Health Equity & Men’s Health OMHARN Conference – March 17, 2012

1. Health Equity & Men’s HealthOMHARN Conference – March 17, 2012 Anthony Mohamed, Senior Specialist, Equity & Community Engagement

2. Our City - Toronto • ~ 4 million residents in Greater Toronto • One of the most multi-cultural cities in the world – UN • 24.5% below LICO (2006 Census – impact greatest among people of colour) • 2.7 % of First Nations, Métis and Inuit peoples in Canada live in the GTA • 50% are not Canadian born (2006 Census) • 47% people of colour (2006 Cen.“Vis. Min.”) • Significant housing differences/homeless • Largest LGBT community in Canada • Full range of diversity represented

3. Overview & Major Clinical Programs INNER CITY HEALTH TRAUMA & NEUROSURGERY CANCER & CRITICAL CARE DIABETES COMP. CARE MOBILITY HEART & VASCULAR *1892 – Sisters of St. Joseph *Strong Mission/Values • *>500 beds *Large Teaching Hospital • *ICH – largest program with significant community engagement • *Centre for Research on Inner City Health/Li Ka Shing KT Institute

4. Equity Strategy Integrated, intersectional, pro-active and on-going approach to equity fully based in our Mission and Values

5. Sample Equity Strategy Interventions • SOAPEE = Safety, Outcomes, Access, Patient experience, Equity & Efficiency = Quality Improvement • Cultural sensitivity training for all staff/students • Valuing & supporting internationally educated professionals • Clear anti-discrimination policies • Free interpreter services in over 200 languages • Patient Advocates • Chinese Outreach Project • Data Collection Pilot Project • Diverse spiritual care & menus • Community Advisory Panels on Homeless/Under-housed; Women & children at risk; Mental health; Aboriginal communities • Disability; HIV/AIDS; Homeless; Seniors; Non-Insured & Dental Access Plans • Harm reduction principles • Patient centred, community based care and research • Leadership within the wider health sector (80+ partnerships)

6. WHO Definition of Health (1948) Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

7. What is Men’s Health?

8. What is Men’s Health? • An initial web search brings up articles on fitness, baldness and erectile dysfunction; • More severe male health issues are often ignored in public eye; • Men need to acknowledge the role we play in perpetuating sexism that clearly harms women and trans people but also is harmful to our own well being; • Sexism feeds belief that men should be so strong as to not express or address discomfort; • “Live strong & die young” attitude is literally killing us; NIH and CDC List (in no order): • Mental health • Heart disease • Sexuality and gender related concerns • Sexually Transmitted Illness • Infertility/Reproductive health • Erectile dysfunction • Testicular, penile, colon, prostate cancer • HPV, HIV, Syphilis and other virus/bacteria based illness • Klinefelter syndrome • Flu • Alcohol/Drug abuse • Domestic and/or street violence • Life expectancy

9. Transgender adults 50% more likely to have suicide ideation (Center for American Progress 2009) Homeless men about 9 times more likely to be murdered than their counterparts in the general population (Hwang SW 2000)

10. Power Study - SDOH • Exhibit 1 | Age-standardized percentage of adults aged 25 and older who reported a lower annual household income,^ by sex and race/ethnicity, in Ontario, 2005

11. Anthony’s definition of Health Equity Health equity refers to the actions required to achieve similar or equal health outcomes among diverse populations

12. Biggest challenge facing multicultural health research What we don’t know Lack of accurate patient socio-demographic data to provide the “evidence” needed for culturally informed interventions. Systemically hospitals only collect: • age, • sex (M/F only) • postal code (as an indicator of income) Most additional data collected, but still rarely are: • Race or ethnicity • Religion for meals/spiritual care

13. What can OMHARN do? Adopt a framework I call D.S.I.M. • Desire to acknowledge and address health inequities • Socio-demographic patient data collected beyond age, sex and postal code • Interventions towards attitudinal shifts, policy change, access to care and behavioural change • Measurement and monitoring through socio-demographic data analysis of health outcome indicators

14. National, Local & Provincial Support for Health Equity • “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.” Canada Health Act 1984 • Health disparities or inequities are differences in health outcomes that are avoidable, unfair and systematically related to social inequality and disadvantage Toronto Central Local Health Integration Network 2008 • “…improving the quality and value of the patient experience through the application of evidence-based health care.” Ontario Excellent Care for All Act 2010

15. Common equity challenges & questions for discussion • Access to dental and eye care • Non-OHIP Insured Clients • Clinical ethics and health system practices vs. religious beliefs • Accessible building upgrades • Which shared room for pre-operative trans patients? • Who pays for interpretation & translation? • Corporate dress codes – what is “professional?” – fitting masks over beards • Gay men donating blood • Identifying good equity based health outcome indicators • Staff language at work • Others?

16. Questions and Thank You Anthony Mohamed, Senior Specialist, Equity & Community Engagement St. Michael’s Hospital 416-864-5087 mohameda@smh.ca