sort of restructuring of models and direction that are supported by new policies that allow us to evolve further forward. I do get quite concerned that trying to take what we have today and make it run faster by putting more money into it is not going to solve the problem. And I think what we need governments to really look at is how are they going to innovate, how are they going to drive change,

which means that means different policies, it means different directions, it means different regulations that enable the industries to start to change the way we're able to provide service. And it is, we are wrapped in a world of bureaucracy in a very big way. And I think if we're going to start to make some of these changes like you've seen in other countries, we need governments to really push on some of those policy changes. And if I may say, we need to look at more creatively at public-private partnerships, right? I mean, it is, in my view, you know, absolutely crazy

that there are still folks, I talk about ideology over evidence, you know, who are saying, no, we should, business shouldn't be involved in, you know, to the extent that it is in housing, right? Business shouldn't be involved in healthcare, right? You know extent that it is in housing, right, business shouldn't be involved in health care, right? You know, the reality is, we need to mobilize the financial, the intellectual and the human capital of the private sector to solve these problems, right? And we can and I, there are a lot of wonderful examples of municipalities working with the private sector and working with health and social service

providers and, you know, you know policing to bring about constructive change and I think that's really healthy. We've got about six minutes left and from what you've just said I think the bottom line is that there's a sense of urgency so we should be doing anything and everything that we can to combat these problems but I wanted to get some quick answers. I want to sneak into more questions because, you know, that's what we try to do. I wanted to get a sense from all of you. What do you think needs to be done to create thriving communities?

Chief, I'll start with you. I think Daniel said it well, is systems coordination needs to happen. You know, without a doubt right now, you can tell by this this provincial government there's a strong emphasis on public safety, right? I think my sector versus your sector versus education may all have different perspectives on it. But and we're very appreciative of that. Back to my earlier comment is that some of the issues that are on our doorsteps are not ours alone. And the concept of community safety well-being, you know, we in the police sector, every chief in Ontario agrees wholeheartedly that we need to bring business community, health, other sectors together at a risk mitigation, prevention

and a social development standpoint in order to enhance how we respond to any risk in the community. I can tell you that is the way to do it. Sectors responding to issues on their own is just futile. You know, we're just going to ask for more resources, resources, resources, but which we may need. But together, I can tell you, we can model something much different here in Ontario. And Cameron, I know you're on the front lines with COVID and we saw how quickly communities mobilized to work together, how sectors mobilized to work together. What do you think needs to be done to create thriving communities? Yeah, so I'll give you a perspective just strictly from healthcare. So we have about 17,000 people that work at our place. We've recruited about

4,500 over the last two and a half years. A lot coming out of schools, a lot nationally, and a lot internationally. People come to communities that thrive because they've got strong sports and rec, arts and entertainment, healthcare, and education. And so when you look at those four sectors, if we wanna have people that are thriving in communities, we have to be focused on those four sectors. What's interesting and I agree with Daniel, the private sector plays a big role in how we support those four components.

And so if we're gonna create strong communities, we have to expand the capacity with the growth that's occurring in those four sectors, particularly health and education. And when you look at health, I think to Nisha's point, this is not just about, we tend to silo ourselves in healthcare and in communities. What's the hospital doing? What's the municipality doing? What's long-term care doing? What's the university doing? The reality is in many of these things as an initiative, they all overlap. And so I think if we're really going to create a thriving community, you can't boil the ocean

here. We have to take that to your point before we have to take the two or three really core things that are really critical, and we're going to have to drive some change across those sectors. Yeah I think if I go back to our Ontario economic report, you know, our case was that there are really four pillars, right? To, to, you know, answer your question. The first is that we have a competitive business environment, right? That

attracts businesses to, you know, be here to stay here to invest here to hire more people to create better jobs. So the competitive business environment has got to be there. Second, we have to have strong and sustainable infrastructure. Third, we have to have a skilled and inclusive workforce that includes people who have been historically excluded. We need to get all the talent off the bench and into the game. And finally, we need healthy communities. And one thing that I said when we unveiled the report in February, I explicitly said this, not just here today, healthy communities include healthy municipalities, right?

And that is fundamental, I think, to our success. Things we could do that will be high on my list, invest in health human resources, right? And closing those gaps. Invest in health data so that data can be more transparently available and serve a patient throughout their life. And invest in post-secondary education. We have here today, coming up, I think in the next session, we have the Council of

Ontario universities. Yesterday we had Colleges Ontario here. And so in some ways, I see a parallel between the municipal sector and the post-secondary sector, in that I think government has to either increase investment in these sectors, or empower them to raise revenue themselves, right? In the case of both the post-secondary sector, it's lifting the tuition ban, a tuition ban, tuition freeze, which has now been in place, I think, six years, Steve Orsini can correct

me, you know, but it's been going a long time. And so either we allow tuition to rise, or we give them more funding. And the same is true of municipalities, we either fund them better, change some of these structures, and or allow them to raise revenue more creatively. You've raised a lot of things that I want to follow up. I'm sorry. In your one minute, in your one minute.

In school, I'm like, oh, maybe another session for another day. But in our final minutes, I really wanted to get some, there's a lot of influential people here, policymakers in the audience today. What's the one thing that you'd like to urge them to do, Chief? Maybe 30 seconds. So I know the subject is fiscally sustainable, responsible municipalities. I just need to say public safety costs.

And if you think that it's not, there's a way to round some corners off to find a way to do it, it's not the case. That being said, the service delivery model needs to change from a non-traditional to a pro-public health in a multi-sector approach. If your chief is not offering you that and also saying, hey, I need help with resourcing,

then you're getting an unbalanced story. Daniel? Well, I guess I'd say, I guess this is addressed to the political leaders in the room at the municipal level. Do what you do best. Campaign. Campaign, you've got to, I think,

achieve this very reasonable request of a social and economic prosperity review. But you have to be united in this. It can't just be, you know, if if if something if this is only good for large municipalities, but not small ones, only good for rural, not urban. That's not going to work. So it's got to be united. And I'd also suggest it should be positive.

Reward political leaders at the other levels of government who sign on and say, yeah, you know, this is needed and I want to be part of that change. Cameron? Yeah, great comments from two colleagues. The only other thing I'd add would be we made a lot of progress together as communities through the pandemic. We did a lot of things differently to deal with pretty catastrophic situation with some pretty impressive outcomes at the end of the day. But there's not a single sector that

didn't change what they did and didn't be very innovative and creative that allowed us to deal with the situation. As soon as the pandemic's done, everything's gone back the way it was. What we need is municipalities and leaders and communities to really open thinking around how do we need to change and take what we learned from the pandemic moving forward because there was a lot of things done well that can create that healthy community particularly from a healthcare perspective. Gentlemen, thank you so much for your time. I've learned a lot from you all. Thank you so much. We appreciate it. A round of applause for them. Thank you so much. Thank you.