Primary care appointments in a local church, information booths at a car rally, health chats at the barber shop – these are some of the ways family physicians are meeting Black Nova Scotians where they are – and opening doors to help them improve their health and well-being.

For Dr. Ron Milne, it’s about making health care inclusive, safe and available to people who have long faced barriers when it comes to receiving the care they need.

The Halifax family physician leads the Nova Scotia Brotherhood, the Nova Scotia Health (NSH) initiative that provides primary care to people in historically Black communities.

“It’s been known for a long time that Black men have increased morbidity and mortality,” says Dr. Milne, who has led the program since it launched in 2015.

“Nova Scotia Health was looking to start a program for Black men, initially, to try and mitigate some of those issues, which are rooted in the social determinants of health – education, income, housing and racism.”

Dr. Milne grew up in Halifax and had worked with youth in the city’s north end before studying medicine at Dalhousie Medical School. After graduating in 1978, he followed in the footsteps of his grandfather, Dr. Alfred Waddell. Dr. Waddell was one of the first Black doctors to graduate from Dalhousie, in 1933. Dr. Milne’s daughter, Dr. Andrea Milne, is also a physician in Windsor, Ont.

After finishing his family medicine residency at Queen’s University in Kingston, Ont., Dr. Milne practised family medicine in Peterborough, the Jane and Finch area of Toronto, and Moose Factory, an Indigenous community on James Bay. He returned to Nova Scotia in 2011 and practised family medicine in Dartmouth and north-end Halifax before starting the Brotherhood in 2015.

Not feeling safe, comfortable or respected while accessing medical care means many Black and African Nova Scotians put off screening for cancer and other conditions, leading to poor outcomes. “For men, there is the added stigma of going to the doctor, especially for mental health issues, which can be viewed as a sign of weakness,” says Dr. Milne.

Over the years, the Brotherhood has found creative ways to reach people on a community level and help break down those barriers.

At the Brotherhood’s Barber Shop Talks, Black men of all ages come together to chat about their concerns while receiving a free haircut or shave. “It’s a safe space for Black men to talk about their health,” says Dr. Milne.

The group also hosts car and bike rallies to help spark conversations among Black men about their health and well-being; these were the brainchild of Duane Winter, the program’s long-time community liaison, who died in 2024.

“We came up with the idea of having a car and bike show because men love shiny things, so let’s have shiny things and a health talk,” said Mr. Winter, in a 2022 interview with Nova Scotia Health.

Holding the events in historic Black communities means people feel safe and supported to open up about their own health concerns. “We’re trying to do our part to improve access and get people to be proactive about their health,” Dr. Milne says.

In 2023, NSH expanded the program to Black women, launching the Nova Scotia Sisterhood and recruiting family physician Dr. Leah Jones to lead it. The Sisterhood holds its own outreach events, including salon talks and Pap parties.

Dr. Jones says Black patients often don’t feel heard in regular health-care settings, even if they have a family doctor. “They’re not sure if their doctor understands their lived experience. It’s not any single person’s fault – this is systemic anti-Black racism that affects the care of Black people in Nova Scotia. But we all have a duty to understand how this oppression can impact people’s route to health care.”

The Brotherhood and Sisterhood teams host primary care clinics in Black communities, rotating weekly though Halifax, Dartmouth North, North and East Preston, and Hammonds Plains. They also provide community information sessions on health topics.

Receiving health care in their own communities from Black physicians is helping to build trust among Black Nova Scotians. “They see people who look like them and understand their issues, and who have that cultural competence and understanding of the issues in the communities,” says Dr. Milne. “That’s been very positive.”

The Brotherhood and Sisterhood teams involve other providers, including a clinical therapist, a wellness navigator who helps patients navigate the system, and a community liaison who coordinates community events. To meet the growing demand, family physician Dr. Tony Sappong recently joined the Sisterhood team to provide patient care.

Many of the people who rely on the clinics for primary care have not received health care in years and need follow-up care that requires more than one appointment. Both Drs. Milne and Jones hope their programs receive more resources, so patients can receive care long term. “The real dream is to have Black health centres across the province that specialize in culturally competent care,” says Dr. Jones.

To that end, the programs will soon help train Nova Scotia’s future physicians. “Starting in February 2025, we’ll have an elective experience for an African Nova Scotian med student,” says Dr. Jones, who is academic director of Black health at Dalhousie and chairs the school’s Black learners’ admissions pathway. “Dalhousie is increasing the number of Black medical students, so we need these types of experiences. It’s exciting because this is our next generation.”

In the meantime, Dr. Milne is growing the Brotherhood in new ways and sparking more connections across Nova Scotia and beyond. He has helped create a multicultural psychiatry program and hosts health retreats for Black men (the next one is in April 2025).

The Brotherhood also holds an annual Black Men’s Health Conference, boosting the dialogue on Black men’s physical and mental health, as well as education, housing, the justice system and other social determinants of health crucial to their well-being. Last year, more than 300 men attended.

Looking back over his 44 years of practising medicine, Dr. Milne says working with the Brotherhood is a meaningful way to bookend his career. “I’ve been quite blessed and I’m grateful. When you love what you’re doing and the people you’re serving, it’s not like work – it’s enjoyment.”