Council opts to study health board reform
City politicians disagree on how to approach governance question, or if change is even required
The city will seek feedback and report back on potential changes to Hamilton’s board of health rather than immediately pursue a new, more diverse body that includes health experts.
“This is not something that we can do just as a knee-jerk reaction,” Coun. John-Paul Danko said in making a pitch Wednesday for more study on the topic.
But board reform has already been the focus of years of input from Indigenous and racialized communities, Coun. Nrinder Nann countered.
Such “lack of action” shakes “faith” in city politicians, Nann added.
“That we are not going to continue to kick decisions down the line and get them tied up in process when the ability is there to make these changes.”
The existing board of health is made up Hamilton’s 16 council members. Despite having the same membership, its decisions must be ratified at council meetings.
Critics of the model have contended it must change to put health experts and equity-seeking voices at the table alongside councillors, as in the case of autonomous boards in Ottawa and Toronto.
Those calls for reform have been heard, and he supported the past council’s direction to explore changes, Danko said.
But the governance question hasn’t been the subject of “scientific, rigorous” consultation, including with seniors and people with disabilities, nor has the city examined its various elements with the “best evidence possible.”
Danko’s motion, which carried on a 9-7 vote, directs staff to consult with city advisory committees, community partners, health-care professionals and the public on the board’s governance.
They’re to report back with options, including a board of health advisory committee, and continue exploring a “semi-autonomous” board by the third quarter of this year.
Danko noted his pitch was a “clear alternative” to Coun. Cameron Kroetsch’s more immediate call for a restructured body.
Kroetsch’s motion proposes a board blended with six community health professionals — such as doctors, harm-reduction workers and disability justice advocates — and an education representative. They would sit alongside six councillors.
A selection committee is to be struck to choose members.
Kroetsch, who delayed his motion until late March for procedural reasons, noted a range of community experts have pushed for such a model for years.
As such, taking action on that advocacy is “not a knee-jerk reaction to anything,” he added.
More consultation and study, including a potential health advisory committee, is “not going to get us anywhere in terms of what we’ve been asked to do by the community.”
Mayor Andrea Horwath said she was pleased to learn as Hamilton Centre MPP that her hometown was exploring a more diverse board of health with community and health experts.
“I agree and I believe that that’s the right direction for us to go,” said Horwath, who was elected mayor in October.
She’s well acquainted with the topic, but with 10 new council members, including her, it makes sense to make sure all are “up to speed” on the important issue.
Horwath said she’s “not interested in ‘kicking things down the road,’ ” but council must do its “due diligence,” to find a model that best addresses the social determinants of health.
There has been resistance to changing the existing board, however, with some councillors expressing concern that a new structure would supplant elected officials, who are responsible to constituents.
In an interview Wednesday, Coun. Tom Jackson reiterated that trepidation, saying he seconded Danko’s motion with an eye to a potential advisory committee, rather than a reworked autonomous board.
“I want diverse voices. I want professional medical staff. Can’t they be part of a prestigious advisory committee?”
Creating a board like in Ottawa and Toronto would “likely” require legislative amendments and cabinet approval, Dr. Kieran Moore, Ontario’s chief medical officer of health, wrote in a Monday letter to Horwath.
But an ad hoc advisory committee, which can include citizens, wouldn’t face that obstacle, Moore noted.
The aim of his motion isn’t to create an autonomous board like in Ottawa and Toronto, Kroetsch told The Spectator. “That’s a different discussion altogether.”
Rather, the membership shakeup would preserve the existing advisory role of the board, which is really a standing committee, he said. “Can we involve the community in that?”
Letters from health professionals on Wednesday’s agenda urged support for Kroetsch’s proposal.
“Health outcomes are the result of complex interactions between our physiology, health system, politics, and socioeconomic statuses,” Dr. Anjali Menezes wrote.
“Navigating such complexities should be done with the valuable input of local health experts,” added Menezes, a family doctor.
“Representation matters, and racialization impacts the political attainment and representation of people from racialized and other equity seeking-communities in elected positions.”
Danko, meanwhile, told his colleagues he didn’t see problems with the current governance structure, which served Hamilton well through the onslaught of COVID-19.
“And somewhat ironically, I think, it worked best when council sort of stepped back and allowed the medical health professionals to provide their best advice.”
I want diverse voices. I want professional medical staff. Can’t they be part of a prestigious advisory committee?
TOM JACKSON WARD 6 COUNCILLOR