Hamilton's board of health needs more diversity, local doctors and advocates say

Some Hamilton doctors, nurses and residents say they want city councillors to step aside from the board of health and make room for community voices. 

The board of health, which recommends policies and programs and advises the city's public health services, is made up of 15 elected councillors and the mayor — the same composition as council. But delegates in Monday's meeting stressed the need for the board to restructure and include diverse voices for better healthcare.

"It's about having that seat at the table and having your voice being heard," said Lyndon George, a community health equity advocate. 

Other communities, like Toronto and Ottawa, include people other than elected officials on their health boards. The board of health in Toronto has 13 members, including six council members, six members of the public, and one education representative.

Changing to this format would mean that people with lived experience, varying educational backgrounds, and expertise in healthcare would be a part of the conversation, George said.

Pandemic highlights health inequities

The call for change, he said, comes as the COVID-19 pandemic shines a light on how some populations are disproportionately more affected than others.

Dr. Theresa Tam, Canada's chief public health officer, urged for structural change in public health in an October 2020 report on an equity approach to combating the virus. She stressed the need the prioritize the perspectives and leadership of people who have experienced stigma and discrimination. 

City of Hamilton data in the fall also pointed out pre-existing inequities in healthcare when it reported that people of colour, low-income earners, and women were more likely to get COVID-19. Other reports in Canada had similar findings.

"Often times it is racialized communities, Indigenous communities calling for transformational change to address these issues," George said, noting that the 2007 SARS commission from Justice Archie Campbell called for change too.

"And the feel is that we're coming back and asking for similar things to improve healthcare so we can have it a little more equitable."

'Make change quickly'

Dr. Kassia Johnson, a developmental pediatrician, said that until now, health and community services have been placed separate from one another. But people exist in and move between these spaces, she said. 

While Coun. Brad Clark (Ward 9, upper Stoney Creek) raised the idea of a task force or committee to assess impacts from the pandemic, Johnson said it brings to mind "paralysis by analysis." She urged the city to "make change quickly."

"We have arrived at this conversation today because we don't see what we don't know," Johnson said. 

Dr. Elizabeth Richardson, the city's medical officer of health, said that it's her understanding that changing legislation for the board of health composition would require provincial government approval. 

George also said that having voices specifically at the board level would be important because there's often a "filter" that blocks genuine reflection of opinions from committees.

"We often are left feeling as if we are on the outside. That those issues are having to go through multiple steps to finally get to the point where we're having the honest conversation. And it can be quite frustrating at times,"  he said. 

Dr. Natasha Johnson, a pediatrician at McMaster Children's Hospital, described posting on the Canadian Paediatric Society's social media in June 2020 about her fears in the pandemic following the killing of George Floyd. Video showed a Minneapolis police officer kneeling on the neck of Floyd, a Black man, until he stopped breathing.

'I was actually terrified for my teenage son'

"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 risk because of the colour of his skin, would be seen as more threatening by wearing a mask in the community," she said.

Johnson said she wondered if this was on anyone's radar, and if the people making public health policy decisions were aware of the impact of discrimination on health, seeking care, and outcomes. 

As an example, Johnson, among other delegates, pointed to vaccine hesitancy among some racialized communities and how it's rooted in a history of distrust of the medical community due to systemic racism. 

Ruth Rodney, a York University assistant professor and Hamilton resident, said that as a Black nurse, "having diverse representation on this board says to racialized front-line workers who are often the only ones, or one of few, that there's greater chance that they have support at the decision-making table."

Dr. Tim O'Shea, an associate professor of infectious diseases at McMaster University — who works with Shelter Health Network and Hamilton Social Medicine Response Team — also spoke in support of restructuring. 

Councillors represent voters

The danger in the board's current structure, he said, is that decisions can be made with good intentions, but can be ineffective or harm the communities they're trying to help. 

Other physicians from McMaster University — including resident physician Dr. Claire Bodkin, hematologist Dr. Madeleine Verhovsek and pediatric surgeon Dr. Mark Walton — also said that a reformed board of health would lead to better care for the community.

The board voted 10-2 in favour of staff looking at governance models in other cities and reporting back.

Coun. Chad Collins (Ward 5) and Tom Jackson (Ward 6) were opposed. Jackson said when he sits on the board, he's representing his constituents, and he wouldn't "abdicate" that responsibility.

When staff report back, the question could be referred to the city's governance sub-committee.