Important to know how city decisions impact our health


For many years, a close colleague at the city has been encouraging me and others to attend and make presentations at Toronto Board of Health meetings because she is keenly aware of the issues and decisions taking place at these meeting and how they affect members of our community. I finally took her advice and attended my first Board of Health meeting recently; it won’t be my last.

In Ontario, the Health Protection and Promotion Act requires boards of health to provide or ensure provision of a minimum level of public health programs and services in specified areas. The Board of Health determines and sets public health policy and advises city council on a broad range of health issues. Recommendations with city-wide or financial implications are forwarded to city council for final approval.

The Board of Health has 13 members – six Toronto city councillors, six citizen representatives and an elected school board representative. The Medical Officer of Health for the City of Toronto, Dr. David McKeown, is the executive officer of the board.

I suspect a similar board of health structure is in place for all cities in the province.

Among a number of issues on the agenda of the meeting that I attended, was a presentation led by Dr. McKeown on a new report entitled Healthy Toronto by Design. This report was prepared to inform the board, city councillors and staff of the major impacts cities have on health, and highlighted the role of local governments in creating healthy and prosperous cities, keeping in mind that a prosperous city provides its residents with opportunities for good health and, at the same time, a healthy population is needed for a city to prosper.

Since the conditions where we live, learn, work and play influence our well-being and the prosperity of the city, it is therefore important to consider how municipal decisions on policies, programs and services impact health.

Consider the responsibilities of local governments – policing, firefighting, transportation, sewage, drinking water, waste management, planning and development, infrastructure, social welfare services, parks, recreation, libraries, employment services, cultural services, affordable housing and public health.

The Healthy Toronto by Design report challenges local governments to be aware of health issues embedded in all of their policies, programs and services. It would involve applying a health impact assessment to inform decision-making such as the re-development of a neighbourhood, the composition of housing units in a new condo development, the closing or amalgamation of elementary schools, adding bike lanes to residential streets, or protecting green space for community gardens and parks.

In describing the report, McKeown made reference to a “health lens” being applied to decision making. I agree. However, I would add that, in Toronto, one of the world’s most multicultural cities, where non-Whites will be the majority in our lifetime, it is imperative that, if any health lens is to be applied in decision-making, as it should be, it must be a “health equity lens”, a lens that not only considers the health impact of decisions but does so with an awareness and analysis that those impacts are unequal among populations.

And also that the root causes of some of the impacts will differ, particularly for Black people (people of African descent) and other populations for which racism and its negative impact is alive and well.

Greater equity and social inclusion must be a desired goal because it not only improves the health of those who are at greater risk, it contributes to the overall prosperity of the city which creates a better environment for all people to reach their maximum human potential.

Although the Healthy Toronto by Design report makes reference to and addresses factors such as natural environment (air and water quality, green spaces), built environment (bike lanes, walking paths, parks), transportation, housing, income and employment, education, food security and health services, the areas that received the most discussion by board members were transportation and housing.

Although every board member and councillor who spoke praised the report, the challenge, as one councillor emphasized, is in the implementation: “That’s where the rubber hits the road”.

When a plan to implement bike lanes or close your road to cars on certain days or times comes to your neighbourhood, how does one get residents to agree with or see the value in the change if it is perceived as an inconvenience or disruption to businesses or how things are being done currently? One board member responded that a community engagement program should be developed and implemented.

Another good idea. People are more likely to support change, in whatever form it may take, if they had a voice in the process; if effective steps were taken to allow them to contribute. Furthermore, a well orchestrated community engagement process allows for fresh ideas to emerge, along with potential pitfalls that may not have been previously considered.

Hidden or underlying the challenge of effective community engagement is ensuring that every effort is being made to include people who are representative of the city’s diverse communities and to eliminate barriers to people’s participation. That means consideration of the time of day of meetings, the possible need for child care, location of meetings, provision for public transportation, language and so forth. For harder-to-reach populations or groups, it will require a strategic approach for their engagement.

To have our community represented at the table where decisions are being made which affect us is the biggest challenge. For us, that’s “where the rubber hits the road”.

The Board of Health’s monthly meetings are open to the public. The agenda with the list of topics to be discussed and associated documents are posted on the City of Toronto website before each meeting.

I would encourage anyone, particularly those working in the health and social sector, to take a minute and look at the upcoming agenda items. There is likely to be a topic or two that interests you.

Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto, and the President of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community.  He can be reached at 416-447-7600 or

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