Board of Health's Governance Structure

The COVID-19 pandemic was responsible for the worsening of existing health inequities both in Hamilton and abroad. In March 2021, delegations were received from the Hamilton community describing the impact of these inequities with a focus on racism, but also included other social determinants of health such as disability and environmental justice. Delegates advocated for the need to include diverse perspectives from community members when making public health decisions. This advocacy is consistent with the later published 2022 Community Impact on Equitable Vaccine Delivery in Hamilton report by the City of Hamilton and the Vaccine Readiness Network (VRN), an open membership group of community organizations and representatives that met regularly to inform Hamilton’s COVID-19 Vaccine Task Force. One of the VRN’s key lessons was the importance of embedding and applying anti-racism, equity, diversity, and inclusion in planning tables moving forward.

In Hamilton, the Board of Health is responsible for setting the strategic direction of public health in the city through the governance of Hamilton Public Health Services (HPHS). The Board is aware of the tenets of good governance, which include the principles of equity, diversity, and inclusion and other tenets such as stewardship, board composition, conduct and processes, relationship between governance and HPHS, community and key partner engagement, risk management, and Board evaluation. Fulfilling these tenets helps to ensure that public health decisions made allow Hamilton’s diverse community to reach their fullest health potential in alignment with the City’s overall strategic goals. Building off the March 2021 as well as subsequent delegations received in June 2021, September 2021, January 2023 and March 2023, Council has directed HPHS through two motions to engage the community to identify issues and opportunities with the current Board of Health governance structure and has listed other structures for consideration. Based on the results of this consultation, staff are to report back with to the Governance Review Sub-Committee by end of Q3, 2023.

What does Hamilton Public Health Services do?

HPHS offers a range of services and supports to improve and protect the health and well-being of Hamilton’s population and reduce health inequities. This includes immunization and screening for communicable diseases, education programs, family, child and youth health services, population health assessment, sexual health services, air quality monitoring, school services, dental services, food and water safety, injury prevention, and public health inspections. Nurses, doctors, public health inspectors, social workers, health promoters, epidemiologists, analysts, dental hygienists, and other trained public health professionals work with community partners to address the growing and changing health needs of our community.

What does the Board of Health do?

The Board of Health governs HPHS which includes approving the Annual Service Plan and Budget and making major policy decisions. The Board is also responsible for appointing the Medical Officer of Health and Associate Medical Officers of Health.

How is the Board of Health structured?

In Hamilton, City Council acts as the Board of Health. Currently, all City Council members meet monthly as the Public Health Standing Committee to discuss topics such as the delivery of programs and services or policy. Recommendations from these meetings are submitted to Hamilton City Council who, acting in their role as the Board of Health, make the final decision to approve or reject the recommendation.

How else could Hamilton’s Board of Health be structured?

Hamilton is exploring 3 different options on how to best provide good governance for local public health:

• Adding an advisory committee made up of community representatives to act as a consultation body to the Public Health Standing Committee. The Public Health Standing Committee would consider this advice in any recommendations made to the Board of Health. Final decisions would continue to be made by the Board of Health, which consists of only City Council members.
• Changing the membership of the Public Health Standing Committee to include both councillors and community representatives to provide recommendations to Council as the Board of Health. Final decisions would continue to be made by the Board of Health, which consists of only City Council members.
• Changing the structure of the Board of Health so that it is partly or fully separate from City Council. The new Board of Health would have final decision making shared between councillors and community members on some or all public health policy, funding, and staffing issues. As this would require changing provincial laws, Hamilton would need to advocate to the Government of Ontario for their preferred model. Certain models may limit the scope of decisions that can be made by the Board. For example, in Toronto, all policy decisions are made by the Board of Health, but budget and some staff decisions are made by City Council.

The questions in this survey will help us to understand what parts of these different models you may prefer with a focus on the tenets of good governance in which equity, diversity and inclusion play a key role.