“How do we ensure that Hamilton voices, equitable voices are at the table from diverse communities from our indigenous community, from racialized communities, and so much more?” was the question in front of Hamilton City Council Monday as community groups and medical professionals called for the implementation one of the recommendations from the 2007 Campbell report following SARS – the inclusion of experts on local boards of health.

Hamilton is the largest single-tier city in Ontario with a Board of Health entirely comprised of politicians, with no medical expertise, overseeing Hamilton’s public health services. Peel and York regions both share the politician-only model.

Lyndon George, a Ward 2 resident who is Black, led off eight delegations. He says restructuring of the Board of Health is long overdue – citing the more focused COVID responses in Toronto and Ottawa. “There was the Campbell report that called for these structural changes to boards of health, you know, close to a decade ago”.

George says it is not enough to have equity and diversity task forces, community voices are needed on the Board of Health itself. “When we talk about inclusion, it’s about having that seat at the table and having your voice being heard”.

The Toronto and Ottawa Boards of Health include community members. Both have elected officials in the majority by a one-vote margin. In Toronto, the 13 member board consists of six city councillors, one school board trustee, and six community members. Ottawa’s 11 member board is six councillors and five community members.

“What we’ve seen other communities in Toronto and in Ottawa, there are community voices that are also in the room helping to shape the discussion of health care”, George said.

Ward 6 Councillor Tom Jackson stated he does not support changes. “You’re not actually looking that non-elected members of our community would have equal say, and decision making, and voting ability at the elected body of Board of Health?”, Jackson asked George.

Dr. Natasha Johnson, a pediatrician at McMaster Children’s Hospital says lived experience of racism is needed on the Board of Health to inform better decision making.

“I was invited by the Canadian pediatric society to post on social media my perspective on what had happened”, Dr. Johnson stated sharing her response to the killing of George Floyd last summer. “My reflections hopefully brought attention to the fact that while I am a highly educated physician, living in an affluent area, I was actually terrified that my teenage son who is already at increased risk because of the colour of his skin, would be seen as more threatening by wearing a mask in the community. I wondered if this was on anyone’s radar, were the people making public health policy decisions aware of the impact of discrimination on health, on seeking care on outcomes?”

“Some communities have a difficult and traumatic historical legacy with the health care system. This must be considered when public health policies are being implemented”, Dr. Johnson stated.

Dr. Johnson’s presentation was well received by Ward 15 Councillor Judi Partridge.

“I listened very carefully to your presentation and it just makes a lot of common sense to have the rest of the community, particularly those areas that are more diverse, and more at risk, to have the expertise around the table … [we] don’t need to have every councillor around the table”, Partridge said. “I think it is it is time to consider it … as our city is growing, and particularly as it’s growing in in diversity”.

Ruth Rodney, an Assistant Professor in the School of Nursing at York University, said a more diverse Board of Health will benefit all by including more areas of knowledge including front-line health care workers such as nurses.

“I’m sure that City Council is often faced with difficult decisions, what we are presenting here today is not one of them”, Rodney said. “This one decision definitely would be a win for everyone, which in turn means that the health and well being of Hamiltonians will improve”.

Rodney, who holds a Ph.D. but did not refer to themselves with the title Doctor, shared experiences of racism they encouraged during their career in nursing.

“I would also say that as a Black nurse who has been called a n****r by patients who has been asked where I was born, and what I’ve put in, they say ‘good for you’. Who has been told that I speak so well, who has had pens and pencils stuck in my hair by colleagues because my hair is so cool”, Rodney stated with exasperation. “Who has breathed a sigh of relief when I began at the ER and saw another black nurse because her presence meant that I didn’t have to shoulder the sole responsibility of constantly responding to racism, and that someone else wouldn’t understand how I felt having diverse representation on this board says to racialized front-line workers, who are often the only one, or one of a few, that there is greater chance they have support at the decision making table in others who can understand and appreciate the added layer of race that has made healthcare for many in this city, inequitable and inaccessible and oftentimes intimidating”.

Dr. Tim O’Shea says the Board of Health needs to have diverse representation to be more effective, and to ensure that well-meaning decisions do not in fact cause harm to diverse populations. “The effectiveness of … decisions are greatly enhanced by having the diverse voices at the table, particularly having community voices, voices of people who are affected directly by the policies that are put in place at the table.

“At this point, the Board of Health does not have broad representation from the community”, Dr. O’Shea stated. “The danger in setting up an organization such as the Board of Health, to not have broad representation is that decisions are made with good intentions that are either ineffective or in fact sometimes harmful to the communities that they’re intended to help”.

Councillor Jackson says he prefers to keep the status quo.

“Our Board of Health under Dr. Richardson’s leadership, and the Emergency Operations Team overall with yourself [Mayor Fred] Eisenberger, General Manager Paul Johnson, [Hamilton Medical Officer of Health] Dr. [Elizabeth] Richardson, the entire team have done an enormous yeoman’s job getting us through this awful unprecedented pandemic, the last 12 months”, Jackson stated.” So I want to stick that for the record today”.

Jackson stated he will oppose changing the composition of the Hamilton Board of Health.

“I will not abdicate my responsibility as a member of council elected to sit on all the standing committees of counsel, and on our board of health … if there seems to be an intent and a desire to have this report brought back and it’s moving us in the direction of potentially community members, non elected, equal voting decision making voices at this table, I’m sorry, I’m stating for the record right now. I cannot support that. I will not abdicate my responsibilities to the constituents of Ward Six”, Jackson said.

Council voted 10-2 to request staff present options for Board of Health reform at a future meeting.

IN FAVOUR: Mayor Eisenberger, Wilson (1), Farr (2), Nann (3), Merulla (4), Jackson (6), Pauls (7), Danko (8), Pearson (10), Partridge (15)
OPPOSED: Collins (5), Ferugson (12)
ABSENT: Clark (9), Johnson (11), Vanderbeek (13), Whitehead (14)