The Role of Local Government in the Provision of Health and Social Services in Canada

Derek Wilkinson is an associate professor of Sociology at Laurentian
University.

Extension of the Welfare State changes the role of local governments. The MacDonald Commission recommended devolution of responsibility to local communities and non-profit associations. Consequently, the role of local government needs reassessment, which the authors try to provide.

The authors begin with an historical account. In the beginning, local and provincial health boards were only established to deal with serious risks. Some rural communities hired doctors. Then in 1968 Medicare was established. Social Welfare services were also provided by municipalities until the twentieth century. This century, major responsibility for health care and some social services was transferred back to the provincial and federal governments. Some responsibility was passed upward from the municipality.

The authors show that there is considerable variation among provinces in the role of municipalities in health and services. They also show the extremely wide range of projects in municipalities across the country — from public health dentists to job search / skill training. Since some expenditures municipalities must make are outside their fiscal control, there is often conflict between municipality and province. Provinces also restrict the amount municipalities can borrow. Most money comes from property taxes. Generally local governments have no significant official role in planning. They do, however, usually have some informal role.

Arguments for local government services include more relation to local needs, more democratic control, and more efficiency in resource allocation. Disadvantages are: tax competition, inefficiency due to inexperience, and a fluctuation of basic levels of service provision. Local governments are unlikely to be expanded since they lack constitutional recognition and fiscal authority. Perhaps there could be more municipal involvement in planning, administration, and delivery, if not funding. The authors think the greatest advantage to be gained would be in citizen participation.