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STEVE BUIST The Hamilton Spectator

Every elementary and secondary school in Hamilton should have a breakfast program. The rst and most immediate priority is to establish a breakfast program in every school in the pre-amalgamated City of Hamilton, particularly the lower city. The province currently funds just 15 per cent of the cost of existing student nutrition programs. The best teachers should be placed in the poorestperforming schools. Before-school and after-school programs should be available at every school in the lower city, heavily subsidized for the neediest parents. Integrate day-care programs for preschoolers with before-school and after-school programs so parents arent required to nd more than one location for their childrens care. University and college bursaries and scholarships could be targeted specically at inner-city high schools. Implement a mentoring program that would match inner-city high school students with successful adults in the community. Those types of relationships could help provide the students with guidance, networking or just a shoulder to lean on. Implement a twinning program that would twin schools in the suburbs with schools in the lower inner city. Cities twin with other cities all the time, so why couldnt schools in a uent parts of the city twin with schools in less a uent areas?

Make healthy choices the easy choices. To quote a popular dictum in public health: The choices we make are shaped by the choices we have. Make it easier for children in low-income neighbourhoods to participate in after-school programs.

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Make physical tness and physical education mandatory for each year of elementary and secondary school. Implement a voucher program for low-income residents to obtain fruits and vegetables from the citys farmers markets. While there is a stigma for people who have to hand over vouchers to a merchant, its less stigmatizing than a visit to the food bank. Plant more trees in low-income neighbourhoods. Did you know the City of Hamilton has a free tree request program that can be completed online? For information, send an email to treeplanting@hamilton.ca. The city could help increase awareness of the tree-planting program in low-income neighbourhoods. Trees are one small way of helping increase property values and neighbourhood pride. It should be mandatory that every person in Hamilton is provided access to a family physician. When a person shows up in the emergency department and reports no family physician, set up a program that matches those people with a family doctor. Undertake a scientic study that examines the di erences in health outcomes and costs between those people in the lower central city who dont have a family physician and those who do. Identify the factors that cause people to either not have or not visit a family physician. For family doctors in the capitation model (where payment is on a fee-per-patient basis rather than fee-per-service), compensation should be increased for patients who are elderly, or have mental health issues, or those with complex medical conditions. Ontarios capitation model of physician remuneration should set a required base percentage of patients on the doctors roster who are elderly, or have mental health issues, or have complex medical conditions. This would help eliminate the cherry-picking of healthy patients by a practice. Parking fees should be reduced at hospitals. A visit longer than two hours triggers the $15 maximum at Hamilton Health Sciences McMaster site and a visit longer than 2 hours means a $20 fee at St. Josephs hospital on Charlton Avenue. At Torontos Hospital for Sick Children, a visit longer than 2 hours costs an outrageous $30. Provide incentives to young, pregnant, at-risk mothers to encourage them to show up for regular prenatal visits to help reduce Hamiltons rate of poor pregnancy outcomes. The incentives could be direct, in the form of nancial compensation, or indirect, in the form of merchandise and food vouchers. The costs are meagre compared to the lifetime cost of poor pregnancy outcomes to the health-care and education systems.

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Move aggressively to cut the rate of births to teen mothers through a targeted, co-ordinated approach that combines the e orts of public health, school boards and social agencies. Last years Spectator BORN series showed the rate of babies born to teen mothers in the lower central part of Hamilton was about 15 per cent, which is about four times the provincial average. Hamiltons landmark NurseFamily Partnership could be extended to all low-income rst-time mothers, regardless of age. For high-risk cases, the Nurse-Family Partnership could be extended to take in not just rst-time mothers. For high-risk cases, the Nurse-Family Partnership could also be extended beyond the childs second birthday and run instead to the start of kindergarten. Improve the distribution of walk-in and after-hours clinics in the lower inner city. According to information from the Ontario Ministry of Health, there are no walk-in or after-hours medical clinics located between James Street and the Red Hill Valley Parkway in the east end.

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Reduce class sizes in elementary schools that have signicant rates of children from low-income families. The minimum wage in Ontario in Canada, for that matter must be a living wage. A person working 40 hours a week for 52 weeks at the current Ontario minimum wage of $10.25 per hour would earn $21,320 for the year, minus statutory deductions. In Hamilton, a living wage has been calculated to be $14.95 per hour. There are 30,000 people in Hamilton who work yet still remain in poverty. The City of Hamilton could lead the way by paying a living wage to all of its municipal employees. Develop an evidence-based system for setting social assistance rates. Currently, 59,000 Hamiltonians rely on either Ontario Works or the Ontario Disability Support Program as their main source of income and most are living in deep, deep poverty, said Tom Cooper, director of the Hamilton Roundtable for Poverty Reduction.

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Aggressively strive to cut the smoking rate among pregnant women. Smoking is a known risk factor for low-birthweight babies and its well known that smoking rates increase as incomes decrease. At Hamiltons Maternity Centre, which helps hundreds of at-risk and low-income pregnant women each year, about one in four expectant mothers smokes. The province must get serious about choking o the supply of cheap cigarettes that ow from native reserves. Study after study in country after country shows the same thing: smoking rates are inversely proportional to income. The higher the income, the lower the smoking rate.

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Increase funding for the child-care subsidy program. The citys waiting list has skyrocketed to more than 1,500 by September from around 1,000 in March.

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Canadas government-funded health-care system should be expanded to include a national pharmacare program to cover prescription medications. Create a one-stop access program for comprehensive health and social care for the elderly that mimics the CHOICE (Comprehensive Home Option of Integrated Care for the Elderly) model in Edmonton. Make neighbourhood equity a part of city council policy decisions, in the same way that economic and environmental considerations are now. Introduce participatory budgeting at the neighbourhood level. The concept of participatory budgeting gives committees of residents the power to recommend spending initiatives and make binding votes based on the idea that groups of engaged citizens can make better decisions than a single politician. The City of Hamilton could consider implementing a requirement that every new singlefamily house built in the ve former municipalities (Ancaster, Stoney Creek, Dundas, Flamborough and Glanbrook) must include a secondary suite that could be used as a rental unit or an in-law suite, if desired. This could increase the stock of rental units in parts of the city that dont traditionally have high numbers of rental units without forcing builders to develop mixed-income subdivisions. Increase the budget to reduce the backlog of social housing units in need of repair. If nothing else, it would help give low-income people some pride in their homes. Make cycling an easier way to get around the city by providing more bike lanes in lowerincome neighbourhoods. Bike lanes help give people the sense that the city cares about their safety. Ensure the federal government commits to a poverty reduction plan, with targets. While many provinces have implemented strategies even Nunavut the federal government is absent, said Cooper. We need national action on housing and homelessness, child care and a rethink of employment insurance. Introduce a low-cost or no-cost transit pass for students in low-income households. The city has implemented a half-price transit pass program for low-income adults but no comparable program for students. Make it easier for foreigntrained immigrant professionals to have their credentials recognized in Canada. My cousin was my family doctor. He was a heart surgeon, said Shamso, an immigrant to Hamilton now living in poverty. When he came to Canada, he became a taxi driver. Nobody was accepting him. Instead of pulling people up, its kind of like pushing them down.

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The City of Hamilton should implement planning policies that ensure the building of mixedincome neighbourhoods with a substantial supply of low- and moderate-income housing in every part of the city. This could help avoid the increasing concentration of housing and residential care facilities for people with low incomes and high needs. If youre going to o er people on assistance a program that provides food boxes, allow those receiving the food to have some choice in the type of food they receive. A one-type-ts-all program may not be practical for people with food allergies or those from di erent ethnic backgrounds. Fully implement the ideas that have been developed in the Neighbourhood Action Plans that have been put forward by residents in Hamiltons priority neighbourhoods. The ideas have been generated by those who best know their neighbourhoods and how they could be made healthier. Education boards should seriously consider developing approaches and policies that would help create mixed-income schools across the city, instead of schools populated primarily with high-income or low-income students. The placement of specialty programs, boundary adjustments and transportation policies could help achieve greater income equality across schools. The city and its partners, such as the Hamilton Community Foundation, need to make long-term commitments to provide community development support and grants to organizations and individuals that are helping improve Hamiltons most disadvantaged neighbourhoods. Create a high-prole, made-in-Hamilton model that mimics Calgarys 10-year plan to eradicate homelessness, and create public awareness about the need for such a program. Decision-making policy must include and be drawn up in consultation with those who are a ected. This comes from a speaker I heard last year: If I dont have the power to say No, then my Yes means nothing, said Laura, a Hamilton woman living in poverty. If you want me to participate in society, it has to start with the rules that youre making about me and my life. Provide free family recreation passes for all families with incomes below the poverty line. Stop the cycle of stigmatization that a ects individuals and neighbourhoods. As successful as The Spectators Code Red series has been in creating awareness, its time to move beyond labelling parts of the lower city simply as Code Red neighbourhoods. And nally, theres one thing you can do: Ask yourself one simple question: If Making Hamilton the best place to raise a child is the citys motto, how can that possibly happen when, according to the last census, nearly one in four children under the age of 18 lives in poverty? sbuist@thespec.com 905-526-3226

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WITH INPUT FROM: Tom Cooper, director of the Hamilton Roundtable for Poverty Reduction; Paul Johnson, Hamiltons director of neighbourhood development strategies; Sara Mayo, planner, Social Planning and Research Council of Hamilton; Terry Cooke, president and CEO, Hamilton Community Foundation. PHOTOS: SPECTATOR ARCHIVES, PHOTOS.COM