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Health Disparities and Racialized Communities

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Title: Health Disparities and Racialized Communities


1
Health Disparities and Racialized Communities
  • Dianne Patychuk,
  • Steps to Equity, Health Equity Consulting
  • October 15, 2009
  • Across Boundaries Ethnoracial Mental Health Centre

2
This talk is about
  • What does the research say about how poverty and
    racism determine health disparities (differences
    in health that are unfair and unjust because they
    result from conditions and policies that can be
    changed)?... root causes of social class and race
    relations are the same race/class intertwined
    structural racism/social stratification ? social
    inequality
  • 2. What does the local data show are priority
    needs and gaps for addressing racialized health
    disparities?
  • 3. What are some opportunities for Across
    Boundaries to influence change in Central LHIN,
    public health, local health system, provincial
    health system. 

Patychuk Steps to Equity/10/09
3
Root Causes of Racialized Health Disparities
Macro Economic Policies Health Social
Policies Culture Social Values
Socio-economic position Class Gender Racializatio
n Power Resources Presitige Discrimination
Exposure to threats to health (work, income,
environment) Differences in Vulnerability Coping
, Behaviours, Understanding, Actions Health care
differences systemic discrimination
HEALTH DISPARITIES Differences in health that
are unfair because they result from social and
health policies, conditions, and practices that
can be changed.
Structural Determinants Root Causes/ (Social
Determinants of Health)
Intermediate Determinants
Modified from briefing paper Health
Inequalities Concepts, frameworks and policy.
H Graham. MP Kelley 2004 NHS and WHO 2007
Conceptual Framework for WHO Commission on the
SDOH.
Patychuk Steps to Equity/10/09
4
How Racism Harms Health2
  • Responses
  • Internalized oppression
  • Harmful use of substances
  • Decline in health5
  • Reflective coping
  • Active resistance
  • Community organizing
  • (Varied i.e. awareness, perception, cognitive,
    physical, spiritual, social, political, etc.)
  • Exposure to
  • Low income, social exclusion, segregation in poor
    environments/bad jobs
  • Toxic substances/hazards
  • Targeted marketing of harmful products3
  • Trauma (direct or experiences threats, slurs,
    verbal abuse, violent acts)
  • Inadequate or degrading medical/other services
    differential treatment/ detention/referral4

Therefore help should be holistic, responsive to
diversity, multilevel, including structural
(tackling multiple oppressions and exposures)
Patychuk Steps to Equity/10/09
5
Health Disparities in Central LHIN
Lowest Income Areas
Analysis of indicators for Central LHIN on the
ICES website show that wealthiest population
groups and areas report better health status and
have lower rates of disease, injury and premature
death than groups with lower income or living in
lower income areas. Lowest income people are two
times more likely to have poor general health or
poor mental heath, and people in lowest income
areas have rates of disability and chronic
disease that are 1.2 to 1.6 times higher, are
more likely to come to emergency or be admitted
to hospital for conditions that could have been
prevented through better access to care in the
community, and face more barriers to access to
prevention, specialist care, surgery, or
diagnostic procedures.
Middle Income Areas
Disease Disability Injury Premature
Death Avoidable ER Visits Hospitali- zations
High Income Areas
Disease Disability Injury Premature
Death ER/Hosp Visits
Disease Disability Injury Premature Death
ER/Hosp Visits
Patychuk Steps to Equity/10/09
6
  • In Central LHIN, if the health of all population
    groups could be improved to the level of the
    higher income LHIN residents with the best this
    would result in more than 3000 fewer cases of
    chronic obstructive lung disease and gt3000 fewer
    cases of ischemic heart disease more than 4000
    fewer cases of osteoarthritis

Patychuk Steps to Equity/10/09
7
Mental Health overlaps with other health
priorities social priorities
(poverty reduction, human rights/anti-racism)
Mental Health Substance Use Addictions
Root/structural and systemic causes of
disparities affect heath status and access to
care in mental health, chronic diseases
(diabetes), access to cancer screening, other
diagnosis, treatment, referral, ER, access to
primary care etc.
Chronic Diseases e.g. Diabetes
A
B
Health Care Primary Care Community
Care e.g. screening for cancer point of
access/referral/equity ER , Specialists,
A.1/3 people with cancer, hypertension, epilepsy,
stroke diabetes suffer form major depression 6
Poorer quality of diagnosis treatment for
people with mental illness4 B. Low income groups
more likely to experience mental health problems,
injuries, chronic diseases, infection and
premature death. Racialized groups and immigrants
who experience discrimination or unfair treatment
experience a decline in self-reported health and
increasing levels of sadness, depression
loneliness 5
Patychuk Steps to Equity/10/09
8
Strategies
  • gt50 Canadian ethno-racial mental health research
    studies, recent Across Boundaries research,
    growing community engagement and commitment to
    equity, access and justice/human rights show
    pathways for change within anti-oppression
    anti-racism lens, that Across Boundaries is
    well-placed to continue to advance

Patychuk Steps to Equity/10/09
9
References (quoted in previous slides)
  • 1 WHO. 2006, 2007. A conceptual framework for
    action on the social determinants of health
  • 2 Krieger N, 2003. American Journal of Public
    Health. p196 Nazroo J. AJPH, 2003 p 281-3
  • 3 Duerksen S et al. 2005. Health Disparities and
    advertising content of womens magazines. BMC
    Public Health. 585
  • 4 National Healthcare Disparities Report, 2007.
    US Dept. of HHS Whitely R et al. 2006.
    Understanding Immigrants reluctance to use
    mental health services. Montreal. Cdn. J of
    Psychiatry Kisely S, et al. 2007 Inequitable
    access for mentally ill patients to some
    medically necessary procedures. CMAJ.176(6)
    Jarvis E et al. 2005. The role of Afro-Cdn status
    in police or ambulance referral to emergency
    psychiatric services. Psychiatric Services, 56
    (6).
  • 5 De Maio F. Kemp E. 2009. Deterioration of
    mental health status among immigrants to Canada.
    Global Public Health 1-17.
  • 6 European Commission. 2006. Background sheet
    Targeting vulnerable groups in society

Patychuk Steps to Equity/10/09
10
Who experiences discrimination?
  • Experiencing Discrimination General Social
    Survey, 2004 Canada
  • Aboriginal People 31
  • Recent Immigrants 26
  • Established Immigrants 18
  • Racialized Groups (All) 28
  • - Black 36
  • - Latin American 36
  • Not in Racialized Group 13
  • Born in Canada 10
  • Gays, Lesbian, Bisexuals 41 (Heterosexuals 14)
  • Youth Higher for immigrant than Canadian-born
    youth 34
  • Experiencing Discrimination Ethnic Diversity
    Survey, 2002 Canada
  • Caribbean 41
  • Jamaican 51
  • South Asian 40
  • Latin American 40
  • West Asian 28
  • Total in Racialized Groups (not including
    Aboriginal) 20
  • Not in Racialized Group 5

Patychuk Steps to Equity/10/09
11
Who experiences poverty? Ontario 2006 Census
  • Somali 69.5
  • Afghan 56.0
  • Bangladeshi 49.4
  • Ethiopian 49.0
  • Pakistani 43.5
  • Korean 42.9
  • Iraqi 41.4
  • Arab 39.9
  • Palestinian 37.2
  • Iranian 35.6
  • Nigerian 35.1
  • Black 33.6
  • Columbian 33.3
  • African nie 27.6
  • Tamil 27.0
  • Sri Lankan 25.8
  • Vietnamese 25.3
  • Chinese 23.8
  • Filipino 14.0

Analysis pf 2006 Census from free
tables, Statistics Canada website. Data is before
tax below low income cut-off for 2005 income
year by ethnic group Patychuk Steps to
Equity/10/09
12
While Central LHIN has 13 of the Ontario
Population, it has
  • 42 of Ontarios West Asian and Korean population
  • 38 of Ontarios Chinese population
  • Over 20 of Ontarios Latin American, Southeast
    Asian and Filipino population
  • Over 17 of Ontarios Caribbean/African/
    Black-Canadian population
  • One in 10 residents of the LHIN is a recent
    immigrant (arrived within 5 years), over 40 of
    the population are members of racialized
    communities one-half of the population have a
    Mother Tongue other than English
  • Among Seniors 1 in 4 are in racialized groups,
    gt1 in 6 need to receive their services and
    information in a language other than English or
    French and 1 in 12 has lived in Canada less than
    10 years (not yet eligible for income support).

Patychuk Steps to Equity/10/09
13
What does the local data show?
  • Maps identify areas of concentration of
    racialized, linguistic and low income groups
    (priority communities) for engagement, outreach,
    investment
  • Data for neighbourhoods, sub-LHINs, quintiles and
    LHIN analysis provide a basis for identifying
    benchmarks for disaggregating data, setting
    targets, comparing users with estimated
    population diversity and needs, and monitoring
    health disparities.

Patychuk Steps to Equity/10/09
14
Chinese ethnic community remains the largest
among racialized groups, but diversity is
increasing
Patychuk Steps to Equity/10/09
15
Between 2001 and 2006, Central LHIN grew by
13 86 of the total population growth was
people in Racialized Groups. Other population
(not in a racilaized group) grew by only 2. The
greatest increase was among West Asian
(Afghanistan) and Korean communities
2006 Census
Patychuk Steps to Equity/10/09
16
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21
Is the LHIN ready to address racialized health
disparities?
  • Review of recent Board and CEO reports on website
    - issues raised CHC resources needed for serving
    non-insured
  • SNAGA noted gaps in availability of linguistic
    and culturally diverse services and the need to
    give priority to NY West (e.g. poverty) and NY
    West identified in LHIN equity priority in
    addition to rural/underserved Nth Simcoe area
  • Aging at Home using MOHLTC draft equity impact
    assessment
  • CEO reports to the Board notes community is glad
    to see health equity in IHSP2
  • LHIN Equity Plan requirements for HSPs.
  • MH Diversity Lens project
  • Equity policies and other tools in LHIN hands
  • LHIN Statement of Commitment to Health Equity

Patychuk Steps to Equity/10/09
22
Central LHIN Central LHIN statement of commitment
for reducing health disparities
  • Central LHIN will strive to reduce health
    disparities as a shared responsibility with its
    health service providers by integrating health
    equity into strategies and activities within its
    mandate and influence.

Patychuk Steps to Equity/10/09
23
LHIN Slide from presentation to Governance
Councils, September 2009
24
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25
What can Across Boundaries do?
  • Work with other local organizations to
  • ask Central LHIN and its MH service providers to
    incorporate postal code and racialized group
    into existing categories in the new Common
    Assessment of Need data set, and compare/match
    population served by MHA services with resident
    population to report, monitor and reduce
    difference/disparities in service use, unmet
    needs and barriers to access
  • Propose a pilot for this type of data collection
  • Contribute to shaping guidelines for equity-based
    data collection (e.g. with Health Equity Council)
  • Encourage similar data collection be extended to
    e-health, diabetes record, and ER patient
    discharge qaire) as part of an equity commitment

Patychuk Steps to Equity/10/09
26
What Can Across Boundaries do?
  • Ask that all new Central LHIN-funded initiatives
    use an equity lens to ensure they are responsive
    to diversity and reduce rather than increase
    health disparities (e.g. ED strategies, Aging at
    Home, roll-out of diabetes strategy).

Patychuk Steps to Equity/10/09
27
What can Across Boundaries do?
  • Given growing momentum and awareness of racism
    and other forms of oppression and their impact on
    health Expand the number of organizations and
    strategic leaders that are aware of the
    importance of integrating anti-oppression/anti-rac
    ism (what it means, looks like, how to do it) and
    Across Boundaries capacity for leadership in
    this area (e.g. leadership in public health,
    community health centres, other sectors)

Patychuk Steps to Equity/10/09
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