Health Equity & Men’s Health
OMHARN Conference – March 17, 2012
Anthony Mohamed,
Senior Specialist, Equity & Community Engagement
Health Equity at St. Michael’s Hospital
Our City - Toronto
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~ 4 million residents in Greater Toronto
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One of the most multi-cultural cities in the
world – UN
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24.5% below LICO (2006 Census – impact
greatest among people of colour)
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2.7 % of First Nations, Métis and Inuit
peoples in Canada live in the GTA
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50% are not Canadian born (2006 Census)
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47% people of colour (2006 Cen.“Vis. Min.”)
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Significant housing differences/homeless
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Largest LGBT community in Canada
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Full range of diversity represented
Health Equity at St. Michael’s Hospital
Overview & Major Clinical Programs
INNER
CITY
HEALTH
TRAUMA &
NEUROSURGERY
DIABETES
COMP.
CARE
CANCER &
CRITICAL
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
Health Equity at St. Michael’s Hospital
Equity Strategy
Integrated, intersectional, pro-active and on-going
approach to equity fully based in our Mission and Values
Health Equity at St. Michael’s Hospital
Sample Equity Strategy Interventions
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SOAPEE = Safety, Outcomes,
Access, Patient experience, Equity &
Efficiency = Quality Improvement
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Data Collection Pilot Project
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Diverse spiritual care & menus
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Cultural sensitivity training for all
staff/students
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Valuing & supporting internationally
educated professionals
Community Advisory Panels on
Homeless/Under-housed; Women &
children at risk; Mental health;
Aboriginal communities
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Clear anti-discrimination policies
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Disability; HIV/AIDS; Homeless;
Seniors; Non-Insured & Dental
Access Plans
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Free interpreter services in over 200
languages
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Harm reduction principles
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Patient Advocates
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Patient centred, community based
care and research
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Chinese Outreach Project
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Leadership within the wider health
sector (80+ partnerships)
Health Equity at St. Michael’s Hospital
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.
Health Equity at St. Michael’s Hospital
What is Men’s Health?
Health Equity at St. Michael’s Hospital
What is Men’s Health?
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An initial web search brings up
articles on fitness, baldness and
erectile dysfunction;
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More severe male health issues are
often ignored in public eye;
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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;
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Sexism feeds belief that men should
be so strong as to not express or
address discomfort;
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“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
Health Equity at St. Michael’s Hospital
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)
Health Equity at St. Michael’s Hospital
Power Study - SDOH
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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
Health Equity at St. Michael’s Hospital
Anthony’s definition of Health Equity
Health equity refers to the actions
required to achieve similar or
equal health outcomes among
diverse populations
Health Equity at St. Michael’s Hospital
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
Health Equity at St. Michael’s Hospital
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
Health Equity at St. Michael’s Hospital
National, Local & Provincial Support for Health Equity
• “to protect, promote and restore the physical and mental wellbeing 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
Health Equity at St. Michael’s Hospital
Common equity challenges & questions for discussion
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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?
Health Equity at St. Michael’s Hospital
Questions and Thank You
Anthony Mohamed,
Senior Specialist, Equity & Community Engagement
St. Michael’s Hospital
416-864-5087
mohameda@smh.ca