Building Capacity for Equity in Health - Abebe Engdasaw

Building Capacity for Equity in Health Promotion for Racialized Communities : 

Building Capacity for Equity in Health Promotion for Racialized Communities Learning Lab Ottawa, November 29, 2010

Health Promotion : 

Health Promotion The process of enabling people to increase control over the determinants of health, and thereby improve their health. (Regional framework for health promotion, WHO 2002) Ottawa Charter for Health Promotion Prerequisites for health Peace, shelter, education, food, income, stable eco-system, sustainable resources, social justice and equity 5 Action Areas Build healthy public policy Create supportive environments Strengthen community action Develop personal skills Reorient health services

Health equity : 

Health equity Health inequities are differences in health that are unfair and avoidable because they result from social and health conditions, policies and practices that can be changed. Equity means fairness. (D.Patychuk – Project Literature Review) Achieving equity in health between and within populations implies that all people have an equal opportunity to develop and maintain their health, through fair and just access to resources for health (WHO, 1996)

Social Determinants of Health and Social Determinants of Health Inequities are not the same : 

Social Determinants of Health and Social Determinants of Health Inequities are not the same Taking a whole of population approach without recognizing existing inequities can exacerbate them Social position is a key concept (WHO CSDH) Need for disaggregation, but data inadeqacies

Growing understanding and acknowledgement of health inequities and need to address these. : 

Growing understanding and acknowledgement of health inequities and need to address these.

Racialized communities face greater inequities : 

Racialized communities face greater inequities Racialization is the process where racial categories are socially constructed as different and unequal in ways that lead to social, economic and political impacts. (Galabuzi 2001). The Ontario Human Rights Commission recommends the term “racialized person” or “racialized group” over terms like “racial minority” or “visible minority” or “person of colour” or “non-white” as it expresses race as a social construct rather than as a description based on perceived biological trait.

Who are the Racialized Communities in Ontario? : 

Who are the Racialized Communities in Ontario? Racialized groups refers to the populations identified by Statistics Canada as “visible minorities” Racialized communities often conflated with immigrant/newcomer communities Inequities persist well into the second generation Need to deepen understanding and analysis of immigrant inequalities through lens of racialization Racism as a determinant of health

Individual and Structural Racism : 

Individual and Structural Racism Individual Racism – attitudes and actions of individuals Structural racism refers to “a system in which public policies, institutional practices, cultural representations, and other norms work in…reinforcing ways to perpetuate racial group inequity. It identifies dimensions of our history and culture that have allowed privileges associated with ‘whiteness’ and disadvantages associated with ‘color’ to endure and adapt over time.” (Aspen Institute, 2004).

Racism remains a marginalized issue in health planning.How can health promotion address health inequities facing racialized communities in Ontario? : 

Racism remains a marginalized issue in health planning.How can health promotion address health inequities facing racialized communities in Ontario?

Building Capacity for Equity in Health Promotion : 

Building Capacity for Equity in Health Promotion Focus on racialized health inequities, especially in low income communities Health Equity Council SEOCHC and other partners Provincial advisory committee November 2009 – March 2011 Funded through the Healthy Communities Fund of the Ontario Ministry of Health Promotion & Sport

Project Vision : 

Project Vision More than a “project” – about social change First such province wide health equity initiative Bring equity lens to practice of health promotion = shift policy/planning + programs and services Build health equity network, set stage for concerted action on health equity Build synergy with other initiatives

Project Overview : 

Project Overview Building capacity for equity in health promotion (policy/planning plus service delivery) Public health Community Health Centres Community organizations Working with racialized communities, especially low income communities Focus on Healthy eating/food security Physical activity Mental health promotion Conferences (Learning Labs), Literature Review, Promising Practice Directory, Resources & tools Bilingual, province wide

Conferences/Learning Labs : 

Conferences/Learning Labs Ottawa (2) – English and French Sudbury – English/bilingual Hamilton – French Toronto – English All in 2010 / 2011 Local partners Local planning committees

Some tools and resources that might be useful : 

Some tools and resources that might be useful

Power Flower : 

Power Flower Reflecting on our social identities in relation to the dominant social identities. Where does the dominant identity lie for each petal/category? Where are we located in relation to it? What privileges or disadvantages does it confer on us? We are not necessarily responsible for our social identities (this is not about guilt), but we can be responsible for our actions Source: Educating for a Change, Rick Arnold et al

First Steps to EquityDianne Patychuk,Daniela Seskar-Hencic : 

First Steps to EquityDianne Patychuk,Daniela Seskar-Hencic Ideas and Strategies for health equity in Ontario, based on new Ontario Public Health Standards. Includes identifying, reporting and using information about health inequities Tailoring strategies to inform actions that meet the needs of priority populations. Provides ideas, steps, examples and resources to support people and organizations working for equity in health in Ontario. Link: http://www.healthnexus.ca/policy/firststeps_healthyequity.pdf

First Steps to EquityKey equity questions to ask : 

First Steps to EquityKey equity questions to ask Assessment & Surveillance What are the unique social and environmental conditions of this community? Who is at risk? How can we design data collection to learn more about relationships between SDOH and health outcomes, behaviours, and knowledge? How can we improve our surveillance systems and build ones that collect data we need? Research Why are some people at greater risk? Where are the people we need to learn more about? How can we reach and engage them in our inquiry? What is the lived experience of specific groups? How does that experience relate to health outcomes and our goals? How are our actions relevant to specific populations? Knowledge Exchange Who are the community stakeholders that we can exchange knowledge with? How can we engage them, learn from them? Are we relevant? Understood? Is our information useful? Is there a sense of community ownership over this knowledge? Program Evaluation Who is accessing/ benefiting from our programs? Who is not? What are the barriers, differential impacts? What can we do to change that?

Health Equity Impact Assessment Tool : 

Health Equity Impact Assessment Tool A flexible and practical assessment tool that can be used to identify potential health impacts (positive or negative) of a plan, policy or program on vulnerable or disadvantaged groups within the general population. (TC LHIN website) Developed and refined since 2008 – being piloted in certain LHINs Tool plus accompanying workbook Based on broader HIA approaches Link: http://www.torontocentrallhin.on.ca/Page.aspx?id=4396&ekmensel=e2f22c9a_72_206_4396_5

HEIA contd. : 

HEIA contd. Questions in the tool How does your program/service affect health equity for these vulnerable or disadvantaged populations? List of health disadvantaged populations – not exhaustive Potential impacts on Social Determinants of Health – positive, negative Where is more information needed? What is your strategy to mitigate /strengthen these impacts? How will the initiative be monitored to assess its impact?

Racial Equity Theory of Change : 

Racial Equity Theory of Change From the Aspen Institute Roundtable on Community Change For communities planning new initiatives, or articulating theories for programs already in existence. A step-by-step guide for defining what is needed to change a specific racial disparity outcome in a given context. Uses “backwards mapping” and sets long-term change targets and identifies early and intermediate requirements or benchmarks logically associated with those targets, “Unpacks" a change process and identifies specific challenges and barriers that must be addressed. www.aspeninstitute.org

Dancing on Live Embers: Challenging Racism in Organizations. Tina Lopes and Barb Thomas, Between the Lines, 2006 : 

Dancing on Live Embers: Challenging Racism in Organizations. Tina Lopes and Barb Thomas, Between the Lines, 2006 Investigates how racism, White power, and privilege operate in the ordinary moments of organizational life. Through stories, it offers concrete examples of racial justice work by a range of experienced activists. This is a hands-on book for a range of people who are trying to create more equitable organizations.

Creating Inclusive Community Organizations toolkit : 

Creating Inclusive Community Organizations toolkit Launched by Ontario Healthy Communities Coalition in November 2004 This tool kit outlines a step by step organizational change process to increase the level of diversity in small to mid-sized organizations and to help them to become more aware, responsive and inclusive of the populations that they serve Main sections Understanding Diversity and Inclusion Organizational Change Strategy Tools Additional resources Link: http://www.ohcc-ccso.ca/en/inclusive-community-organizations-a-tool-kit

Inclusive Model for Sports & Recreation Programmingfor Immigrant and Refugee Youth : 

Inclusive Model for Sports & Recreation Programmingfor Immigrant and Refugee Youth OCASI with partners (OCISO, SISO, COSTI and other partners) 12 elements of an Inclusive Model for Sports and Recreation Programming for Immigrant and Refugee Youth Combine education with sports and recreation activities Introduce familiar and popular sports and recreation activities Encourage Parental involvement Develop youth leadership by offering basic training in officiating and coaching Build working relations and collaborations with other service providers Ensure that facilities are within geographical reach of youth Develop supportive internal organizational structure and top management support Create Funding Opportunities and develop strategies for working with funders Mobilize Communities Ensure Programming Reflects diversity and cultural sensitivity Operate under an anti-oppression and anti-racism framework Acquire transportation for youth

Recommendations : 

Recommendations Bring together community-based, immigrant- and refugee-serving organizations to implement the model Promote the model to mainstream sports and recreation organizations Promote dialogue and collaboration between the settlement agencies and mainstream organizations Train staff and recreation leaders CIC should include the sports and recreation component in settlement funding Link: http://www.ocasi.org/index.php?catid=130

A Framework for Thinking about our Work in Health Promotion : 

A Framework for Thinking about our Work in Health Promotion

Reflect on : 

Reflect on The complex and intersectional nature of racialized health inequities and the pathways by which these are created and exacerbated Different frameworks to approach the issue of health inequities will yield different strategies to address these - A universal, cultural competence versus a racialized health disparities approach

Culturally Competent Approach – some elements : 

Culturally Competent Approach – some elements Training for staff around how to work with diverse communities Culturally appropriate programs and services (e.g. indigenous and alternative forms of stress reduction) Targetted interventions based on disease rates among particular groups Scope and quality of programmes available to racialized groups often not addressed Underlying causes not addressed, and long term, fundamental changes may not occur Everyday racism may be unrecognized and unchallenged Essentialism and stereotyping can occur, distinctions within communities (political, historical, ethnic, social, etc.) may be ignored (Project literature review – forthcoming)

Racialized Health Disparities Approach – some elements : 

Racialized Health Disparities Approach – some elements Recognize intersecting forms of power and privilege, and how everyday interactions perpetuate discrimination and social exclusion, and work to dismantle individual, organizational and structural racism. Proactively tackling policies and practices that discriminate against racialized groups Ensure these groups have decision making roles, power and resources to participate in desiging and delivering HP strategies Identify and expose health inequities, commit to reducing them Anti-racism, anti-oppression organizational change, including top management, organizational practices and processes, design of programs and services Promote awareness and identification of systemic racism/discrimination so that it can be challenged (Project literature review – forthcoming)

Thank you for your participation today. Our work is just beginning… : 

Thank you for your participation today. Our work is just beginning…

Slide 31: 

Kelli Tonner kellit@seochc.on.ca www.seochc.on.ca Subha Sankaran s.sankaran@healthnexus.ca www.healthnexus.ca