Health Disparities and
Racialized Communities
Dianne Patychuk,
Steps to Equity, Health Equity Consulting
October 15, 2009
Across Boundaries Ethnoracial Mental Health Centre
This talk is about:
1. 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
Root Causes of Racialized Health Disparities
Macro
Economic
Policies
Health &
Social
Policies
Culture &
Social Values
Socioeconomic
position:
Class
Gender
Racialization
Power
Resources
Presitige
Discrimination
Structural Determinants
Root Causes/ (Social
Determinants of Health)
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.
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
How Racism Harms Health2
Exposure to:
Responses
- 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
- 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.)
Patychuk Steps to Equity/10/09
Therefore help should be holistic,
responsive to diversity, multilevel,
including structural (tackling multiple
oppressions and exposures)
Health Disparities in
Central LHIN
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.
Lowest
Income
Areas
Middle
Income
Areas
Disease
Disability
Injury
Premature Disease
Disability
Death
Injury
Avoidable
ER Visits Premature
& Hospitali- Death
ER/Hosp
zations
Visits
High
Income
Areas
Disease
Disability
Injury
Premature
Death
ER/Hosp
Visits
Patychuk Steps to Equity/10/09
• 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 cases of 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
Mental Health “overlaps” with other health priorities & social
priorities (poverty reduction, human rights/anti-racism)
Mental Health
Substance Use &
Addictions
A
Chronic
Diseases
e.g. Diabetes
B
Health Care
Primary Care & Community Care
e.g. screening for cancer; point of
access/referral/equity
ER , Specialists,
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.
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
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 antioppression anti-racism lens, that Across
Boundaries is well-placed to continue to
advance
Patychuk Steps to Equity/10/09
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
4 National 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
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
Who experiences poverty? Ontario 2006 Census
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Somali:
Afghan:
Bangladeshi:
Ethiopian:
Pakistani:
Korean
Iraqi:
Arab:
Palestinian:
Iranian:
Nigerian:
Black:
Columbian:
African nie:
Tamil: 27.0%
Sri Lankan:
Vietnamese:
Chinese:
Filipino:
Portuguese:
British Isles:
Polish:
English:
Italian:
69.5%
56.0%
49.4%
49.0%
43.5%
42.9%
41.4%
39.9%
37.2%
35.6%
35.1%
33.6%
33.3%
27.6%
25.8%
25.3%
23.8%
14.0%
11.8%
11.0%
11.2%
9.7%
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
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
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
% Of the Total Central LHIN Population 2006
Ko
re
an
Ja
pa
No
ne
e
tR
ac
ia
liz
ed
n
sia
W
es
tA
Ar
ab
Fi
lip
in
o
Am
So
er
ou
ica
th
n
ea
st
As
ia
n
La
tin
ac
k
Bl
an
As
i
So
ut
h
Ch
i
ne
se
16
14
12
10
8
6
4
2
0
Chinese ethnic community remains the largest among racialized groups,
but diversity is increasing
Patychuk Steps to Equity/10/09
% Change Central LHIN 2001 to 2006
Ar
W
ab
es
tA
sia
n
Ko
re
an
Ja
pa
No
ne
tR
e
ac
ia
liz
ed
ac
k
Bl
Fi
lip
in
o
A
So
m
er
ou
ica
th
ea
n
st
As
ia
n
La
tin
Al
To
ta
lR
l
ac
ila
ze
d
Ch
in
es
So
e
ut
h
As
ia
n
80
70
60
50
40
30
20
10
0
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
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
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
LHIN Slide from presentation to Governance Councils, September 2009
What can Across Boundaries do?
Work with other local organizations to:
1. 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
2. Propose a pilot for this type of data collection
3. Contribute to shaping guidelines for equity-based
data collection (e.g. with Health Equity Council)
4. 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
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
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