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 Racialization 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. 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 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.) How Racism Harms Health2 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 casesof chronic obstructive lung disease and >3000 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 • >50 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 women’s magazines. BMC Public Health. 5:85 4National Healthcare Disparities Report, 2007. US Dept. of HHS; Whitely R et al. 2006. Understanding Immigrant’s 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% Other Studies: • 1/5 young black women face discrimination in health care (WHIWH,2003); Across Boundaries youth (30% young males & 20% of young female exp. physical attacks because of their race); & AB trauma report, MH Commission, polls, racism in rental housing, policing, hiring, health care 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% • Portuguese: 11.8% • British Isles: 11.0% • Polish: 11.2% • English: 9.7% • Italian: 9.4% 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 Ontario’s West Asian and Korean population • 38% of Ontario’s Chinese population • Over 20% of Ontario’s Latin American, Southeast Asian and Filipino population • Over 17% of Ontario’s 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, >1 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

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

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-racism (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