CBRM Council Part Two: Health Check

CBRM Council held its regular monthly meeting last night and heard not one but two presentations on healthcare.

All told, they spent almost an hour on the issue and if you think that means they heard interesting, concrete proposals for solving our healthcare problems then [SPOILER ALERT] you’ll be as disappointed as I was.


Party time

First up were Cape Breton Centre NDP MLA Tammy Martin and the leader of the provincial NDP, Gary Burrill. I was interested to hear what they had to say for one, very selfish, reason: I’ve been having ongoing debates about healthcare with a staunch liberal of my acquaintance (who shall remain nameless) whose response to my complaints about the healthcare system is always: but what are the Tories and NDP going to do to improve things?

So as Martin and Burrill took the podium, I sat with pen in hand, ready to transcribe their prescription for Cape Breton healthcare. And they presented this:

(Apologies for the quality of those images, but slide presentations reproduced for distribution at CBRM Council meetings always look as though they’ve been photographed underwater.)

Councilor Eldon MacDonald, having listened to the presentation, said that if the NDP had a solution to our healthcare problems, they needed to present it now — not keep it secret so that other political parties couldn’t steal it. Burrill responded by saying that he was sure the councilor didn’t want to hear the NDP’s thoughts on primary care, emergency care, long-term care and mental health care — which I think is precisely what the councilor wanted to hear. Burrill and Martin had 20 minutes — they could have offered at least one, solid suggestion in any of these areas and I suspect it would have gone over very well. Instead,¬† they promised to keep the hospitals in Glace Bay and New Waterford open.

Except not necessarily the two, actual, physical buildings — they were open to constructing new buildings.

Which, the last time I checked, was precisely what the Liberals are proposing.

But all was not lost — Burrill drew the connection between poverty and health in a refreshingly direct way, which led to a discussion of the NDP’s proposal for fixing the province’s equalization system, which allowed Burrill to reiterate the NDP’s position, which is to inject $50 million into the CBRM budget each year for three years while working out a more equal equalization system.

Councilors, for the most part, received this promise cautiously.

Eldon MacDonald took the opportunity to remind Burrill and Martin that former NDP Premier Darrell Dexter¬† and former Cape Breton Centre MLA Frank Corbett had stood before Council and promised the province would take on the full costs of “education, healthcare and housing” only to abandon the plan once in office. Corbett, MacDonald suggested, had had no choice but to go along with the decision in the name of party unity.

“Party politics,” said MacDonald, “drive me crazy.”

I have to say, I couldn’t agree more.


What Makes Us Sick?

Next up, the Community Health Boards of the CBRM.

If you’ve never heard of a Community Health Board, welcome to the club — I hadn’t either. And frankly, I still don’t really understand what they do. And this slide wasn’t particularly enlightening:

That first descriptor is a little confusing — the Community Health Board is not our eyes and ears, it’s the eyes and ears of the NSHA in our community, which is not at all creepy.

As for setting priorities and taking action, I’m not sure how much of either they actually do, which is not to slight Carol MacLellan, the co-chair of the Northside-the-Lakes Community Health Board, who presented so well last night, I found myself wishing she headed an organization that actually did set priorities and take action.

As best I can figure, the Community Health Boards (there are 37 in total in Nova Scotia and they consist entirely of volunteers) ask people about their healthcare priorities and develop a “collaborative community health plan,” the latest of which (2019-2022) they presented to Council last night. Credit where credit is due, the health boards seem to be very good at this and that’s no small thing — MacLellan says for their most recent plan they had input from 600 citizens, which is a statistically significant sample for Nova Scotia.

Also worth noting: this plan is the first presented jointly by the three Cape Breton Community Health Boards — Northside-the-Lakes, Central Cape Breton County, East Cape Breton County.

And some of the information presented last evening was honestly interesting — particularly this diagram illustrating the social determinants of health (which I think means everything other than the genetic determinants of your health):

I’d love to tell you the source of this information, but I can’t read the slide, for the reasons noted above. Here’s a better version from the Community Health Boards’ web site. The graphic apparently comes from the Canadian Medical Association:

Social determinants of health (Infographic courtesy of the Canadian Medical Association.)

Infographic courtesy of the Canadian Medical Association.


As you can see, access to healthcare (or more accurately, the lack thereof) accounts for 20-25% of what makes you sick. Socioeconomic factors — including income — account for 40-50%.

Again, that link between poverty and health.

So while the Cape Breton health boards’ first priority is access to healthcare, its second is economic conditions. MacLellan told Council conditions on the island had inspired the board’s “biggest leap” to date, which was to advocate for a poverty reduction program. (I found it curious that this should be considered such a big leap so I took a quick look at some of the recommendations made by other boards and found the Northern Zone boards advocating for a living wage.)

The Community Health Boards seem to be made up of engaged and hardworking volunteers (mainly women, as you can see from the photos):

I’m very curious as to how much impact their work is having on healthcare in this province, although the fact that people constantly invoke the word “crisis” to describe conditions here suggests I already know the answer.

My initial impression is that the boards are to healthcare what school advisory councils are to education — safe, powerless organizations into which a provincial government obsessed with centralization (another point made by NDP leader Gary Burrill) can channel citizen concern and anger.

Which is, again, not to denigrate the work the Community Health Boards do — quite the opposite. They seem to have done an excellent job of surveying the public about healthcare and if their recommendations are a bit too vague and broad (which MacLellan herself acknowledged might be a criticism) their priorities seem right. If only they had more influence.

That’s my first take — but I think this is a subject I should look into in more detail.


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