EXPERIENCES CANADA

Anti-Racism Conversations

Healthcare

Overview

Healthcare

• Social Determinants of Health
• Access
• Unauthorized procedures
• Mistreatment
• COVID : living conditions, anti-Asian racism

Mental Health

• Effects of racism
• Stigma
• Decolonizing mental health

Activity : Social Determinants of Health

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Determinants of Health: are a broad range of personal, social economic and environmental factors that determine individual and population health.

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There are 12 main determinants of health:

• Income and Social Status
• Employment & Working Conditions
• Education and Literacy
• Childhood Experiences
• Physical Environments
• Social Supports and Coping Skills
• Health Behaviours
• Access to Health Services
• Biology and Genetic Endowment
• Gender
• Culture
• Race/Racism

Social determinants of health

How might race and racism determine someone’s health?

Anti-black racism: Determinant of health

Anti-Black racism is a system of inequalities in power, resources and opportunities that discriminate against people of African descent.

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Experiencing discrimination throughout a lifetime can lead to chronic stress and trauma on mental and physical health. It is important to note that the Black population in Canada is diverse, and overlapping identities (i.e. age, immigration status, sexual orientation, gender, religion etc) can shape or impact health and wellbeing.

Health inequalities in canada

Experiences of discrimination, racism and historical trauma are important social determinants for Indigenous Peoples, Black and LGBTQ2s+ Canadians.

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Differences in health status among individuals or groups are called health inequalities.

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Health Inequities are inequalities that are unfair or unjust (i.e. Remote or Northern communities in Canada do not have the same access to fruits, vegetables or other food as communities in Southern Canada).

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Healthy Equity seeks to reduce inequalities and to increase access to opportunities and conditions that increase health for all.

• 7.7% of Canadian households are food insecure, which means nutritious food is unavailable or inaccessible. At-risk populations more likely to be affected are lone-parent families, women and children, immigrants, the elderly, and Indigenous peoples.
• 60% of Inuit women reported that their families could not afford to buy all the foods they needed from the store
• 70% of Inuit children live in food insecure households
• Approximately 1 in 6 children live in households experiencing extreme poverty. Low income affects access to healthy foods, housing and is associated with poor mental health and physical outcomes. Those at risk from coming from low income families were found to be:
• 2.7x higher among Black Canadians
• 2.2x higher among those who are recent immigrants
• 2.0x higher among Arab, South Asian and West Asian Canadians
• 1.7x higher among among East and Southeast Asian Canadians
• First Nation children are 2.6x and Metis children 1.4x higher to come from low income families compared to non-Indigenous children

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Healthcare: Access

• Geographic isolation hinders access to medical care as health care facilities are small and sparse
• 1 in 10 First Nations people living on reserve report unmet health care needs, and 1 in 5 do not have a family doctor
• Communication barriers also hinder access to health services information, as it is usually only available in English or French

Healthcare: Unauthorized procedures

There are many instances of racism in healthcare in Canada. Sometimes, this takes the form of unauthorized procedures, procedures done to a person without their knowledge or consent.

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Nutrition Research in Indigenous communities and residential schools (1942-1952):

• Federal government-approved experiments on vitamin supplements for undernourished people
• Experiments were performed on malnutritioned Indigenous children in Northern Manitoba and in six residential schools across Canada without obtaining their informed consent, nor providing them with adequate nutrition or dental care.

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Sterilization Acts

• Alberta Sexual Sterilization Act, 1928-1972
• British Columbia Sexual Sterilization Act, 1933-1973

These were acts of “negative” eugenics; a practice aimed at controlling the procreation of individuals or groups viewed as having inferior or undesirable characteristics and genes.

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By 1972, First Nations and Métis people represented over 25% of those sterilized in Alberta - around 1,200 women in the 1970s alone

Healthcare: mistreatment

Systemic racism in Canadian healthcare is pervasive and can be fatal. For Indigenous communities, colonial policies, limited healthy food choices, inadequate living conditions and substandard healthcare treatment are contributing factors to health inequities experienced by Indigenous peoples and communities across Canada.

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Brian Sinclair and Joyce Echaquan are two unfortunate examples of how racism in healthcare can be fatal.

Brian Sinclair, an Ojibway man, was 45 when he died waiting to be seen in the emergency room at Winnipeg’s Health Sciences Centre, in September, 2008. He was discovered dead 34 hours after he arrived.

Joyce Echaquan was an Atikamekw woman who filmed her interactions with hospital staff in Joliette, QC. The video captured her being insulted, sworn at, and harassed due to her race. She died in hospital shortly after.

Healthcare: mistreatment

In a Canadian context, health data among Black Canadians is limited. The lack of data increases vulnerabilities and can lead to misinformation within the community.

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Black women in particular report routinely having their pain denied, undertreated or ignored by medical practitioners.

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A 2019 literature review found that Black women from Sub-Saharan Africa are less likely to be screened for cervical and breast cancer than white Canadian women. This variation is important for researchers, doctors and policy leaders to know as it can lead to increased health promotion, prevention and educational initiatives among communities most impacted by this disparity.

From left to right: Dr. Aisha Lofters, Dr. Onye Nnorom, and Nakia Lee-Foon

Healthcare: covid-19 - living conditions

There are many ways in which the COVID-19 global pandemic is disproportionately affecting racialized communities. For example, in First Nations...

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• Approx. 23% live in unsuitable housing
• Not enough bedrooms for the size and composition of the household, according to the National Occupancy Standard
• Approx. 24% live in homes in need of major repairs
• Poor physical condition and quality of home (i.e., plumbing, water access, allergen exposure)
• Many live in multigenerational households (e.g., grandparents with their grandchildren), further increasing the chance that at-risk groups (i.e., those over the age of 60) get severe COVID-19 symptoms.

How might these living conditions affect the spread of COVID-19?

What can be done to help communities combat the spread?

Racial disparities of covid-19

Race and socio-economic data for COVID-19 in Canada shows that the virus is disproportionately affecting groups of Canadians.

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For example, Montreal districts with higher numbers of Black residents and cramped housing have registered the most cases of COVID-19.

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Toronto Public Health found that COVID-19 disportionality affects low income residents and recent immigrant

Healthcare: covid-19 anti-Asian racism

According to Incident reporting centres (elimin8ate.org and covidracism.ca): over 600 incidents of anti-asian racism in Canada have been reported since the start of the pandemic:

• British Columbia is the region with the most reported incidents per capita in all of North America.
• Women reported the highest number of incidents (approx. 60% of all cases).

Mental health and racism

Long-term exposure to racism is linked to negative mental health outcomes:

• Higher levels of anxiety, stress and stress-related illness
• Higher risk of depression and suicide
• Feelings of helplessness, hopelessness, fear, mistrust, despair, alienation and loss of control
• Damaged self-esteem, higher risk of addiction and violence

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Racial discrimination strongly predicts a decline in self-reported mental health status, especially among racialized immigrants.

• Black immigrants are 76% more likely to assess themselves as “unhealthy” compared to other racialized groups

There is limited race-based data on mental health in Canada but a report (2020) from Ottawa Public Health (OPH) surveying the city’s African, Caribbean and Black communities found that:

• Racism, police brutality and daily microaggressions negatively impacted their mental health.
• Stigma and a fear of being judged prevented many from telling others about their struggles.

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“No data, no problem, no solution”.

-OPH

Mental health: stigma

A survey conducted by Black Mental Health Canada Inc found that stigma around mental health within the Black community, negative experiences with mental health services, and lack of accessible and culturally sensitive services resulted in Black Canadians being less likely to access and receive mental health supports.

#blackmentalhealthday

#Blackmentalhealthday was created on March 2nd, 2020 by TAIBU Community Health Centre to bring awareness of how anti-Black racism affects mental health of Black Torontonians year round. The aim of this annual event is to start productive conversations that acknowledge the challenges and gaps, while also advocating for systemic change.

Activity - the social determinants of health

• What sorts of social factors do you think might determine someone’s health? Brainstorm ideas together on a blackboard or virtual whiteboard.
• Review the 12 social determinants of health. Discuss how privilege/race and health outcomes can be connected.
• Use the Health Inequalities Data Tool to explore health outcome data for different groups of Canadians. (ex. social inequities + food insecurity + racial background)
• Debrief:

What were some of the most surprising findings?

What seem to be the biggest contributors to unequal health outcomes?

How can we address these disparities as a country? In our communities?