Reimagining Health in Ontario: The Legacy of the Premier’s Council on Health Strategy

Setting the Stage: A New Vision for Health in Ontario – In the fall of 1987, Premier David Peterson’s Liberal government established the Premier’s Council on Health Strategy (PCHS) to chart a bold, new direction for health and health care in Ontario.

This initiative was prompted by a trio of influential reports tabled earlier that year:

• Toward a Shared Direction for Health in Ontario (Evans Report) – The report tabled by the Ontario Health Review Panel (OHRP) outlined major health care issues, a foundational philosophy, and key priorities for reform.
• Health for All Ontario (Spasoff Report) – The report proposed health goals to guide policy development and resource planning.
• Health Promotion Matters in Ontario (Podborski Report) – The report explored community health promotion and individual responsibility for well-being.

Collectively, these reports had a significant impact on health and health care thinking in Ontario. Among them, however, the Evans Report—chaired by the late Dr. John Evans—was the most influential, serving as a catalyst for the creation of the PCHS and helping to shape its mandate.

Ontario Health Review Panel (OHRP): Foundational Values and Priorities

In 1986, Premier David Peterson established the OHRP to help guide changes to health care in Ontario. It set out seven key values: equity, quality, comprehensiveness, informed choice, accountability, cost-effectiveness, and a commitment to the future. These values have shaped health policy in the province ever since. In more recent years, patient-centred carehas also become an important focus. The Panel recommended priority actions to create a comprehensive health vision for Ontario:

• Empowering individuals
• Strengthening cross-sectoral linkages
• Shifting care to ambulatory and community-based settings
• Establishing a high-level strategic forum for health system reform

For the last priority, the Panel recommended establishing a Premier’s Council on Health Strategy. This Council would act as a strategic forum to show strong leadership and commitment to finding new ways of thinking about health and health care—bringing everyone involved together to support change.

The Premier’s Council on Health Strategy (PCHS): A Bold Experiment

Launched in November 1987, the PCHS was established by Premier Peterson “to provide leadership and guidance to the whole government in achieving the goal of health for every citizen of Ontario.”

The PCHS was innovative in a number of ways:

Early subcommittees drew expertise from within and beyond the Council and focused on:

• Health care systems
• Healthy public policy
• Health goals
• Integration and coordination

In spring 1989, the PCHS released its landmark report, A Vision of Health: Health Goals for Ontario, articulating a consensus vision and five overarching goal .

Vision of Health & Supporting Health Goals

Vision of Health: We see an Ontario in which people live longer in good health, and disease and disability are progressively reduced. We see people empowered to realize their full health potential through a safe, non-violent environment, adequate income, housing, food and education, and a valued role to play in family, work and the community. We see people having equitable access to affordable and appropriate health services regardless of geography, income, age, gender or cultural background. Finally, we see everyone working together to achieve better health for all.

Health Goals:

1. Shift from treatment to health promotion and disease prevention
2. Strengthen families and communities
3. Ensure a safe, high-quality physical environment
4. Increase years of good health by reducing illness and premature death
5. Provide accessible, affordable, appropriate health services for all

Later in 1989, another report – From Vision to Action – proposed practical reforms, including piloting Comprehensive Health Organizations—early models of team-based, community-driven primary care. These innovations laid the groundwork for later policy reforms. In the fall of 1990, subsequent reports developed by the PCHS were ready for release from the committees of Council.

Final Reports of The Premier’s Council on Health Strategy Released in 1991

Achieving the Vision: Health Human Resources – specified a number of essential and important changes required in the human resource pool to accomplish reform to the health care system.

Towards Health Outcomes: Goals 2 and 4, Objectives and Targets – presented specific degrees of change by specific dates for Goal 2, to “foster strong and supportive families and communities,” and Goals 4, to “increase the number of years of good health for the citizens of Ontario by reducing illness, disability and premature death.”

Nurturing Health: A Framework on the Determinants of Health – outlined a breakthrough framework on the determinants of health

Local Decision Making for Health Service: Bringing Health and Social Services Together in the Community – recommended the creation of devolved regional authorities for health and Social Services.

Toward a Strategic Framework for Optimizing Health – a summary report which reviewed the key recommendations of the PCHS and its membership.

Expanding the Vision: The Premier’s Council on Health, Well-being, and Social Justice (PCHWSJ)

After the 1990 provincial election, NDP Premier Bob Rae expanded the Council’s mandate and renamed it the Premier’s Council on Health, Well-being, and Social Justice (PCHWSJ). In a rare show of unity, all three major political parties endorsed the Council’s original health goals in the Legislature in 1991, establishing a strong non-partisan foundation for ongoing health reforms.

The newly expanded Council built on the work of the original PCHS, with a stronger focus on equity, public education, and empowering both policymakers and communities to take action on the social factors that influence health. Its work was grounded in the belief that good health depends on fair access to meaningful work, income, housing, education, and a healthy environment. The Council also maintained the PCHS’s cross-government approach, bringing together senior ministers from various departments to support collaboration and coordinated action.

Enduring Legacy Across Governments

Although fiscal constraints in the early 1990s limited the pace of implementation of the Councils advice and recommendations, the Councils nonetheless achieved transformative and lasting outcomes

The Premier’s Council on Health Strategy and its successor, the Council on Health, Well-being, and Social Justice, laid the groundwork for a bold, inclusive, and long-term vision of health—one that reached far beyond health care services. They reframed health as the outcome of connected policies in housing, education, employment, and the environment. Their work led to structural reforms, inspired key programs, and emphasized the value of community input and cross-sector collaboration. Their legacy remains significant. No comparable mechanism has existed since. As is often the case with policy, the full impact of the Councils’ efforts became clear over time—and their influence and impact has been undeniably lasting.

Reflections on Influence & Impact

The Premiers’ Councils approach to health policy making (public policy for health) was an early example of innovative social policy which attempted to ensure equity in health.  It was also an example of a structure that facilitated intersectoral involvement in developing advice and recommendations to shape the policy development process and priorities.

1. Redefining Health and Embedding Population Health

The Councils introduced a broader understanding of health rooted in the social determinants of health. The 1994 Health for All Ontarians [2] policy marked a pivotal shift, recommending:

• A reallocation of resources from treatment to prevention
• Health impact assessments for all Cabinet submissions

2. New Approach to Healthy Pubic Policy

The PCHS was a groundbreaking experiment in whole-of-government, public-policy-for-health thinking (“healthy public policy”). It reframed health as a societal issue—not just a medical one—and offered a blueprint for collaborative, equity-driven changes supporting the creation of new government structures aligned with a broader vision of health:

• Ministry of Children and Youth Services
• Ministry for Seniors’ Affairs
• Institute for Work & Health
• Inter-Ministerial Committee on Healthy Living

Together, these institutions reinforced the idea that policies across all sectors play a vital role in improving population health and supporting economic prosperity.

3. Influencing Major Policy Reforms

The Councils’ work spurred investment in early childhood development, healthy aging, and social justice. In particular, the Councils helped drive investment in key areas, especially child and youth development leading to development of:

• Ontario Early Years Centres
• Better Beginnings, Better Futures program

These initiatives exemplify how the Councils translated population health theory into cross-sectoral action.

4. Shaping System-Level Reform

The Councils’ ideas helped shape major health system reforms that emphasized investment beyond hospitals, improved integration, and stronger community involvement. Their influence is evident in several key transformation initiatives, including:

• Ontario Health Services Restructuring Commission (1996–2000)
• Local Health Integration Networks (LHINs) (2006–2021)
• Several pivotal Senate of Canada reports on population health and health reform

These initiatives reflect the lasting impact of the Councils’ vision—looking beyond health care investments to build a more integrated, community-focused health system.

Conclusion: A Vision That Still Matters

Nearly 40 years later, the Councils’ influence remains strong. They played several key roles:

• Steering Committee: Engaged hundreds of individuals and communities in setting directions and shaping policy
• Research Centre: Led and funded projects to test new ideas and innovations
• Communications Forum: Produced accessible and academic materials to support participation and policy dialogue
• Government Partner: Facilitated collaboration among key ministries and central agencies
• Sounding Board: Reviewed and responded to proposals from across the system

While many recommendations have been embraced in principle, the biggest challenge persists: shifting meaningful resources from health care to health. With health care consuming over 40% of the provincial budget, a deeper reallocation toward investments in the key drivers of health—housing, income, education, and the environment—remains a vision rather than reality. This unfinished business represents both the challenge and opportunity for the next 40 years.

This article was co-authored by Beverley Jean Nickoloff  who has been involved in major health policy reforms since the mid-1980s and served as Lead of the Health Reform Committee for the Premier’s Council on Health, Well-being, and Social Justice (1991–1995).