1. Inclusive Leadership in Governance Orientation Webinar Part One
In 2018, New Public Health foundational standards came into effect including Population Health Assessment, Health Equity, Effective Public Health Practice and Emergency Management. The Health Equity standards are part of a cross-cutting vision and fundamental philosophy to guide public health practice in Ontario. There are 3.5 million people in Ontario who face barriers to health. Health equity means that all people can reach their full health potential and are not disadvantaged from attaining it because of their race, ethnicity, religion, gender, age, social class, socioeconomic status or other socially determined circumstance.
This is the first of a 2-part series to share inclusive leadership tools and practices in action within Boards of Health of Public Health Agencies.
Prepared by: Heidi Schaeffer, Special Projects Consultant,
Alliance for Healthier Communities

2. Public Health Equitable System Change Training Collaborative
Public Health Equitable System Change Training Collaborative is about supporting Boards of Health and Public Health agencies to adopt the new Ontario Public Health standards, and in particular the new Health Equity standards adopted in Please visit: to learn more about this project and access the learning resources.
PHESC is one of seven projects funded by the Ontario Ministry of Health and Long-Term Care (MOHLTC) through the two-year Health and Well-Being Grant. Views expressed here are PHESC's alone and do not necessarily reflect those of the Province.
Le programme comprend un comité consultatif de programme composé de personnes issues de bureaux de santé de différentes régions, d’autres intermédiaires du système de santé et de services sociaux et d’experts en diversité, en équité et en formation.

3. Learning Goals:
Become familiar with important concepts related to inclusive leadership in governance
Understand board actions to advance inclusive leadership in governance
Use practical reflection tools to support board learning
After completing these webinars, board members will be able to:
• Appreciate the idea of Cultural Humility and ways to think about our biases and opportunities to practice around the board table;
• Appreciate some important concepts related to inclusive leadership such as reflecting on the concept and term “Intersectionality”.
• Understand questions the board can ask about how it practices being an Ally to populations who experience bias and discrimination; and
• Use practical reflection tools to consider how structural forces influence life experiences, including your experiences of being included and excluded.

4. in·clu·sion The action or state of including or of being included within a group or structure.
Let’s examine the term “inclusion” first. Inclusion as a principle is about identifying and addressing structural barriers that exclude certain groups of people in our communities. When it comes to the board deciding on a policy or program, the board can be inclusive by considering how people with barriers and fewer advantages will be affected by the policy or program. To better understand the impacts of a policy or program the board will actively seek out and include contributions, perspectives and experiences from specific population groups, especially those community members whose daily lives are to be most impacted by the boards decisions.

5. lead·er·ship Boards of Health are Strategic Leaders
Now let’s examine the term “leadership.” There are dozens of definitions of leadership! In the context of this webinar, leadership is defined as thoughtful, creative guidance that combines insights, self-reflection and big-picture thinking. Leaders can be anywhere in an organization, and what they do is demonstrate and encourage those around them to think deeper and strategically.
Leadership is defined in the Ontario Public Health Organizational Standards in relation to board of health functions. The organizational standards define Board of health leadership as assessing and taking action to improve its governance processes to accomplish its objectives which include: strategic direction setting,; promotion of appropriate ethics and values within the organization; effective organizational performance management and accountability; and effective coordination of board of health activities at all levels of the organization.
Specifically the board of health has responsibility for strategic direction setting. The organizational standards state that a strong strategic plan recognizes internal and external forces for and against change, incorporating strategies to overcome resistance to change and addressing gaps, and committing to action steps to adapt to changes.

6. What Does Inclusive Leadership look like with Boards of Health?
The term “Inclusive Leadership” for Boards of Health, describes how the Public Health agency, its senior management, and Human Resources can prioritize and create a culture of inclusion, where all staff, community members and groups are valued and can participate meaningfully and feel valued.
Inclusive leadership in Boards of Health also means building more diversity around the board table overtime (more people with lived experience of poverty, more people who reflect the communities served such as Indigenous peoples, newcomers and LGBT people).

7. Inclusive Leadership in Governance includes:
understanding equity, diversity and inclusion
engaging in behaviors and practices of equity
reflecting on your Public Health agencies values and beliefs
taking proactive action as a Board to create and sustain an inclusive organization
The literature on effective board governance does not include equity, diversity and inclusion? This orientation webinar focuses on governance roles to advance equity and inclusion. Inclusive Leadership in Governance means understanding the concepts of equity, diversity and inclusion; and engaging in behaviors and practices of equity; reflecting your Public Health Agency’s values and beliefs and taking proactive action as a Board of health to create an inclusive organization.

8. Actions to Advance Inclusive Leadership
The new Ontario Public Health Standards set out a clear role for the public health sector in health equity. Public health units, in collaboration with other local partners, are expected to champion and facilitate the types of analyses and public policies that reduce health inequities. Medical officers of health — the spokespeople for health in their communities — will actively promote health equity for the entire population.
Inclusive Leadership in Governance provides Boards with the means to take action on the values or beliefs of their Public Health Agency. This means acting in ways that demonstrate and practice the key concepts of equity, diversity, inclusion, anti-racism, anti-oppression and health equity.
Through Inclusive Leadership in Governance, your Board can ensure a broad range of perspectives, experiences and skills will be an integral part of its discussions and decision-making processes. This means you can be more innovative and more effective, whether internally as you support the Public Health Agency through your oversight, or externally as you build networks, connections and capacities within and across the communities your Public Health Agency serves.
Inclusive Leadership in Governance deepens your Board’s capacity for community input and meaningful community involvement with diverse communities. This, in turn, leads to better decision-making and ensures that you as a Board are able to advance population health equity.
Through the Public Health Training for Equitable Systems Change Project there are resources to support boards with adoption of the Health Equity requirements. See the resources page.

9. INCLUSIVE LEADERSHIP IN GOVERNANCE
Framework for Action on Equity from Community-Centred Primary Health Care Organizations
Here is a framework for action on inclusive leadership in governance used by Primary Care organizations. We will use this to examine common governance opportunities to practice inclusive leadership.
Each gear refers to a task area for all types of Boards. These gears demonstrate areas for inclusive leadership actions:
Thinking and Leading Strategically
Driving Progressive Policies
Enhancing board attributes and Structures
Championing Systems Change
There are key concepts and approaches that are integral to the framework, and they need to be integrated in the work to advance inclusive leadership. They are anti-racism, anti-oppression, the concept of intersectionality , the practice of allyship.
We will review each of these key concepts but first we will take a moment to reflect on the value of each gear in the framework and present examples of inclusive leadership actions by boards of health.

10. Example: Naming equity and inclusion in your strategic plan
An example of thinking and leading strategically in governance is by naming equity and inclusion as a priority in your strategic plan.

11. Example: Toronto Public Health Strategic Plan
Be a healthy workplace
Implement a workforce strategy to recruit and retain highly skilled staff, at all levels of the organization, that reflect the diversity of the city we serve
Promote an environment of inclusion, collaboration and mutual respect where the diversity of staff, students and clients is welcomed
Acknowledge staff and their contributions to excellence in all aspects of public health
Toronto Public Health is a leader in reducing health inequities by working to address unfair and avoidable differences in health outcomes between groups. TPH collaborates to identify and respond to health needs of vulnerable populations by providing accessible services and advocating for policies that address the social determinants of health.
Toronto Public Health strategic priorities include:
Implement ng a workforce strategy to recruit and retain highly skilled staff, at all levels of the organization, that reflect the diversity of the city we serve
Promoting an environment of inclusion, collaboration and mutual respect where the diversity of staff, students and clients is welcomed
Acknowledging staff and their contributions to excellence in all aspects of public health

12. Land Acknowledgement Policy
Example:
Land Acknowledgement Policy
Example: Naming equity and inclusion in your strategic plan
An example of thinking and leading strategically in governance is by naming equity and inclusion as a priority in your strategic plan.

13. Example: Peterborough Public Health Policy
Peterborough Public Health have a policy to incorporate a land acknowledgement as a regular practice at all meetings that are hosted by the organization. Staff are encouraged to incorporate a land acknowledgement as part of their meeting agendas.
The policy includes the objective of the policy which is to acknowledge the Indigenous history of the land as a first step in a reconciliation journey. It represents an opportunity to pay our respects to the original inhabitants and owners of this land within your health unit boundaries, and to acknowledge their ongoing custodial role. As a daily practice for those who identify as settlers, it provides an opportunity for self-reflection and growth as allies and advocates. For those who self-identify as Indigenous, it reminds them of their connection to this land, and can strengthen their belonging and self-worth.

14. Land Acknowledgement Policy
Example:
Land Acknowledgement Policy
Example: Naming equity and inclusion in your strategic plan
Example:
Board composition, representation and diversity
An example of thinking and leading strategically in governance is by naming equity and inclusion as a priority in your strategic plan.

15. Making the Case for Board Diversity
Literature and evidence on non-profit governance rarely discuss equity or inclusion
Boards have played key roles in supporting equity and inclusion however there is no comprehensive training or capacity-building specific to governance
Growing awareness of Board composition (representation and reflection of communities) as essential to advance equity and inclusion at all levels of the organization
There is some evidence that diverse groups make better decisions
Boards have and continue to play a key role in supporting equity and inclusion. However, there has been a gap in accessing training, capacity-building and tools on how to lead using inclusion.
A scan of literature on governance reveals very little on equity and inclusion. Traditional approaches to governance often ignore issues of equity, diversity and inclusion.
There have been many conversations about who makes up Boards – in terms of representation and reflection of communities. While there has not been a requirement to have quotas, public reports or other accountability mechanisms, there is a growing awareness of gaps and opportunities in terms of Board composition.
Healthy Debate article In health care, do the people in power reflect the people they serve? (2018): Healthy debate source:
DiverseCity onBoard A Snapshot of Diverse Leadership in the Health Care Sector (2013): Women represented on Boards in health care sector in Greater Toronto Area, but other dimensions of diversity underrepresented
OnBoard Canada source:

16. Land Acknowledgement Policy
Example:
Land Acknowledgement Policy
Example: Naming equity and inclusion in your strategic plan
Example:
Board composition, representation and diversity
An example of thinking and leading strategically in governance is by naming equity and inclusion as a priority in your strategic plan.
Example: Advocacy & Coalitions for oral health access

17. Example: Public Health Advocacy for Access to Dental Care for populations with barriers
Oral health is key to overall health. Ottawa Public Health advocates for oral health and recognizes the unequal burden of poor oral health on low-income and otherwise disadvantaged Ontarians. Advocacy efforts by Public Health and the Ontario Oral Health Alliance have been successful. Results of championing system change came in the April 2019 budget with the announcement of a dental program for seniors living on low-Income.

18. Board Reflection: Option 1
Think about a challenge from your Public Health agency which relates to Inclusive Leadership in Governance
You can relate it to one of the gears:
Thinking and Leading Strategically
Driving Progressive Policies
Enhancing Board Attributes & Structures
Championing System Change
Now that the benefits of Inclusive Leadership in Governance have been described,, and examples of how boards are practicing and can increase their practices. Take a moment in your board education session to discuss challenges. You can consider the following questions
What is the context of the challenge? (including if there is a history)
What has been done so far?
What is missing? What gaps exist?
What opportunities might exist?

19. Board Reflection: Option 2
What challenges related to Inclusive Leadership in Governance does your Board face?
Recruitment of diverse Board members
Retention of diverse Board members
Policy development or review (policies related to equity, diversity and inclusion)
Integrating equity into strategic plan
Different understanding of equity amongst Board members
Connecting with diverse communities served
Advocacy and system role of Board
What else?
Now that the benefits of Inclusive Leadership in Governance have been described,, and examples of how boards are practicing and can increase their practices. Lets take a moment in your board education session to identify and explore challenges and how to address them.

20. Essential Resource on the PHESC.CA Website
 Effective Public Health Practice: health-practice
Inclusive Leadership in Governance, Webinar Part Two.
Board Resources Handout: Self-Reflection Tools for Inclusive Leadership Practices.
Please access the board resources handout and second webinar on the PHESC.ca project website.

21. Acknowledgements: Some material in this webinar was adapted from the Inclusive Leadership in Governance project designed for members of the Alliance for Healthier Communities. Thank you to Anu Radha Verma, curriculum lead for the project, and the other project partners including, Onboard Canada, Health Nexus and the Alliance for Healthier Communities. Thank you for content review and feedback from PHESC advisors: Dr. Vera Etches, Medical Officer of Health for Ottawa Public Health. And, Dr. Rosana Salvaterra, Medical Officer of Health for Peterborough Public Health.
The Inclusive Leadership in Governance Framework was developed by Heidi Schaeffer and Anu Radha Verma. with feedback from the Alliance for Healthier Communities board of directors in 2017.
Thank you to PHESC project advisors: Dr. Vera Etches, Medical Officer of Health for Ottawa Public Health, and Dr. Rosana Salvaterra, Medical Officer of Health for Peterborough Public Health, for providing feedback on the board of health Inclusive leadership in governance content.
Prepared by: Heidi Schaeffer, Special Projects Consultant,
Alliance for Healthier Communities