Hamilton's Board of Health Begins 2027 Budget Planning

Hamilton's Board of Health began planning its 2027 budget, with staff proposing a maintenance budget that would increase the municipal contribution by about $1 million, or 5.9%, to preserve existing services. Board members questioned stagnant provincial funding, expiring federal opioid grants and the lack of detail about which services could face reductions. The board also reviewed its citizen-involved governance model and approved follow-up work on public health improvements and freedom-of-information administration.

Topics Discussed

2027 PUBLIC HEALTH BUDGET

Hamilton Public Health is preparing a 2027 preliminary budget for further review in December or January before it goes to the General Issues Committee in January 2027. Staff described the proposal as a maintenance budget, with no increases in service levels or new programs.

The municipal contribution is projected to rise by about $1 million, or 5.9%, to approximately $19.5 million. Staff said the increase would maintain current programs at present-day costs while provincial funding remains flat and staffing and operating costs rise.

Staff reported that 81% of the overall public health budget is spent on personnel, with employee-related costs exceeding 85% in most programs. Councillor Mark Tadeson asked how much of specific program budgets, including infectious-disease control, is used for salaries and benefits.

Programs remaining in the budget framework include Ontario Seniors Dental Care, residential care facilities, Out of the Cold, immunization, child and youth health, and addiction and mental-health services.

Councillor Craig Cassar said provincial health standards are not adequately funded to maintain existing services. "In a sense, it's a form of provincial downloading if we want to continue to offer the same service," he said. "Or we can make the decision that we'll let the service decline with the amount of revenue that's allocated to the city."

PROGRAMS AT RISK FROM GRANT EXPIRIES

The board discussed the expiry of federal Emergency Treatment Fund support for opioid-related programming. Staff said Hamilton had received "a couple of million dollars in total" over several years through the funding stream, but the source is no longer available. Programs funded through the stream "of course also end when the funding ends."

Members asked staff to identify which services could be affected and what municipal funding would be required to maintain them. Staff identified three recommended public-health priorities: "child and youth healthy growth and development, climate related environmental risks, and preventing substance use and related harms."

Cassar also asked what measurable effects would result if municipal funding did not increase. He said provincial funding was not keeping pace with staffing costs, creating a service gap over time.

USER FEES, IMMUNIZATION AND AIR QUALITY

Staff proposed a 3.5% increase in public-health service user fees, saying the increase was approximately equal to the rise in costs for the services supported by those fees.

Public Health plans to maintain expanded immunization services and cross-train nurses so staff can establish larger clinics during a health emergency.

The budget includes approximately $135,000 to replace an air-quality monitoring device known as an "airpointer." Councillor Tammy Hwang questioned whether the equipment purchase was sufficient for Hamilton's air-quality needs. "We buy an air pointer because we need it but then that doesn't adequately reflect the kind of work that we need to do in terms of air pollution," Hwang said.

PUBLIC HEALTH COMMUNICATIONS

Board members questioned how the budget accounts for communications related to health advisories, emergencies, seasonal campaigns and misinformation.

The Medical Officer of Health said communications costs are distributed across Public Health's programs rather than tracked through a separate activity-based budget. "Communications really is built into all of our programs and services," she said. "We don't do activity based costing in our organization more broadly. We don't have the systems. We don't have the platforms to do that."

Public Health currently relies on about two full-time-equivalent positions from the City's central communications system. Staff said a fully integrated strategic budget may not be available until next summer.

GOVERNANCE REVIEW AND PUBLIC PARTICIPATION

The board reviewed its 2026 self-evaluation following the move to a semi-autonomous model that includes citizen members and an education representative. Consultant Peter said the model was working well and that he had heard "consistent and broad support from both counselors and citizen members." He said the new structure gave the board "greater community and clinical expertise" and more lived experience. The review also identified a learning curve for citizen members regarding motions, amendments and parliamentary procedure. Recommendations included mentoring, governance retreats and improved communication between the board and councillors who are not members.

Vice Chair Joseph questioned whether weekday meetings beginning at 9:30 a.m. limited participation by people with day jobs. Joseph asked whether moving some meetings to the evening would improve accessibility and equity. The Clerk said a formal motion would be required to change meeting times.

Motions

• 2027 Public Health Preliminary Budget — Board of Health 26032: Preliminary budget planning was received and referred for further development, with additional detail expected in December and January.
• Health MAP — Board of Health 26029: Report received. The initiative will track long-term health trends and modelling over three years, with updates incorporated into Community Health Status reporting.
• 2026 Q2 Budget Variance — Board of Health 26031: Report received without debate.
• Board of Health 26030: Consideration deferred because the consultant was unavailable when the item was scheduled.
• 2026 Board of Health Self-Evaluation Results: Report received for information.
• Action plan on self-evaluation recommendations: Motion passed unanimously, 11–0, directing staff to return in the first quarter with an action plan for feasible improvements identified through the Ontario Public Health Standards self-evaluation.
• MFIPPA/FOI administration: Motion passed unanimously, delegating administration of municipal freedom-of-information matters for the Board of Health to the City Clerk's office and legislative coordinator.

Attendees

Councillors identified in the meeting material as present:

• Chair Cameron Kroetsch
• Vice Chair Joseph
• Councillor Fang
• Councillor Craig Cassar
• Councillor Mark Tatterson
• Councillor Alex Wilson

Other participants included Medical Officer of Health Dr. Elizabeth Richardson, citizen member Ryan Jansen, consultant Peter of MASS LBP, and other citizen and education representatives.