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Fair Care: Government Collaboration with Community

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I acknowledge that I am in Mi’kma’ki, the ancestral and unceded territory of the Mi’kmaq People. This territory is covered by the “Treaties of Peace and Friendship” which Mi’kmaq, Maliseet and Passamaquoddy Peoples first signed with the British Crown in 1726.

These treaties did not deal in the surrendering of lands and thus I wish to honor this treaty by acknowledging that I am a guest in Mi'kma'ki and respectfully call Kjipuktuk home for as long as I am welcome, I come with respect for this land that I am on today, and for the people who have and do reside here.

Land Acknowledgment

Together we should begin by recognizing that the land upon which we work, live, and gather is the traditional territory and ancestral homeland of the Mi’kmaq Nation. Our relationship is based on a series of sacred and historic Peace and Friendship Treaties. We pay our respect to the Mi’kmaw People, and recognize in Nova Scotia, we are All Treaty People.

We acknowledge that people of African descent have been in Nova Scotia for over 400 years and we honour and offer gratitude to those ancestors of African descent who came before us to this land and help shape the fabric of Nova Scotia.

Il y a plus de 400 ans, des colons français fondaient le premier établissement permanent en Amérique du Nord à Port-Royal, dans cette province. La colonie développera petit à petit principalement le long de la baie Française jusqu’en 1755 et elle donnera naissance à ce peuple fier, résilient et courageux : le peuple acadien.

More than 400 years ago, French settlers founded the first permanent settlement in North America at Port-Royal, in this province. The colony would flourish along the French Bay until 1755 and give birth to this proud, resilient and courageous people: the Acadian people.

African NS acknowledgement

Acadian community acknowledgement

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Equity & Engagement Division…Who We Are and What We Do

Divisional Mandate

The Department of Health and Wellness established its Equity and Engagement Division in May 2021.

Internally: the division’s mandate is to identify and remove systemic barriers impacting the progress, wellbeing, and overall sense of belonging for all staff, and in particular equity-seeking staff.

Externally: the division’s mandate is to ensure- lived experiences, strategic partnerships and public engagement continue to inform and shape the government’s vision for a more engaging and equitable health system for Nova Scotians.

Approaches: the collective mandate of the division is carried out through inclusive engagement, equity education, focus groups, data and evidence-based analyses, capacity building, strategic planning, measuring indicators and progress reporting.

Employee Engagement & Staff Committees

Public Engagement & Capacity Building

Equity Programs & Initiatives

Data, Metrics & Research Analyses

Strategic Health Partnerships & System Strategies

Equity and Engagement Division

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Race-Based and Language Identification Information

FAIR CARE NS

Project Overview and Outcomes

Community advocates have expressed frustration at Government’s inability to identify and report on the inequities in the healthcare system through data and evidence.
Human rights commissions across Canada, including the NS Human Rights Commission, have been calling for the collection of race-based data to help identify inequities.
There have been long-standing requests from the Health Association of African Canadians (HAAC) for collection of race-based data within the health system.
Identified as a foundational action in Count Us In to better serve health and wellness needs of African Nova Scotians.
Launched: October 2022

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Racial & Linguistic Identifiers/Categories

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As Nova Scotia is the first province to adopt the CIHI standard, the approach is to:

Gather feedback on the self identification standard proposed by CIHI

Do communities feel reflected in the CIHI categories ; and
Suggested adaptions

Input on communication to the public

What information to share
How to share it

40 Sessions/� ~400 People Engaged

The Canadian Institute for Health Information (CIHI) developed pan-Canadian minimum�standards for collecting race-based and Indigenous identity data in health care, the purpose of these standards is to support harmonized, high-quality data collection and to help identify and address health inequities related to racism.

NS was the 1^st province to adopt this standard. However, the province wanted to ensure that this identification standards was correct and appropriate for the Nova Scotia Context.

This is why we created the Primary Reference working Group. This group was responsible to reviewing and suggestion adaptions to the CIHI standards; The PRWG was also tasked to engage and connect the race-based data project with their community. this community engagement saw 40 session and around 400 diverse community member engaged.

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The 12-member group comprised of key individuals representing some of the major equity groups in Nova Scotia, including alignment with census demographic data and representations

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The Primary Reference Working Group – Community based working group

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Collecting Identifiers

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Acceptance of Categories

Primary Reference Working Group (PRWG): community-based working group to help engage communities, supported by government representatives.

Community organizations: Communities Reached:
Bangladesh Community Association of Nova Scotia	South Asian and Bangladeshi community
Health Association of African Canadians	African Nova Scotian Community
Immigrant Migrant Women’s Association of Halifax	Latin American Community
Indian Festivals Club of Nova Scotia	South Asian, Southeast Asian and Indian Community
Iranian Cultural Society of Nova Scotia	Middle Eastern Community
United African Canadian Women’s Association	African Descent and African Immigrant Community
Réseau Santé	Acadian and Francophone communities
Halitube	New Filipino, Chinese, Korean immigrants

PRWG was entrusted to lead All Community Engagement Sessions and surveys thru a MOA. The each PRWG submitted a budget to carry out the sessions and surveys. The sessions and surveys took place between 01 September and 15 November 2021. The Surveys and session were to provide feedback on: (1) IDENTIFIERS (2) COLLECTION METHOD (3) COMMUNICATION TO THE PUBLIC ABOUT THE FAIR CARE INITIATIVE

The PRWG was responsible for following from the sessions:

Convening and hosting between 6 and 10 Community Engagement Consultation
Each Community Engagement Consultation Session should produce at least 10 to 25 Survey Responses
A concerted effort should be made to host Community Engagement Sessions in communities and regions throughout the Province of Nova Scotia
At the conclusion of this phase, each PRWG member will complete a high-level narrative report citing their findings and recommendations

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Between fall 2022 and summer 2023, the group collaborated with government to develop a data governance framework which determined:

Use
Access
Data integrity
Improve health outcomes – specific to community in question

The Primary Reference Working Group (PRWG) – a model for successful community and government collaboration

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PRWG – a model for successful community and government collaboration

5 keys to building a successful partnership

Build a Relationship
Reparations
Lead with community
Time
Accountability

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PRWG – The model (continued)

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Building a relationship

Invite the community to put forward members that will advocate for their communities
Give the community leaders space at the table to share their lived experiences
Keep them involved

Invite the community to be a part of the initiative/project

Before, during and after

Reparations

Address any concerns, past wrongs or broken promises

Important before building a new relationship

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PRWG – The model (continued)

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Lead with community

Determine how the community leads with government on initiatives, �projects and programs

Time

Don’t rush community�

Accountability

Document how you will enact what they are sharing and continued engagement

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Concepts to Apply

Communication
Accountability
Transparency

Two way street

Power to influence change

Community voice

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Future Collaboration of the PRWG

Media, FOI request for race based/linguistic data

Data Requests within and between DHW, IWK, NSHA

DHW Data Governance Review

(privacy and risk review)

Data Request Fulfillment

Fair Care Governance Committee Informed

Here are the most common streams we anticipate data to be requested, this list is not exhaustive and is designed to illustrate the highest likelihood of ways the data will be requested, it is not the only way data can be requested. For example: community requesting the use of the data is not in the table, the approach for a community researcher to request data will be similar to the academic stream (right stream).

The streams include engagement with the Community Governance committee, this is primarily to ensure that the requests benefit community. In the case of a Freedom of Information request, the committee will only be informed of the data shared, through DHW data governance review the requested data released will not be identifiable data that may cause harm or discrimination direct or indirect to community.

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Voluntary Self-Identification Processes

Opt-in via DHW Website

MSI Application & Renewal processes

MSI 1-800

Race-based identifiers will not be on the physical Health Card (including magnetic strip)

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There are three was to provide you racial identifier- online, by phone and on the renewal form.

I want to emphasis that your personal information will not be connected to your Health card and your data will remain private and confidential.

TO FINISH:

As the Keynote speaker at the Black Health Conference – Notisha Massaquoi stated last night Modifying her words– IF YOU ARE NOT COUNTED, YOU DON”T COUNT! The lack of race-based data renders Black experiences invisible.

And frankly, providing your race-based data will make my work easier! Also the work of the Karen, the African NS Health Equity advisor at our office and the work of Rhonda, NSH African NS health consultant. So we can go with the data to:

OAMH and say that people of African descent are not accessing mental health services as you thought

Go to NSH health and say we told you so, Black men in Upper Hammonds Plains have higher rates of prostate cancer.

But flipping that coin we can say look at the great health outcomes of African NS in Digby. This is because of their ANS centre of excellence/community centre which does health and wellness program and also combat the social and structural determinants of health by providing training opportunities with NSCC at the centre

Or African NS having increased rates of accessing services at the new Cape Breton Regional hospital because the OHPR increasing representation of African descent health professionals at the site, I can go across the hallway from my office and see the director of infrastructure and say because you incorporated a safe place and inviting environment in the plans of the hospital African NS fell more comfortable in accessing service e at the hospitals and I can go to my family at African NS Affairs in Cape Breton and let them know because you advocated for ANS to have construction jobs at the hospital they feel a part of the hospital and therefore more willing to go there to obtain services.

So be ready to mark that one line.

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Modified Standard for Nova Scotia

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Addition of a Linguistic Identifier

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Questions?

Comments

Raoul Tan-Yan

raoul.tan-yan@novascotia.ca