HANSARD
NOVA SCOTIA HOUSE OF ASSEMBLY
STANDING COMMITTEE
ON
HEALTH
Tuesday, June 9, 2026
COMMITTEE ROOM
Brotherhood and Sisterhood Programs
Printed and Published by Nova Scotia Hansard Reporting Services
HEALTH COMMITTEE
Danny MacGillivray (Chair)
Adegoke Fadare (Vice-Chair)
Julie Vanexan
Ryan Robicheau
Nick Hilton
Lisa Lachance
Rod Wilson
Hon. Iain Rankin
Hon. Becky Druhan
[Lisa Lachance was replaced by Suzy Hansen.]
In Attendance:
Gordon Hebb
Chief Legislative Counsel
Judy Kavanagh
Legislative Committee Clerk
WITNESSES
Nova Scotia Health Authority
Dr. Annette Elliott Rose, Chief Nurse Executive & Vice President,
Clinical Performance & Professional Practice
Dr. Ron Milne, Family Physician and Brotherhood Physician Lead, Central Zone
Mahogany O'Keiffe, Senior Director, EDIRA
Department of Health and Wellness
Joy Knight, Senior Executive Director, System Integration
Rod Francis, Executive Director, Equity and Engagement
HALIFAX, TUESDAY, JUNE 9, 2026
STANDING COMMITTEE ON HEALTH
1:00 P.M.
CHAIR
Danny MacGillivray
VICE-CHAIR
Adegoke Fadare
THE CHAIR: Order. I call the meeting to order. This is the Standing Committee on Health. I am Danny MacGillivray, MLA for Pictou Centre and the Chair of this committee. Today we will hear from the Nova Scotia Health Authority and the Department of Health and Wellness regarding Brotherhood and Sisterhood Programs.
A reminder to please set your phones to silent. Don't touch your microphones; staff will take care of that. They'll light up automatically once I call your name. Before members introduce themselves, I'd like to welcome MLA Vanexan and MLA Druhan as the newest members of this committee. Welcome to the committee.
Now I ask committee members to introduce themselves for the record by stating their name and constituency. We'll start to my left.
[The committee members introduced themselves.]
THE CHAIR: For the purposes of Hansard, I'll also recognize the presence of Chief Legislative Counsel Gordon Hebb to my left and Legislative Committee Clerk Judy Kavanagh to my right. I'd like to welcome the witnesses here this afternoon. Thank you for taking the time out of your day to appear here. I'll ask you to please introduce yourselves, starting on the left.
[The witnesses introduced themselves.]
THE CHAIR: I understand we have two opening remarks. We'll start with Ms. Knight.
JOY KNIGHT: My colleague Rod Francis and I and my Nova Scotia Health Authority colleagues are really pleased to be here with you today to speak about the successes, impact, and importance of the Nova Scotia Brotherhood and Sisterhood programs. We also look forward to discussing more broadly how these and other initiatives contribute to advancing health equity across Nova Scotia.
Everyone's health care journey is unique. That journey begins long before you step inside of a hospital, a clinic, or a doctor's office. We know that the social determinants of health, such as income, education, racism, and access to opportunities all play a critical role in shaping individual and population experiences and health outcomes. It is why programs like the Nova Scotia Brotherhood and Sisterhood are vital to improving access and health outcomes for Black and African Nova Scotians. They work to address longstanding systemic, social, and health inequities experienced in these communities by bringing together supports and services for medical, social, and emotional needs in a holistic, community-based approach and a safe and supportive environment.
The Nova Scotia Brotherhood was launched in 2015, and by 2023 was expanded to include the Sisterhood to support Black and African Nova Scotian women and gender-diverse individuals. We know their great work is making a difference. In the past year these programs have facilitated more than 5,600 appointments and services from primary and mental health care to health promotion, education, and helping people to navigate the health system.
As essential as these programs are, it is also the responsibility of the department to take action, to recognize and address the systemic barriers creating unequal access to care in Nova Scotia and the impact that this has on health outcomes. We must ensure that our efforts to recruit, retain, and train health care professionals are representative of the diverse communities that we serve.
We are committed to supporting initiatives that address these realities, and I look forward to sharing more with the committee today on this. The change that is required will take time, but we are committed to a collaborative approach that includes working with health care providers, health system partners, and most importantly, with community. Thank you, and we welcome your questions.
THE CHAIR: We'll ask Ms. O'Keiffe for opening remarks as well.
MAHOGANY O'KEIFFE: Good afternoon. My name is Mahogany O'Keiffe, and I recently joined Nova Scotia Health Authority as a Senior Director of Equity, Diversity, Inclusion, Reconciliation, and Accessibility. I am joined here today by Dr. Annette Elliott Rose and Dr. Ron Milne. We look forward to providing some updates around Sisterhood and Brotherhood.
I'm going to begin by providing a bit of history, specifically the use of “Black” and “African Nova Scotian.” African Nova Scotians are a distinct group in our province, with 52 historical African Nova Scotian communities dating back over 400 years. Black Nova Scotians are another distinct population group who may have arrived as newcomers to Canada, from America, or from Canada's other provinces.
Anti-Black racism affects all social and structural determinants of health, and it is rooted in our unique history and the dehumanizing experience of enslavement caused by the oppressive legacy of colonialism. It is deeply entrenched in most institutions and functionally normalized or rendered invisible to our larger society.
For example, I'm sure it would come as a surprise to many that Dr. J. Marion Sims, credited for their work in the field of gynecology, conducted surgeries on enslaved Black women without anaesthesia or consent because it was theorized that Black people felt less pain than their white counterparts. Or there's the 40-year Tuskegee study, where the U.S. Public Health Service deceptively injected 400 Black men with syphilis and deliberately left them untreated so they could observe the disease's progression.
Current research shows that anti-Black racism is a structural driver of poor health, shaping access to care, treatment quality, and long-term outcomes for Black communities.
There are higher rates of hypertension, mental health strain, and unmet health needs among Black individuals and African Nova Scotians.
In response to needs of members of community, the work of the Brotherhood and Sisterhood programs and services aims to improve preventive care and screening, primary care supports, and access to specialized services, mental health care, and much more. There was a recent article, which I'd love to share, on CBC that quoted a patient as saying, “This is more than just a doctor's office. I feel validated and seen, probably for the first time in my life.” I can personally say that I've accessed the services and I have felt seen. The Nova Scotia Brotherhood and Nova Scotia Sisterhood programs are powerful examples of what becomes possible when care is shaped not only by medical experts but by cultural understanding, community trust, and lived experiences.
The success of the program over the past decade is not measured only in appointments booked or services delivered, though those numbers and the demand for the services continue to grow. Their success can be measured by the Black or African Nova Scotian man who finally felt safe and comfortable managing his diabetes. The success of the Sisterhood can be measured by the Black or African Nova Scotian woman who finally felt comfortable completing cervical cancer screening.
The Brotherhood and Sisterhood programs have directly improved access to care, improved screening rates, and supported better management of chronic conditions. They have helped us strengthen trust between the Nova Scotia Health Authority and Black communities and shown where the Nova Scotia Health Authority must do better. The Brotherhood and Sisterhood programs are proof that meaningful change begins with listening, believing, and partnering, and that we cannot improve health outcomes, without first acknowledging the legacy that created the differential treatment in the first place.
I look forward to sharing more about these programs as we continue our discussion here today, and highlighting what is possible when health care is shaped by the voices, strengths, and lived experiences of the communities we serve. I'm so happy to be here.
THE CHAIR: Thank you, Ms. O'Keiffe.
Again, the questioning is 20 minutes per party. We'll start with the NDP to my right. MLA Wilson.
ROD WILSON: Thank you, everyone, for coming today. I wish we had you for the whole afternoon. There's so much I'd like to learn about the work that you're doing.
The first question I have is probably related to the people at the Nova Scotia Health Authority - or the Department of Health and Wellness. As you mentioned in your opening comments, this started in 2015 and expanded in 2023. At that time, my understanding - the Health Equity Framework was released.
In preparation for today, I was looking for metrics of any measurements - key performance indicators and any evaluation of quantitative or qualitative - what's been the impact, not only since 2015 but also in the last three years? I may have missed it, but I'm just wondering if someone can speak to what metrics are being measured. What are the key performance indicators? Is that information available to the communities and to the public?
THE CHAIR: Mr. Francis.
ROD FRANCIS: From the Department of Health and Wellness's perspective, we have a staff equity strategy that we are currently implementing. It's certainly comprised of initiatives focused on creating safe and supportive work environments within the Department of Health and Wellness. We also have what we call the LEAP, which is the Leadership Equity Achievement Program, which is designed to support staff from underrepresented communities to advance in leadership positions within health.
From a department perspective, those are some of the initiatives and programs that we currently have in place, and we're starting to see more people, students, particularly individuals applying for positions within the Department of Health and Wellness because they see themselves now within that work environment. We've revamped our EDIRA committee. Certainly, that enables department staff to grow an equitable, inclusive work environment. We have an Equity Youth Health Experience Program and a Black Youth Development and Mentorship Program.
These are just some of the initiatives that we currently have within the department. When it comes to measuring it, it's a constant process for us. One thing that we are moving towards and doing the work is really shifting the focus from a community involvement process to a community-guided process with our communities, because it's important that the communities guide us in this work. We are learning all the time. As we continue to move forward with that piece, it's important that we continue to listen, learn, and be guided by the communities in which this framework was created.
It's shifting, and it's really good to see how, because we've moved to that community-guided approach, we're starting to see positivity there.
ROD WILSON: I want to be more specific. You spoke to the process, but again, I'm wondering what metrics and evaluation there has been - what community feedback you've received, what metrics are there to ensure the programs are meeting the needs of communities. In metrics and evaluation, we use them to adjust - do the programs have the right resources? Can you be more specific about what you've heard and what you've listened to, and how you pivoted in terms of what metrics you're using to ensure the programs are having an impact? Also, what's the community feedback for the programs?
ROD FRANCIS: The feedback has been positive, for sure. We're starting to put - from an evaluation perspective, it's a constant evaluation. One thing that, since coming into the department as executive director, I've been really focusing on in equity and engagement is how we do engagement. That's how we collect that information: through community voice, listening, and doing more engagement. From an evaluation perspective, that's how we're gathering that information: by being in community, listening to community, and allowing them to guide us.
ROD WILSON: Which adds to my next question. I couldn't find what I was looking to see what the metrics were and what evaluation has been done. Is any of that publicly posted?
ROD FRANCIS: Not that I'm aware of, but I can certainly get back to you with that answer.
THE CHAIR: MLA Hansen.
SUZY HANSEN: I want to talk about the effects of environmental racism on health in this province. Dr. Ingrid Waldron recently published a study on the health effects of the Shelburne town dump. She spoke to 39 African Nova Scotians who grew up in that particular area and are still living there today. They believe that the high rates of cancer and COPD in their community are linked to their exposure to hazardous substances from the dump.
[1:15 p.m.]
My question is to Mr. Francis or Ms. Knight. What is your department doing to address the health effects of environmental racism?
THE CHAIR: Ms. Knight.
JOY KNIGHT: We do work very closely with our Public Health colleagues around understanding the population health changes and impacts that they are seeing. We've recently engaged in conversation in another part of the community with similar concerns, and I know that they play a critical role in helping us to understand and monitor what those impacts look like.
It's not an area that I'm necessarily an expert in, but I know we have to pay really close attention. In my role, we're focused on policy and standards and strategy for clinical care in the province, and we want to make sure that the policies and standards that we're setting should dictate and allow us to understand the outcomes that we have and the expectations we have for the well-being of Nova Scotians. If we're not aware of the environmental impacts of where people are living, we're not targeting our resources and our funding in the right places and we're not working with our Nova Scotia Health Authority partners in the right way to drive investment where we know it's needed.
We try to stay very closely in tune with those conversations and inform our policy and our funding decisions as a result.
SUZY HANSEN: I'm glad to hear that you're taking the information so that you can apply them in ways through resources and funding that are going to directly affect or impact these particular harms.
I'm just wondering, has the department allocated anything in particular to help with these health effects of environmental racism? Are there any specifics or any areas in which funding or resources have been allocated to be able to address some of these things?
JOY KNIGHT: I'm not aware of specific funding targeted to the community that you mentioned. I'll have to take that away and connect with my colleagues around what may be happening in that area.
SUZY HANSEN: Dr. Milne, the Nova Scotia Brotherhood held an official launch event with the Nova Scotia Health Authority a decade ago. Since then, the Brotherhood has helped many Black men get health care across Halifax. We've heard testimony today, and I've known many in community. But we know that there are 52 African Nova Scotian communities right across the province. Moving forward, do you hope to see the Brotherhood expand to more rural areas of the province with the support and services and resources that are needed to do that work?
THE CHAIR: Dr. Milne.
DR. RON MILNE: The answer is yes. We have done outreach in several communities outside of HRM - the Truro area, the Valley. A few years ago, we went to Whitney Pier and did a presentation there. People in those areas are just crying out for health care, but particularly health care that meets their needs, is culturally competent, and has providers who look like them and understand the culture.
A group of us two years ago developed a plan led by Dr. Leah Jones. She couldn't be here today, but she's the Sisterhood physician. She's just back after maternity leave, so she's quite busy. We developed an idea around Black centres of excellence. The plan was to start in the HRM area with several locations and then expand the principles of the Brotherhood right across the province to meet the needs of the other communities that aren't being addressed.
We have a proposal. It's a three-phase proposal. We've presented it to the Department of Health and Wellness several times now, and we're hoping to work with them and with the Nova Scotia Health Authority to bring this into reality. Basically starting off, we're looking at two locations in the HRM area - the historic house that Dr. Ligoure had in the North End. People may not know about him, but he was a physician from Trinidad who worked - not for very long, four or five years, maybe - in Halifax but had a huge impact during the Halifax Explosion, where he turned his house into a hospital, basically, and treated people of all races in his home. That is one location, which is owned by the Province, so we're hoping to develop that.
The other one is in the Akoma area where the Nova Scotia Home for Colored Children was, where a nursing home for African Nova Scotians is in the development stage. We're hoping to be a part of that in partnership with, of course, community, have a community board, hopefully involve IWK Health as well. Right now, we really treat people aged 18 and up, but we're hoping to make that connection. Families, children - we have women now because of the Sisterhood.
Yes, it's definitely in the planning stage, we've made the presentations, and we're hoping to get a positive response from the Department of Health and Wellness.
SUZY HANSEN: I await to see the amazing things that come from that. I think there are huge benefits and impacts that that will have for all of those communities. I want to direct this to the Department of Health and Wellness. Mr. Francis, why haven't we seen these great programs expanded across the province? Is this something the department is looking at doing? We've just heard that it has been presented a number of times. I'm curious to know why we haven't moved forward with community voice and community-guided information?
THE CHAIR: Mr. Francis.
ROD FRANCIS: We received the proposal earlier this year, and we committed by the end of June to going back and meeting with that group to have a conversation and see where that proposal's going to go. We're committed by the end of June.
THE CHAIR: MLA Hansen with seven and a half minutes remaining.
SUZY HANSEN: I'm going to hand it over to my colleague.
THE CHAIR: MLA Wilson.
ROD WILSON: Pursuing that question, is there funding in the current budget or a process that would allow the proposal that Dr. Milne has presented to allow it to be created this year, or would this get deferred to yet another budget year, if approved?
THE CHAIR: Mr. Francis.
ROD FRANCIS: That I cannot answer at this time, but I can certainly get back to you on that one.
ROD WILSON: What would be the usual process within the department if you received a proposal like Dr. Milne's during the mid-year and it was approved and required funding? If that were to happen, what would be the usual process?
THE CHAIR: Ms. Knight.
JOY KNIGHT: Because it's an unfunded proposal at this time, we would seek government approval of what we bring forward and recommend.
ROD WILSON: What minister would that go to? The Minister of Health and Wellness, the Minister of African Nova Scotian Affairs? Where would that approval come from - the Treasury Board?
JOY KNIGHT: I appreciate your mentioning ANSA there. I think you did. It would be a partnership approach. We want to make sure that all of our government departments are engaged in that work. We talked about the social determinants of health, and there's a role for engagement with our colleagues at the Department of Opportunities and Social Development, the Office of Addictions and Mental Health to make sure all of the right pieces are in place and that if we're able to move forward with a recommendation to government that there is a commitment from all aspects of government that are needed to make this successful. Those are the pieces in play right now. Those are the conversations we want to secure so it's an endorsement of that proposal. We would be seeking government approval through Treasury and Policy Board.
ROD WILSON: Dr. Milne, (inaudible) what are you most proud of in your Brotherhood and Sisterhood Programs, and what would you like to see happen besides the proposal you've presented? What are you most proud of and would like to see expanded?
THE CHAIR: Dr. Milne.
RON MILNE: I'm proud of a lot of things. I think we started this journey - first of all, I practised in Ontario for many years, though I'm born and raised in Halifax. My grandfather was one of the first Black physicians in Nova Scotia many years ago. It's been a vision of mine to come back to Nova Scotia and in some small way try to carry on some of the work that he did. I feel like we've accomplished that in a lot of ways by bringing forward a lot of the issues of social determinants of health and the problems that the Black community has encountered in getting equitable health care.
Our programs all work toward addressing the social determinants of health, and not only in our clinics, which are an important part of it; we have many other programs. We have clinical therapists. We have developed a good working relationship with the Department of Psychiatry under Dr. Vincent Agyapong, who's the head. We have direct access of our patients to providers who look like them and have the cultural competence that they need. We have a dietitian. We have a program with a lawyer - pro bono - that our clients have. We have a walking and running program. We have book club. We have - one of the things I'm most proud of is barbershop clinics, which we developed through Brotherhood. It's a model that other groups have picked up on. It's a safe space for Black men to come and talk about issues that affect them in their health, as well as other areas of the social determinants of health. We have a Nova Scotian Black Men's Health Conference. This will be our seventh year this year. Last year we had 300 participants.
We just came off a very successful program that was not a Brotherhood program directly, but we were connected with it. The Black Men's Health Summit - 130 men at the Tatamagouche Tim Horton Children's Camp. Again, a health-related event.
We have connections with the court that we've established - the Domestic Violence Court Program as well as the Wellness Court Programs - supporting African Nova Scotian men. We have advocacy at the Abbie J. Lane Memorial hospital for psychiatric in-patients. We have an anger management program. We've done outreach to federal and provincial corrections.
There are a lot of things that are not just me; we're a team. We're very proud of what we've done. I think we've made a huge impact in the health of African Nova Scotians.
THE CHAIR: MLA Wilson, one and a half minutes remaining.
ROD WILSON: I will leave you with a question that we'll catch up with in my next round. What will the proposal that you submitted allow you to do that you're not currently able to do? What does success look like with that proposal in terms of the impact on the communities?
THE CHAIR: Dr. Milne with one minute and five seconds remaining, if you'd like to...
ROD WILSON: We can follow up on that.
RON MILNE: Okay, good. Thanks for the question.
First of all, it will be totally community based. We'll have a community board, which will be our governance. We'll have locations that are in the community. We'll have providers who are of African descent, mainly. We'll have our staffing, budget, physical spaces that we need. The physician payment model is another issue that has dogged us, really, since we started this program.
I think as far as extending it out, there are 52 historic Black communities, as Mahogany mentioned, that are really crying out for health care that's representative of their needs. We want to go forward with that as well.
THE CHAIR: Order. Sorry. Thank you. We'll now move on. The 20 minutes have elapsed. We'll now move on to the Liberal caucus. MLA Druhan.
HON. BECKY DRUHAN: I'm actually going to continue on with the thread that my colleagues were asking about. I'll just pick up, I think, where we left right off a moment ago in relation to access for rural Nova Scotian - Black and African Nova Scotian communities across the province.
Dr. Milne, I appreciated your description of the outreach that has previously been done and the proposals that have been submitted to expand access to that, but I wonder if you could talk a little bit more and describe any other ways that rural Nova Scotians can access programs, or to the extent that they can't, where you see those gaps being most significant.
[1:30 p.m.]
THE CHAIR: Dr. Milne.
RON MILNE: I think at the moment, in the Northern Zone - Truro - we've extended some service there that's in the development stage - also in the Western Zone. We're sort of in the contact stages right now with the Eastern Zone, where there's a lot of need as well. A lot of it is aspirational. I think part of what we may be able to do is through virtual care, because we just don't have the providers. There's only one Brotherhood physician; that's me. I'm not at the beginning of my career, as you can probably tell - I'm towards the end of my career - but I'm hoping to see some of these programs be carried on and be something that will continue.
I think those are some areas where we can make an impact in those communities, but we need manpower - person power. We do have two physicians now with the Sisterhood - they're both part-time - and a nurse practitioner whom we're trying to retain funding to keep and expand. There's potential there to do those things in terms of support, but I think where the money is is really with the Black centres of excellence. That's where we can make the biggest impact, in my opinion, on the whole province.
BECKY DRUHAN: I think expanding on that and the prospects for extending these programs so that the reach can be expanded - there's a proposal in place now, and I'm just curious in terms of financing and budget cuts. I think this is probably for DHW. We did see many cuts to important programs and initiatives that support Black and African Nova Scotian communities, as well as Mi'kmaw communities, in this fiscal year. I'm wondering: Have those cuts impacted the funding for the Brotherhood and Sisterhood programs? Has the funding changed? Has it been decreased as a result of those cuts?
THE CHAIR: Ms. Knight.
JOY KNIGHT: No, there haven't been any cuts to the Brotherhood and Sisterhood funding.
BECKY DRUHAN: That's great to hear. I'm really pleased about that. Looking forward, though, to the need to expand these services and have access more broadly across the province, and to be responsive to the proposals that are in, we have seen government projections of additional cuts to programming generally and funding generally within the budget over the next three years. I wonder if there's been any discussion internally as to how that may impact funding for the Brotherhood and Sisterhood programs, either with signals from government as to whether they'll be impacted or discussion on how to mitigate internally in the event that that happens.
JOY KNIGHT: No, there have been no conversations around reductions to the budget. I would say that the Brotherhood and the Sisterhood are very deeply valued by the department. I would say, to take it a little bit further, back to my opening comments, we do understand we play a role in the space; it's not just for community to impact the systemic barriers facing Black and African Nova Scotians. Within the department, we are working on new policies and standards to ensure cultural competency is actually an expectation of how care is delivered. We are investing in training for our staff. Policy leaders have to be culturally competent as well; it's not just clinicians in the Nova Scotia Health Authority and IWK Health. We're also really investing in that space as well.
BECKY DRUHAN: That is really great to hear.
I wonder as well - Dr. Milne gave a very detailed and, I think, helpful description of the work around social determinants of health and the community connections that are necessary to really do that. It goes beyond core health care services into other community supports and services, with physical activity programs, book clubs, the barbershop clinics, and even connections into the court system.
I might ask this question broadly of DHW and also Dr. Milne and anyone else who may be able to comment on this. We have seen government make cuts to some of those really important social spaces - community spaces, third spaces - and programs, as well as core programs. We know there have been cuts to the Domestic Violence Court Program. We've seen recently cuts to libraries. I do know that some of the outreach in the Health Equity Framework was done through libraries.
Can anyone speak to the impact that that has on holistic programs like the Brotherhood and Sisterhood programs, where it is so much beyond core health care and requires that connection with organizations that support the broader social determinants of health?
THE CHAIR: Dr. Elliott Rose.
DR. ANNETTE ELLIOTT ROSE: I'll start to say that the Nova Scotia Health Authority has a number of community partnerships. We work very closely locally, and we value the spaces and the relationships with community in order to advance a number of programs.
The programs that Dr. Milne described are within the Brotherhood, so the Nova Scotia Health Authority, with the funding that we have, advances those activities and initiatives within that funding portfolio. Of course, we do that in partnership with and designed by community. We continue to work with community to make sure that we can provide services in the places that are the most valuable for them.
JOY KNIGHT: If it's okay, I could add a little bit from the department.
I would just like to say a little more broadly - what we certainly recognize is how much we have to work differently as a government. Working horizontally has never been more important. As colleagues, in particular, I work very closely with the Office of Addictions and Mental Health and the Department of Opportunities and Social Development. We talk about wanting to make sure that impacts to communities from the social determinants of health lens aren't having negative health outcomes.
We know we have to work differently together. There are excellent community-driven and community-led programs out there. If we actually work differently together as colleagues within government, I think we can smooth the pathways for people to access those services they need in a much more meaningful, better way. That's a lot of our focus right now - building those strengthened relationships within government as well.
BECKY DRUHAN: I'm curious about the programming of the Sisterhood in relation to the Brotherhood. We know the Brotherhood has been in existence for, I think, eight years longer than the Sisterhood. I'd just like to know more about whether there are learnings from the Brotherhood that still need to be implemented, or programs, as the Sisterhood works to - I won't say “catch up,” but works to build out from their establishment in 2023.
RON MILNE: Yes, the Sisterhood budget is separate. Unfortunately, I don't have their numbers with me today, but they do have some unique programs that they've developed for women.
One of the things that was determined several years ago - there was a study that showed a 40-percent decrease in the uptake of pap smears and mammograms for African Nova Scotian women. That's one of the areas that the Sisterhood has tried to address in a unique way with what they call “pap parties,” where they'll have - well, if you can make a pap smear into a celebration - but anyway, make it as welcoming as they can for screening. Yes, they do have their own unique programs as well. Unfortunately, there's no one here from the Sisterhood to really address the programs they have. They've certainly built on and added to what we've done.
BECKY DRUHAN: I'd like to shift focus now to the Nova Scotia Health Equity Framework. I have a few questions around that. That was released in July 2023, almost three years ago. The report provides a list of the Province's intended actions under the framework's key themes. I have some specific questions around those actions and what updates could be provided around that.
The first question is in relation to the establishment of a Health Equity Framework partnership charter involving core health systems, institutions, and community partners. I wonder if we could be provided a status update around that. I'll leave it at that for now.
JOY KNIGHT: I'm actually not familiar with where the status of that is right now. I apologize. We'll have to get back to the committee on that.
BECKY DRUHAN: I appreciate that. Maybe I'll just provide some specifics for that follow-up. We're interested in understanding the status of that charter. If it's not complete, what stage is it in? What work is under way to progress it? What system partners are involved, and when is the anticipated completion date?
THE CHAIR: Mr. Francis.
ROD FRANCIS: The charter itself, we are still currently working on. It's still in the middle stages of the completion. We currently are bringing community partners, as well as our government partners to the table, and our partners at the Nova Scotia Health Authority and other community partners, but we are probably, I would say, in the middle stages of that right now. I can provide you a more detailed update.
BECKY DRUHAN: The next question I have, again in relation to the action items under the Health Equity Framework, is the improvement of reporting systems for racism and discrimination. My question in relation to that is: What are the systems that are in place and what specific improvements have been made? As well, if that work isn't complete, what is on the horizon? What additional improvements are being considered or implemented?
ROD FRANCIS: Since 2022, the Fair Care Project, we've been collecting race-based and linguistic data to improve equity, inclusion, and diversity in health care to address racism. Right now, there are 480,000 Nova Scotians who have opted into the Fair Care Project to provide race-based and linguistic data. We are currently in the process of vetting some of that data, because there's no doubt there would be duplications and stuff. We're currently in the process of vetting some of that.
We're also working to stand up a community-driven data governance process. This will commit to the community partners who support the regional design of the Fair Care Project. The data governance process will provide opportunities for community group representatives to also vet that to advise and ultimately approve any request that we may have as well around data and the piece for when we collect that racism and the approach in which we do that.
BECKY DRUHAN: My follow-up question to that would be: Given the status of that, are you at the point where you are accessing data to assess health equity outcomes, or are you still at the point of setting up the structure and ensuring the data is coherent and usable?
[1:45 p.m.]
ROD FRANCIS: Again, as I said, we're currently vetting it. There is some great data in there that will certainly help as we move the work forward, but we are currently vetting that. With that, as I said, 480,000 Nova Scotians have opted into that. As you can appreciate, there is a lot of data there to vet.
BECKY DRUHAN: I think my follow-up question to that would be: Is there an anticipated timeline for when that data will be in a state that it can be evaluated and assessed to give us information on those health equity outcomes and then drive further action? What would that timeline look like? When can Nova Scotians expect that data to start to drive decision making?
ROD FRANCIS: As you can appreciate, this is important data. We want to ensure that we are analyzing it correctly. To give you an exact time, I can't provide that right now, but we are certainly recognizing that this is very important.
BECKY DRUHAN: Thank very much, Mr. Francis. I think I will just introduce the next question. I suspect I'll have to pick it up again the next time around. Again, this is in relation to Health Equity Framework actions. This was in relation to the action of completing the policy audit of the health system. I'm looking for a status update on that work as well, and some information on what the results were and actions that may be coming out of that.
THE CHAIR: Is there anyone who would like to take that one? Dr. Elliott Rose.
ANNETTE ELLIOTT ROSE: From a Nova Scotia Health Authority perspective as an organization, our policy team is developing an equity lens that we'll be using to review all of our policies, both existing policies and those that we'll develop new.
BECKY DRUHAN: One of the other action items that the Health Equity Framework calls for is removing red tape and barriers that affect various equity communities. I'd love to hear an update on that as well: What steps have been taken around that, what barriers still exist, and what work is under way to address those?
JOY KNIGHT: There'd be a number of places in which we're focused for that. Health human resources would be an important part around how we create pathways for African Nova Scotians and Indigenous Nova Scotians to enter into health care. What is the training? I'll let my colleagues at the Nova Scotia Health Authority speak in more detail to it, but what is the training that's in place to reduce the barriers for people to not just train and bring more people into the system, but also to remove experiences of racism within the system and to work in a more culturally safe environment? Several initiatives, I know my colleagues have in that space already.
There would be barriers related to trust in the system and pathways into health care. That's in working in partnership with colleagues at the Department of Education and Early Childhood Development around what scholarships look like, what it looks like to bring awareness through community-based organizations to the professions in the health sector, and how we help people to learn and grow into those roles. I think there are a number of things under way from a government perspective, but I'd invite my colleagues at Nova Scotia Health Authority to highlight their work if they'd like.
THE CHAIR: Okay, I'm going to call order. The 20 minutes has expired, sorry. We'll move to the PC Party, and we'll start with MLA Hilton.
NICK HILTON: Thank you, Chair, and thank you to all of you for coming in this afternoon and sharing a wealth of information, a lot of it new for me. Being from Yarmouth, I don't get to experience the Brotherhood and Sisterhood programs a lot but looking forward to seeing how they spread across the province in time.
Of all the comments made so far, the ones that really stick with me are from your opening statement, Ms. O'Keiffe, in how you experienced a Sisterhood program yourself and the difference that made. I'll carry that forward with me.
Dr. Milne, you said you were in Ontario for several years before you came here. I just personally wanted to ask - the experience from health care there to here when it comes to programs like this. I believe that the Brotherhood and Sisterhood programs are quite unique. I'd just like to hear how we are moving things forward here in Nova Scotia.
THE CHAIR: Dr. Milne.
RON MILNE: Ontario, of course, has a much bigger population. It has a much bigger Black population than Nova Scotia. I feel like what we're doing here is quite unique. I don't really think there's anything like it anywhere else in Canada from what I've heard. I've also had outreach from people in the U.S. who are quite astounded by what we've done here. There's really nothing similar. They have the barbershops there, and we got the idea for that from the States.
In Ontario some of the work I did - I worked mainly in Peterborough, Ontario, which really doesn't have a large Black population. It has a large Indigenous population, but not Black. During my career I also worked at Black Creek Community Centre in Toronto, which has a high Black and immigrant population in the Jane and Finch area, if you know anything about that. It's a high social needs area. They have a sort of multi-profession community there, but again, I don't think they have a lot of the outreach programs like we have in Brotherhood. I think what we're doing is really quite unique.
NICK HILTON: Thank you for sharing that and thank you for coming home to work here in Nova Scotia. Just to build on that a little bit, we know that the Brotherhood and Sisterhood programs are quite unique, and they're considered grassroots and tailored to community needs. This is both for the department and for the witnesses. What insights can you give on how they provide on health outcomes and health system integration? How do these programs help move us forward?
RON MILNE: Well, I mean, I can speak from my personal experience on that. I've seen a number of men who have had no health care probably for 10 years - haven't had a family doctor, haven't really accessed the health care system, including people who really need to: people with diabetes, hypertension, undiagnosed conditions. I think we've made a huge impact that way. But also in our outreach programs, we do a lot of advocacy in the hospital, in the area of corrections, in the courts. I know that has made a big impact as well on people's lives.
There are lots of things beyond what you would look at as a traditional health care system - doctors, nurses, pharmacy, medications, and that sort of thing - more into the area of social issues and social determinants of health, especially which, for our population, are huge. The social determinants of health are really what determine people's lives in many ways. Those are all things that we try to address. Things like the barbershop help to lower the barriers and raise the trust because that's one of the biggest problems that we have in the health care system - lack of trust that people are going to be treated fairly and equitably, and are going to be looked at without that kind of unconscious bias that we all have, let's face it - that that's not going to impact on the kind of health care they get.
I think when people come to see us, right away the level of stress goes down because they see people who look like them, maybe have some shared experiences, understand some of the struggles that they're going through. I know that has made a big impact in itself. I think, unfortunately, the lack of providers - not only of African descent but lack of doctors, lack of health care professionals - is another area that we're trying to fill.
THE CHAIR: Ms. Knight.
JOY KNIGHT: I would just share what kind of comes to mind when you ask about from a departmental perspective, what we feel the impact has been. To build on what Dr. Milne said there, the fact that people can access the care they deserve in a way that is driven and led by community is a really powerful lesson for all of us. I think that what we learn form the success of the Brotherhood and the Sisterhood extends into other pieces of work that we have in the department. It certainly is having an impact on how we think about our community health centres and ensuring there are areas - access to health care from a social determinants lens for all marginalized populations and communities, and the power of when you make that available to people, and the impact it can have.
It's certainly moving and impacting our work when we think about our homeless population where there's a disproportionate representation of Indigenous and African Nova Scotians, and the need to focus on wraparound services, and the way the Brotherhood and Sisterhood are delivering it where it meets people where they are. There are a lot of broader lessons to inform our policy and our approaches to health care delivery in the province, and we're really lucky to be learning from them in this space.
NICK HILTON: How do patients find out about these programs, and what does an intake look like to these organizations?
RON MILNE: Well, we have a website and people find out through that, through word of mouth, through programs that we do in the community. We do a lot of outreach to our events, like the annual Nova Scotian Black Men's Health Conference and the summit that we just did with 130 men from all over the province. I can't take credit for that as a Brotherhood event, but we were involved in it - so these kinds of things. We discussed Brotherhood programs at that event, so that's largely how people find out. We have intake and an admin person who sets up our appointments and so forth.
NICK HILTON: Just my last question, more for information purposes. To your point, we don't have anyone speaking directly about Sisterhood, but I've read a lot about the programs that they offer, and the new clinic that opened on Wyse Road last year and the successes that they're having as well. Could someone from either or both NSHA or the department speak to the satellite clinics in the communities of North Preston, East Preston, and Upper Hammonds Plains just to explain what their role is and the whole process, too?
RON MILNE: From the outset, we have had the five locations - Halifax, Dartmouth North, North Preston, and East Preston, and Pockwock-Hammonds Plains. They're all part of our clinic rotation. Each week, I travel to a different location, and we put our clinics on in those communities. They're all part of our program.
THE CHAIR: MLA Vanexan.
JULIE VANEXAN: Thank you all for being here. My understanding is that this model was inspired by another program. I was hoping that maybe you could help highlight some of the adaptations that went into modelling this for a Nova Scotian context.
[2:00 p.m.]
THE CHAIR: Dr. Milne.
RON MILNE: The initial work for developing this program came out of the need to recognize that there were shortcomings and problems with outcomes for Black patients, and also for access. One of the most striking pieces of data we had was the life expectancy between - in particular, Cole Harbour area and the Preston area - a 10-year difference in life expectancy for men in those two communities. Those are some of the things that really highlighted the need.
The Health Association of African Canadians, mainly through the work of Sharon Davis-Murdoch who, on her own expense, went to Chicago along with, I think, several other members of HAAC and looked at the Chicago Project Brotherhood model, which was a little bit different than ours. They provided haircuts, but they also provided meals, housing, a lot of different aspects of care. At the same time, the men could access health care, get their blood pressure checked, maybe their diabetes or whatever.
Of course, the situation in the U.S. is different because the health care is not universal, and a lot of those people really had no health care. So we adapted that to our system where health care is universal, and we built on it. The barbershop clinics and some of the other programs that we have came out of that model, but we developed a model that was unique for Nova Scotia because Nova Scotia is unique in many ways.
JULIE VANEXAN: I know that the program has been operating for quite some time and that you've spoken about a lot of different things here. Thank you very much for sharing. I was hoping that maybe you could provide some more examples of the program's impact and reach, maybe speak some more about the demographics. I know that you had shared right now that it's 18-plus that you were looking at how you could support in other ways, but maybe some more around the trends that you might be seeing.
RON MILNE: Yes, I think one of the biggest areas that we've tried to make an impact on is in mental health. I think just in the 10 years that Brotherhood has been operating, we've seen some huge shifts in mental health, especially around young people who, with social media and all the stress and problems that brings, with drug use, with early psychosis, especially in young people and oftentimes around drug use. That's a huge problem that we've been trying to access. Also, depression, anxiety, suicidal ideation - these are all things that have been huge problems that we try to address.
Also, I think the more common things - and this is where our data comes in that's so important. The data we operate on is all basically from the U.S. and U.K., which are different in many ways from what we experience here. The need is for data and understanding what the health problems are that are affecting our Black population here so that we can target and address those things. Typically, diabetes, hypertension, vascular problems, cancers like colon, prostate, breast, ovarian cancer - these are all things we try to target and educate people on, and be as proactive towards prevention as we can. Also diet and nutrition is a big part of it. We do have a dietician who's very active in our program. She's also our team lead, Natalie, from the Sisterhood. Those are some of the - I hope that's given you an idea.
THE CHAIR: MLA Vanexan, with four minutes remaining. Sorry. Dr. Elliott Rose.
ANNETTE ELLIOTT ROSE: I want to add to Dr. Milne's information as well. For the Brotherhood initiatives, starting in 2022-23, there were 196 men who were seen for primary medical care. That rose to 683 by 2025-26. For mental health, 64 men were seen in 2022-23. That rose to 855 in 2025-26. For the Sisterhood initiative, 42 women were seen in 2022-23 for primary medical care; 1,272 were seen for primary medical care and clinic visits by 2025-26. Thirty-two women were seen for mental health in 2022-23; 445 by 2025-26. Dr. Milne has shared wonderful examples of the success, and the numbers speak about the success and how people are seeking the services and benefit from the services.
JULIE VANEXAN: Thank you for adding some numbers to that as well. I appreciate that. For the members of the committee who might be asked about these programs by residents, what would you say is one of the most important things that you want Nova Scotians to know about the Brotherhood and Sisterhood? That would be open to any of the witnesses here.
RON MILNE: I think first of all that our program is open to people of African descent, men and women, from the age 18 and up - that it's a free program, that we offer a lot of different resources. I think that it's a safe space with culturally competent health care providers. What else could I say about it? I think that we're non-judgmental. We try to be holistic, to look at the whole individual, to give people enough time to address as many of their issues as we can. I think that's important. We have the resources, especially the mental health resources and other providers outside of myself and the other physicians who can address a lot of different health care needs.
We're community-based. We work in the community and try to be part of the community, try to take our direction from what the community needs are. I think those are all part of what we try to provide.
THE CHAIR: Dr. Elliott Rose, there are 30 seconds remaining.
ANNETTE ELLIOTT ROSE: I will say that the Brotherhood survey results for Northern Zone, to Dr. Milne's comments: 100 percent of people said it was psychologically safe. How wonderful is that? Seventy-one percent said it had a behavioural impact. Participants reported tangible changes. A testimonial from someone: The involvement has helped create a consistent, trusted space where participants can engage in meaningful conversations around mental wellness, physical health, identity, and personal development.
THE CHAIR: Order. Thank you, Dr. Elliott Rose. Perfect timing. We have 12 minutes remaining for each party for questions. We'll start the first 12 minutes with the NDP. MLA Wilson.
ROD WILSON: Given the successes we've heard from everyone, I can't imagine why this program's proposal is not going to be supported. My question to the folks at the Department of Health is: When should the Brotherhood and Sisterhood expect a definitive answer to this amazing, exciting proposal?
THE CHAIR: Ms. Knight.
JOY KNIGHT: I think what we've been saying here is that we wouldn't want to push timelines that go against the meaningful conversation with community. We acknowledge that we have an updated proposal in our hands and that we need to meet and continue to advance those conversations. I think the timeline will be driven by the comfort of everybody involved.
I will say that there are elements of that proposal that we want to act on now. A centre of excellence model involves education and training, and there are aspects in those spaces that the Nova Scotia Health Authority and the department are moving on actively now, because there's a lot of value in that centre of excellence approach.
I know one quick highlight would be - I just recently had a conversation with the Sisterhood about some research they're going to be doing around Black women's health with Dr. Dol at IWK Health. We know we need to continue to advocate and push in that space, not just through the proposal we've received through the Brotherhood and Sisterhood but in general, more broadly, as a department we need to advance more research, education, and training.
ROD WILSON: The ones you want to act on now - when will that happen?
JOY KNIGHT: If you're asking about what actions we currently have in play right now?
ROD WILSON: You said there was something you'd like to act on right now.
THE CHAIR: MLA Wilson.
ROD WILSON: Sorry.
JOY KNIGHT: To clarify, I think I said we are acting on some things now.
ROD WILSON: Or you thought you...
THE CHAIR: MLA Wilson. (Laughter)
ROD WILSON: Sorry. Still learning.
If I heard you right - and maybe I misunderstood - there are things that you want to act on right now, if that was correct. If that's correct, when might those happen?
JOY KNIGHT: Thank you for the clarification. I think what I was trying to say is that we want to move now - we don't want to wait - and we are. I wasn't trying to suggest that we're also not moving in that space. We recognize and want to move in (inaudible).
THE CHAIR: MLA Hansen.
SUZY HANSEN: I just want to touch on health care and mental health care. I know that health care and mental health care for African Nova Scotians looks different. There was a question from the Desmond Fatality Inquiry that I made. It was clear that African Nova Scotian men need better access to culturally appropriate mental health care, especially in rural areas, because they often feel stigma. I know that those were some of the comments that Dr. Milne had mentioned. When going to a doctor to get help, there's that feeling of distrust.
This is to the Brotherhood, because the Brotherhood does excellent work and has excellent Black providers and is providing services that draw people in, as we heard from the data. I'm just wondering, Dr. Milne, are there things that the government could be doing better to support African Nova Scotian men in rural areas to get the mental health help that they need?
THE CHAIR: Dr. Milne.
RON MILNE: It's a challenge for sure, because number one, the lack of providers, and number two, the lack of providers with cultural competence and just general lack of resources.
I think maybe providing some of the programs that we're offering would be helpful, like the barbershop clinics. Clinical therapists are a big one, and of course I know it's not easy to extend that, but the access to psychiatry is pretty huge - and not only psychiatry but mental health providers in general.
SUZY HANSEN: I appreciate that from your expertise and perspective, because at a different committee on the Desmond Fatality Inquiry, we heard that the Office of Addictions and Mental Health were not sure how many net new Black psychologists and psychiatrists had started working in the province since the inquiry's recommendations were released.
Dr. Milne, do you have a sense of the current gap here? Is this an area where we need more recruitment?
RON MILNE: We've been very fortunate. Again, I mentioned Dr. Agyapong - who's the head of Dalhousie Department of Psychiatry - that we've been able to develop the transcultural psychiatry program so that our patients - Brotherhood and Sisterhood patients - have access to psychiatry. I think it's once every three weeks or so we have a clinic where they see people. I think that's quite unique. That extends also to the Indigenous population and newcomers as well. They're part of that trans-cultural psychiatry program. I think initiatives like that, where you can get access for specific underserved populations that have high needs, I think that's important.
[2:15 p.m.]
THE CHAIR: MLA Wilson.
ROD WILSON: How much time do I have?
THE CHAIR: Six minutes and 20 seconds. MLA Wilson.
ROD WILSON: Excellent. What I'm wondering is - evaluation is not so much a pass or a fail, but it's a method to improve on. Dr. Milne, do you feel you have enough resources to get that feedback and evaluation to enhance programs? Evaluation requires funding. It can't be done by the side of a desk. I'm wondering, in your programs, both Brotherhood and Sisterhood, whether you have dedicated funding to get that feedback from community members, and input?
THE CHAIR: Dr. Milne.
RON MILNE: Does anybody feel they have enough funding? Raise your hand. Seriously, I think the program that we're advocating for, the Black centres of excellence, can address a lot of these needs. We're hoping that will help to address some of the challenges we have that I've talked about.
ROD WILSON: You also mentioned - which I have a lot of respect for - the role of cultural competence. Certainly, most of my career has been in Indigenous communities and working on cultural competence. This question is probably for both yourself, Dr. Milne, and Dr. Elliott Rose. Do you feel like we're actually making success, or am I being cynical about developing cultural competence in the education of health care providers, nurses, physicians, occupational therapists? Is it still something that feels good but isn't getting the attention it needs?
RON MILNE: The PLANS program at Dalhousie University I think has gone a long way to addressing that for training Black physicians. I think that program, which is under Dr. Leah Jones, is a great example. Also, the work with Indigenous health that Dr. Brent Young is doing through the Mi'kmaw Native Friendship Centre. I think those are examples of some leadership there. I think there's need for improvement. There's a need for more providers of African descent or Indigenous descent, probably other ethnicities and races too. I think it can always be better, but it's a start, anyway.
THE CHAIR: Dr. Elliott Rose.
ANNETTE ELLIOTT ROSE: I agree with Dr. Milne that it's a journey, and we need to continue to build those knowledge skills and competencies around cultural safety for sure. At the Nova Scotia Health Authority, we do have a certain level of equity, diversity, inclusion, reconciliation, and accessibility education for all new hires now as part of general orientation. We also include a different level and a more detailed level of cultural safety education for clinicians, knowing the very unique role that they have caring for Nova Scotians.
I'll give you a couple of examples. We have partnerships with ISANS. They have a program: Building Intercultural Competence. We've had about 297 attendees from Nova Scotia Health over the last couple of years. There is also a course called Inclusive Perspectives focused on clinical leadership, 131 attendees; Strengthening Inclusive Interprofessional Practice, 50 attendees; and there are several more around specific courses around microaggressions and whatnot.
With Ms. O'Keiffe's leadership - and we're so pleased to have her in the role as senior director for EDIRA - and building out a portfolio and a program of equity and belonging differently at Nova Scotia Health Authority, our plan is to continue to move this forward, continue to offer more education around cultural safety.
THE CHAIR: MLA Hansen, with two minutes remaining.
SUZY HANSEN: Ms. O'Keiffe, I am very interested in knowing more about what the programs are and things that are being implemented within the department that you feel are being credited as a success. Are there things that you're seeing impact, are there noticeabilities or data points that you're noticing that are creating a change within the work that you're doing throughout the department?
THE CHAIR: Mrs. O'Keiffe.
MAHOGANY O'KEIFFE: I started at NSHA in October, so I know very little (laughs) and I'm still learning. However, I think what is happening is that there are pockets of really great work happening. I know there's some really great work, EDIRA work, in cancer care. They've done some really inventive things. Public Health has done some really extraordinary pieces. I think at this point it's a matter of - we're figuring out, we're gathering the data of what's currently happening, and we're having more of a systemic conversation of how we can ensure that it's aligned across the system. That's a big part of why I came over to NSHA - to really help with the alignment piece.
I know we spoke a lot about reporting earlier and tracking. That's going to be really beneficial once we have a handle on what's actually happening across the board and we're all on the same page of “this is what's going on.” Then we can have even more robust conversations about tracking and reporting, which I think will help with the health equity framework pieces and the KPIs in that regard.
There are wonderful things that are happening. At this point we're just trying to gather all those wonderful things and talk about how we can better align those pieces so that it just makes sense and it's consistent. When it comes to competency in training, everybody needs to be saying the same thing across the board. We're getting there, to our point. It's a journey.
THE CHAIR: I'll have to call order. Sorry. We'll now move on to the Liberal Party and MLA Druhan. Twelve minutes.
BECKY DRUHAN: I wanted to pick up on some of the comments that Dr. Milne made around the availability and access to providers and continue on with the questions that I had around the actions from the Health Equity Framework. The comments in particular that I think I was interested in were the challenges with lack of providers, particularly those providers with cultural competence.
I appreciated the comments and details that were given around some programs that are supporting that, but one of the ways that we do that is by ensuring that we have diversity in our providers, among our providers, and among leadership. We see that reality reflected in the action that calls for increasing equity representation in health leadership in front lines, building a health care workforce that reflects increasing diversity of all people who live in the province.
I'm not sure who to direct this to, but I'll throw the question out there and hopefully whoever may have pieces of it can answer. The question that I have is: What actions are being taken on that front? What data is being collected to measure those improvements, and is that data that can be shared or is there a detail you can point us to today around increases in equity representation?
THE CHAIR: Ms. Knight.
JOY KNIGHT: I'll start, and then I'll pass to Dr. Elliott Rose, if that's okay. I'll just highlight from the Office of Healthcare Professionals Recruitment, there are a number of investments that have been made in this space recognizing exactly what you said. We need to create pathways for people from communities to come into health care so that we're more representative of the people we're serving. That was highlighted before. There are some leadership programs within DHW to advance people from marginalized communities to hold leadership positions within the department and across government.
There is funding and a partnership with Tajikeimɨk specific to a nursing strategy to have more Indigenous nurses in the system. We have seats that are designated for African Nova Scotians and Indigenous or underrepresented communities at Acadia University, Dalhousie University, and CBU, I believe, for nursing seats. There has been an ongoing agreement with Dalhousie for an Africentric social work cohort because we recognize that we need more African Nova Scotian and Black social workers. There are a number of initiatives that are intended to grow the number of individuals in our workforce.
I think I had another point. It just left my head, so I apologize. Perhaps I will pass it to Dr. Elliott Rose.
THE CHAIR: Dr. Elliott Rose.
ANNETTE ELLIOTT ROSE: Obviously, Nova Scotia Health Authority is committed to equity in hiring. All of our job postings include an invitation to applicants to voluntarily self-identify. There's work we need to do in this space as well, so creating, I'll say, more customized and community-partnered pathways. We know there's more and better that we can do other than self-identification. Certainly, working with Mi'kmaw and Indigenous partners, we know that there are pathways where people have connections with community that actually support equity hiring in a different way. There's work that's happening there.
We had 65 designated positions posted across Nova Scotia Health Authority, which doesn't seem like a lot, but it actually is in an environment where we're often framed by collective agreements and other things when we do hiring and postings. That, I think, is important. We have also hired a number of people internationally. I don't want to give the impression that all internationally educated health professions come from an equity population, but many do. For example, typically we're hiring 300 or so internationally educated nurses every year. I was looking for the statistic, and I will find it and share it with you later, but it was shared publicly that - I think it's around 40 percent of the new physician recruitments come from international pools as well. So some success there.
Of course, as we do that and we recruit more people, to your point earlier, then we're diversifying our workforce, and then we're building that cultural safety and competency in a new way. We, of course, want to do that.
BECKY DRUHAN: I appreciate the picture of the work that's under way to expand those efforts and to ensure that there's an attention on hiring folks from diverse backgrounds. Is there data that you can share that's being collected to measure the improvements in those areas? Dr. Elliott Rose mentioned some numbers around postings and hirings. Is there additional data that gives us a snapshot of the improvements? Are you able, as well, to identify areas where we're seeing real success around that, as well as areas where you're seeing challenges in recruitment of equity-deserving folks?
JOY KNIGHT: I'll start, and if others have any comment - thank you for raising that again. That was the point that left my head last time. I did want to highlight that there is a lack of data in this area for us. We don't fully understand what that looks like from a representation perspective and to understand if we're making a difference with the investments and efforts that we're making. We've recently entered into a partnership with the colleges to - we've made an investment to build databases so that the colleges are able to understand their members. This is in the regulated health professions, so it is limited to that, but we are working with them very closely to help not only build the database but to understand what an appropriate way is to ask these questions and to collect race-based data in a trusting, respectful way.
That work has just started, but we are hoping that over time, we're going to build a capacity and understanding of professionals and understand why there may be issues in recruitment and retention in particular fields.
BECKY DRUHAN: Going back again to the Health Equity Framework action items, one of the other action items was implementing trauma-informed person-centred care. This can be very individual and granular. I'm wondering if you can share what efforts are under way around that and specific changes that have been made either in policy approach or otherwise as a result of that work.
[2:30 p.m.]
ANNETTE ELLIOTT ROSE: I'm just looking for a specific number. We do offer trauma-informed care to thousands of employees at the Nova Scotia Health Authority every year. There's an established provincial approach in partnership with IWK Health around trauma-informed care that's been in place for - I want to say a couple of decades. Maybe not quite that long. It's active education that we do with teams, particularly with mental health and addictions teams. We continue to do that.
My colleagues are wonderful. They're sharing the numbers with me. More than 6,000 health care providers have received trauma-informed care training - this is in the mental health space, particularly - including over 1,000 staff in mental health and addictions.
BECKY DRUHAN: That's excellent to hear - that that training is under way. I wonder, has - the framework came out in 2023. The action around this item was to get input and feedback from underrepresented and underserved patients and families and apply it to system design, staff training, and programs. Is there any information that can be shared around whether that training has been adapted as a result of engagement with patients and families, or whether there are other system designs or programs that have been implemented or are under way through the Health Equity Framework work?
JOY KNIGHT: I won't speak specifically tied in to the Health Equity Framework, because it is not as a result of its existence that this work is under way. It is because we strongly hold within my own team, of course, and within the Department of Health and Wellness, that we can't develop, design, or execute good policy if we do it in isolation of engagement and consultation with community and with impacted individuals and partners.
We are in a number of spaces right now in which we have active engagement with community. I think to highlight one might be around women's health. It's a very active conversation space right now. We know that Black women in particular see negative health outcomes because the research hasn't been done to appropriately inform policy and clinical practice in a way that it should be.
There's a lot of dialogue happening in that space, and yes, through the Health Equity Framework that will happen too, but I think the purpose of that framework is to ensure that all of us act and work differently in our roles. I think it's having a really meaningful impact in how we do our work daily.
BECKY DRUHAN: I think the last question I'll ask is the last action item that's identified on Page 2 - it's actually the first one, but I'm getting to it last. That is reporting systems for racism and discrimination - creating a safe, effective system so that we can identify, report, and address racism and discrimination incidents when they happen at hospitals and health care locations.
I'm curious if we can get an update on - or I guess a snapshot of what systems are in place, and then an update on what is happening with that action item and what specific improvements have been made. We're probably out of time, so this might be a take-away question.
THE CHAIR: Dr. Milne with 30 seconds remaining.
RON MILNE: Oh, I was going to talk about something else, but related - in terms of policy-making, we need to see more people of African descent and Indigenous descent at the highest levels of policy-making.
I personally fought very hard to get a Black manager for our program. I was successful, and we've had three Black managers now, but at the higher levels - director, senior management - there's a void there. Dr. Brendan Carr...
THE CHAIR: Order. Sorry, I have to call order. We'll move on to the PC Party now for the final 12 minutes. The questioning will begin with MLA Fadare.
ADEGOKE FADARE: Thank you to the witnesses here today.
One of the things that impressed me a lot today has been the discussions around Brotherhood and Sisterhood have gone beyond what I would call (inaudible) health care, where we've heard about partnerships, evolving mental health, legal support, witness programs, community organization, and outreach programs.
I want you to help me paint a picture about these two programs. I know that the Sisterhood is not here, so maybe more of the Brotherhood. I know that both programs have what we call community liaison officers who have developed partnerships with various organizations. Can you paint a clear picture or a concrete example of a partnership that has led to what I would call a measurable improvement in health care outcomes, either for a patient or for a community?
At the end of the day, pictures speak a thousand words. Are you able to paint that picture for us of a particular partnership that you've had or you have and has led to what we call measurable outcomes, either for a community or for a patient?
THE CHAIR: Dr. Milne.
RON MILNE: I'll take as an example our Nova Scotian Black Men's Health Conference. We started that through the community Black men's group as part of the Brotherhood. We started at a very low level, maybe 50 or 100 participants, and increased it as the years went on. During the pandemic, we had a virtual program with Dr. Joy DeGruy. We had over 1,000 people on that virtual program for our Black Men's Health Conference.
As I mentioned, last year we had 300 participants. After the conference, we've had spinoffs of other programs like the barbershops and this Black Men's Health Summit that I talked about with 130 men several weeks ago at Tatamagouche. There have been other spinoffs from that as well of men talking about their health and also starting programs and activities through their own communities. I think that's one example of a measurable partnership that we've done.
ADEGOKE FADARE: Anytime a program is created, it's created to be able to solve a particular need. Obviously, one of the things we've always known is there are many issues around historical barriers to African Nova Scotians. I say the historical Black communities, and I also say the Black communities generally, also. I'm wondering: What exactly has this program - what exactly are they addressing regarding historical barriers that are faced by either people from the 52 historical communities or Blacks in general, whether they are Caribbean Blacks, Blacks from the motherland, or Blacks across the province? What are those things you would say that this program is addressing, those specific barriers that we've talked about for awhile?
RON MILNE: The number one barrier I would say is trust in the health care system. As Mahogany just very eloquently talked about, there hasn't been a lot of trust in the system because of exclusion, lack of problems being addressed, and also about assumptions made about people as regards to their - as an example, not feeling pain in the same way. There are a lot of issues with, for instance, skin conditions in people with darker skin that haven't been addressed because of the lack of training there. That's still a big gap.
I think those are some of the examples, but I would say also mental health is one of the most important areas where, because of a stigma in some of the Black communities against seeking help if you have mental health issues, addressing your emotions, talking about your feelings - these kinds of things have been taboo in the past because Black men felt they had to be regarded as being strong, not showing any sign of weakness, and not being emotional on any level. That's a barrier that we've tried very hard to break down.
The barbershops are one way that we can accomplish that. Also through our conference, because I think it's a safe space where men can talk about what's really on their mind, what's holding them back, talk about racism, talk about exclusion, talk about discrimination, all of those things that are so important not just socially, but to people's health, actually. They have huge impacts on people's health. I think those are some examples.
ADEGOKE FADARE: I do agree with you that trust is one of the biggest barriers. In another lifetime of mine, I worked at Dalhousie University and I led a province-wide project around the historical communities back then and I knew that came up. It was around vaccination and a refusal for African Nova Scotians, Black communities to take that. That was one of the reasons why I felt like the recruitment around bringing international doctors was very critical. That's what led to that desire for me because I realized that when people see people who look like them - because I always say trust is the barrier of the bridge between what somebody needs and the care they require where they are.
Because we're here, we have the opportunity to get insight from you, I want to make sure we take all that we can take out of this. What insight would you - because Sisterhood is not here - be able to provide or to offer the health care system as a whole when it comes to men and health of men and women's health needs in Nova Scotia? What insight, because you talked about the interactions you had with the men. Overall, the entire health sector, what insight would you be able to say based on the experiences you've gathered over time, based on interactions? These are the insights that can provide, that can help us holistically as a province regarding the health care sector.
RON MILNE: Well, I think first of all, one insight that we've gathered is that it's long overdue. There have been years of neglect for these problems. Talking about them, talking about the impact of racism, talking about the social determinants of health, but also just having people think about and talk about their health and addressing it.
We did a project several years ago producing a booklet called Know Your ABCs, which is basically directed at people understanding the risk of diabetes, hypertension, high cholesterol. Those are the three ABCs. From an education point of view and creating that booklet, we used people from the community to talk about what's important to their health, what they need to know, where the gaps are. That helped us produce this booklet, which is, I think, very useful for people to understand and to come in and be checked up.
For men particularly, regardless of their race, it's a real barrier to get them to talk about their health, to come in and have a checkup, to get their prostate checked, for instance. That's one huge barrier. Of course, that's very important in the Black community because prostate cancer is more common and it presents at a more advanced stage in Black men, so we've really focused on that and on prevention in general.
For women I talked about the mammograms and pap smears and the gap there, and I always talk about the colon cancer screening program because that's so vital. It's such an important thing that you can actually prevent a very lethal form of cancer just by submitting a sample.
I think these are the kinds of things that we try to - not only me counselling one-on-one, but in our community activities, in our conference, in the summit that we try to address all these things. Prevention is so important. Diet, exercise, controlling your weight, smoking - I could go on and on. They're common themes that everybody needs to follow, but in the Black community especially because of the increased risk of some of these conditions. Again, that's where our data comes in that we really do need to have a snapshot of what the conditions are that we really need to target.
THE CHAIR: MLA Robicheau with one minute, 45 seconds remaining.
RYAN ROBICHEAU: Thank you to all the witnesses here today. I know I've learned quite a bit from these discussions and questions and answers.
[2:45 p.m.]
I understand that patients using Sisterhood or Brotherhood programs may or may not have family doctors. How does the program coordinate their participation in the program with their ongoing care?
THE CHAIR: Dr. Milne.
RON MILNE: That's a challenge because, as I say, to get many of the men particularly to even come to a doctor is a big step. That's where I think having a program that's responsive to their needs that's welcoming, that's non-threatening, that is Afrocentric and holistic, that's where personally I try to take the time to spend with the men, to listen to them. What is it they're concerned about? What are their needs? Where can we help? I always ask them when they come in, first question, “What's your age? Are you married or single? Do you have a family doctor?” I always ask them that, and I try to keep the family doctor in the loop as much as I possibly can, but in a lot of cases, they don't have a family doctor, so we're considered to be the primary provider.
We do our best to try to keep those men coming. I always tell them, “Go on the 811 list. If you want to keep coming to see me, that's fine, but you need to get on the list to get a family doctor” - particularly the ones who have chronic medical problems like diabetes, hypertension, heart problems, COPD that need to be followed.
THE CHAIR: Order. Thank you, Dr. Milne. A very informative question and answer. Now it's time for closing remarks. Is there anyone who would like to give closing remarks? Ms. Knight.
JOY KNIGHT: I just wanted to say thank you for the opportunity to have this important discussion and reiterate to the committee the department's commitment to taking the learnings from the Brotherhood and the Sisterhood and to improving equitable access to care in Nova Scotia. Thank you very much.
THE CHAIR: Thanks for that and thank you to all our witnesses for appearing this afternoon. We'll now end the question-and-answer session and we'll move on to committee business, but before we do that, we'll take a minute or two to recess to allow the witnesses to leave and then we can reconvene in a minute.
[2:47 p.m. The committee recessed.]
[2:54 p.m. The committee reconvened.]
THE CHAIR: Order. I call the meeting back to order. Some committee business. The first item is some correspondence from May 14, 2026: An email from the Office of Addictions and Mental Health in response to questions asked at the January meeting on the Community Wellness Framework. This was forwarded to everybody. Any questions or discussion? Hearing none. Other business?
MLA Wilson.
ROD WILSON: I just wanted to ask members of government - I think it's this committee I asked last time: What's the current status of the CEO position at the Nova Scotia Health Authority? Is Karen Oldfield still in the position or leaving the position? Is it being posted? I just wanted to know the position of the senior leadership role at the Nova Scotia Health Authority.
THE CHAIR: MLA Hilton.
NICK HILTON: Karen was on a three-month term that began in April, so there should be a conclusion this month. We'll be able to give you some more information probably at the next meeting.
ROD WILSON: Then what's happening after where that is now?
NICK HILTON: I don't have that information yet. We'll share with you as soon as we do.
ROD WILSON: Rather than wait another month, can we just get a quick note in writing to the committee about the status of that position after starting July 1st?
NICK HILTON: I'm pretty sure as soon as we know, you will know, but I can communicate that with you.
THE CHAIR: Okay. So everyone's good? I think that's it for committee business.
Hearing no more, we'll call for the meeting to adjourn. Thank you very much.
[The committee adjourned at 2:56 p.m.]
