Proposed Hamilton board of health changes deferred to late this year


Published February 8, 2023 at 3:55 pm

A city councillor commented on the irony of his own motion before the elected leadership of Hamilton voted to defer board of health changes — on the margin of a vote by Mayor Andrea Horwath.

For about two years, spread across a change election last fall, there have been calls for the elected leadership of Hamilton to add health-care professionals to the board of health (BOH), rather than having it comprised solely by the mayor and city councillors. Ottawa and Toronto have added citizens with health-care expertise, with the intention of creating more responsive public health intervention to better support racialized patients, people with disabilities or those from vulnerable populations.

Last summer, during the previous term, Hamilton’s council wrote to the province to ask about the “feasibility” of doing so, with the notion that the decision would be presented this term. Creating such a board requires revising two provincial laws.

Ward 2 Coun. Cameron Kroetsch introduced a motion for the council meeting on Wednesday that called for the Hamilton BOH to have a standing committee with six city councillors, six community health professionals, and one education representative. He withdrew on a procedural ground. Ultimately, council voted 9-7 in favour of a motion from Ward 8 Coun. John-Paul Danko to study two reform options — reforming an advisory committee or taking a step beyond that to one that is “semi-autonomous.” The findings from staff would come back to a council sub-committee prior to the end of third quarter of the city’s fiscal year.

In introducing that motion, Danko mentioned that the COVID-19 pandemic showed the value of listening to “subject matter experts,” rather than politicians. The latter will make up the whole of the health board for a while yet, and still would have under Kroetsch’s motion, which was addressed at changing a standing committee.

“It is incumbent on us to reach everyone we can so we can be deliberate in our decision-making process,” Danko said, referring to the need to consult with disability advocates and seniors, among other groups. “My personal thoughts on the board of health is that I don’t see what the issue is with its current governance of the board of health. This term of council is a brand-new board of health, so we’ve never had the opportunity to see if there were issues with the previous board of health, if those carry over to the current council.

“Also, going through the (COVID-19) pandemic, a public health emergency that is unprecedented in the last century, my personal assessment of the board of health over the past term is that it was exemplary,” Danko added. “Working through those decisions that had to be made, and somewhat ironically, I think it worked best when council stepped back and allowed the MHP to provide their best advice and provide us with the direction forward without us interfering with politics. Kind of ironically, I suppose that makes the case for subject matter experts on the policy.

“But it’s important for us as a council to set a path, listen to the consultation and make an informed decision… this is not something we can do as a knee-jerk reaction. It requires a methodical approach.”

Coun. Maureen Wilson, though, noted that she had spent last weekend — her birthday weekend — poring over public health reports from decades ago. Wilson related that Black, Indigenous and racialized people, among others, would benefit from citizen representation on boards of health.

“In order to effect outcomes, governance matters,” Wilson said. “The recommendation in those documents from the 1970s was that those governance models be comprised of people whose health outcomes are unequal. That discussion has been going on for decades. Why do we continue to have these health outcomes, and why does our governance model not change?

“COVID-19 also had a disproportionate impact,” Wilson said. “I cannot speak for those groups, but those lived impacts have to be brought in at the beginning, not at the end. At the centre of public health is equity. We have had these deliberations for so very long. To be telling communities feeling the effects to ‘just wait’ is a disservice. We know what those impacts are. Let’s lean into our purpose, let’s lean into our privilege, and uphold the credibility of our institutions.”

Following the vote, the Hamilton Centre for Civic Inclusion likened the outcome to an “erasure of previous work done by community members, community (organizations). It noted that close to 200 people, in mid-2021, asked the city to consider the idea — which does remain in play today.

Danko and Ward 6 Coun. Tom Jackson, the seconder of the motion, are the two holdovers from last term who voted against asking the province about the possibility of a change. At that time, Horwath had not yet announced her run for mayor.

“I was really happy to hear the conversation here in Hamilton taking place about having a semi-autonomous board of health that was populated by members of council, as well as experts, as well as lived-experienced voices from our community,” the mayor said on Wednesday. “I agree, and believe, that’s the right direction for us to go. I can say, though, that I’ve been aware of these kinds of issues for some time now. I don’t know the extent to which other members of council, two-thirds around this table (10 of 16), are aware of it.

“I don’t think Q3 is too slow to learn about the benefits of a different way of governing public health in our city. It’s not a matter of getting something done. It’s a matter of due diligence.”

The vote somewhat broke along the suburban vs. urban line. Couns. Matt Francis (5), Esther Pauls (7), Brad Clark (9), Jeff Beattie (10), Mark Tadeson (12), and Mike Spadafora (14) also voted in favour.

‘Tied up in process’

All four lower-city councillors — Kroetsch, Wilson, Nrinder Nann (3) and Tammy Hwang (4) — voted against it. They were joined by Couns. Craig Cassar (12), Alex Wilson (13), and Ted McMeekin (15).

In 2021, dozens of doctors and community health advocates called for reforming the board of health. Former mayor Fred Eisenberger wrote to the province about the matter on July 19, 2022. Ontario Chief Medical Officer of Health Dr. Kieran Moore did not initially respond to it until the city sent it a second time.

Nann, one of two racialized councillors, said an ample amount of appropriate consultation has already occurred vis-à-vis board of health reforms.

“I don’t like being in this situation,” Nann said. “What I have humbly learned over 25 years of working with from equity-seeking communities is ‘we are tired of being consulted.’ I know that may sound difficult to understand if you are not from those communities. More consultation is generally better, but in this case I say ‘no’ because we have received years and years of opinion from Indigenous and racialized people who are also seniors, who are also living disabilities, who have other intersectional needs, and they have said the board of health needs to change.

“When people tell you they have been ‘over-consulted,’ our job is to acknowledge exactly what we have heard to date and be ready to respond with why we are not willing to act on those opinions,” Nann added. “It is the lack of action that causes distrust in our communities.”

Kroetsch emphasized that his motion only called for changing the composition of an advisory committee, and that council would remain the actual voting board of health.

“There has been a measured and long-standing approach that has gone on,” Kroetsch said. “This motion is not going to get us anywhere.”

Moore averred that board of health changes would involve revising the City of Hamilton Act, and the Health Promotion and Protection Act. (The latter is also supposed to give local public health officials the latitude to create pandemic protections.)

All of the discussion has come amid a vaguenss about the future of local public health units in Ontario. The Premier Doug Ford-led Ontario PC Party government, since 2019, has spoken about a public health restructuring that could compact the 34 PHUs into somewhere in the 10 to 14 range. But there has been no firm language from the province.

Councillors clear up kerfuffle

Clark, Jackson and Kroetsch, by public accounts, sorted out the differences from Tuesday. During a general issues committee meeting, Clark ordered Kroetsch ejected after he refused to withdraw a comment that Jackson’s phrase “everyday taxpayers” conjured up a loaded phrase, “old stock Canadians.”

Kroetsch, who previously chaired the city’s LGBTQ2SIA+ advisory committee, said there was healthy dialogue and apologies on Wednesday morning.

“I was trying, obviously unsuccessfully, to do something that so many queer folks before me have done in similar situations — to speak about the impact of something harmful that was happening,” Kroetsch wrote in a Twitter thread on Wednesday night.

” … the suggestion for me was that there were somehow a group of ‘everyday’ Hamiltonians whose concerns about their taxes were seen as important and valued, and a group of ‘other’ Hamiltonians whose concerns about taxes were of lesser value,” he added.

“To illustrate my point, some antonyms, or opposites, to the word ‘everyday’ are — abnormal, unusual, different, exceptional, and special. As a queer person, these words have all been used to describe my family, and me personally, in a very negative manner.”

Kroetsch added that Jackson had explained he had no such intention, and proffered an apology. The longtime East Mountain councillor, at the meeting, had said he was unaware of the phrase or the meaning it gained after then-Conservative leader Stephen Harper used it in a televised debate prior to the 2015 federal election.

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