1. Experiences of Racial Discrimination in Toronto: Prevalence, Socio-demographic and Health Correlates Donna Ansara 1, Jennifer Levy 1, Patricia O’Campo 2 1 Toronto Public Health 2 Centre for Research on Inner City Health, Toronto Canadian Public Health Association Conference May 28, 2014 1

2. Rationale Toronto Public Health Reports  Racialization and Health Inequities in Toronto (2013)  The Global City: Newcomer Health in Toronto (2011)  The Unequal City: Income and Health Inequalities in Toronto (2008) Toronto is the most diverse city in Canada – half of residents are racialized

3. Objectives 1.To examine experiences of racial discrimination in Toronto 2.To examine how these experiences differ by socio-demographic characteristics in Toronto 3.To examine the health correlates of racial discrimination in Toronto 3

4. Project Advisory Committee Toronto community/academic researchers  Grace-Edward Galabuzi  Bob Gardner  David Hulchanski  Axelle Janczur  Kwame McKenzie  Patricia O'Campo  Yogendra Shakya Leading American researcher  David Williams 4

5. Definitions Racialization is “the process by which societies construct races as real, different and unequal in ways that matter to economic, political and social life” (Ontario Human Rights Commission, 2005) Racialized groups “can be understood as non- dominant ethno-racial communities who, through the process of racialization, experience race as a key factor in their identity and experience of inequality” (Galabuzi, 2006) 5

6. Racialization and Health International research shows racialized groups have poorer health than non- racialized groups on several outcomes Canadian research is more recent but shows some evidence of racialized health inequities Racial discrimination is one mechanism that may explain racialized health inequities 6

7. Racial Discrimination Interpersonal  Structural Interpersonal discrimination: unfair or negative treatment because of race Structural discrimination: policies or practices that result in the inequitable treatment of racialized groups Discrimination may be unintentional 7

8. Racial Discrimination and Health Most research focuses on self-reported interpersonal discrimination Racial discrimination  morbidity, esp. poor mental health, health behaviours Racial discrimination = Stress Mechanisms: negative emotional states, behavioural coping, physiologic responses 8

9. Data Neighbourhood Effects on Health and Well-being Study (NEHW) Probability sample collected 2009-2011 in Toronto (n=2,412) Includes residents 25-64, spoke English, lived in neighbourhood for  6 months Conducted by CRICH (Toronto) in collaboration with the Univ. of Toronto Response rate = 72% 9

10. Measurement of Racial Discrimination Everyday Discrimination Scale 1.You are treated with less respect than other people 2.You receive poorer service than other people at restaurants or stores 3.People act as if they are afraid of you 4.People think that they're better than you 5.You are called names or are insulted 6.You are threatened or harassed 10 Williams et al., 1997

11. Health Outcomes ConstructMeasurementCoding Life stress40-item stress scale2/3, 1/3 Work stress6-item stress subscale2/3, 1/3 Depressive symptoms 20-item CESD-R<16, 16+ Self-rated health In general, would you say your health, compared to other people of your age, is: excellent, very good, good, fair, poor f/p, g/vg/e High blood pressure Lasted 6 months+ and diagnosed by a healthcare professional yes, no 11

12. Statistical Analyses 1.Prevalence (%) –  2 tests 2.Socio-demographic correlates multivariate logistic regression sex, age, racialized group, immigrant status, Engl. proficiency, education, SES 3.Health correlates multivariate logistic regression, adjusting for age, sex, immigrant status, income 12

13. Characteristics of the Sample Socio-demographic factors (n=2,412) n (%) Sex Male Female 1,022 (42.4) 1,390 (57.6) Age group 25-34 35-44 45-54 55-64 319 (13.2) 555 (23.0) 763 (31.6) 775 (32.1) Racialized group White Black South/West Asian/Arab East/Southeast Asian L.A./Multiple/Other 1,700 (72.1) 150 (6.4) 146 (6.2) 136 (5.8) 224 (9.5) Immigrant status Born in Canada Immigrant >10 years Immigrant <= 10 years 1,496 (62.1) 769 (31.9) 143 (5.9) Proficiency in English Lower Intermediate Higher 314 (13.3) 594 (25.1) 1,460 (61.7) Education High school or less Non-univ cert/diploma University 490 (20.3) 616 (25.5) 1,305 (54.1) Monthly finances A lot of money left over A little money left over Just enough Not enough 422 (17.7) 1,089 (45.7) 681 (28.6) 192 (8.1) 13 * p< 0.05

14. Prevalence of Racial Discrimination (%) Everyday Discrimination Scale (α = 0.86) WhiteRacial- ized You are treated with less respect than other people 20.149.8* You receive poorer service than other people at restaurants or stores 14.837.2* People act as if they are afraid of you 11.420.5* People think that they're better than you 27.854.8* You are called names or are insulted 15.424.7* You are threatened or harassed 13.417.2* Any racial discrimination No racial discrimination 63.833.1 Any racial discrimination 36.266.9* Less frequent racial discrimination 22.135.4* More frequent racial discrimination 14.131.5* 14 * p<0.05 (  2 tests)

15. Socio-Demographic Correlates Socio-demographic factors (n=2,259) AOR Sex Male Female 1.00 0.89 Age group 25-34 35-44 45-54 55-64 2.02* 1.69* 1.71* 1.00 Racialized group White Black South/West Asian/Arab East/Southeast Asian L.A./Multiple/Other 1.00 5.10* 2.20* 3.92* 3.24* Immigrant status Born in Canada Immigrant >10 years Immigrant <= 10 years 1.00 0.67* 0.59* Proficiency in English Lower Intermediate Higher 3.45* 1.88* 1.00 Education High school or less Non-univ cert/diploma University 0.90 0.96 1.00 Monthly finances A lot of money left over A little money left over Just enough Not enough 1.00 1.70* 1.58* 2.94* * p< 0.05 15

16. Health Correlates Health Outcomesn Never (AOR a ) Less frequent (AOR a ) More frequent (AOR a ) High life stress2,3741.001.53*3.37* High work stress1,7421.001.76*2.77* Depressive symptoms2,3631.001.172.90* Self-rated health2,3731.001.49*1.62* High blood pressure2,3701.000.921.30 16 * p < 0.05 a adjusts for age, sex, immigrant status, income

17. Summary Discrimination was prevalent in Toronto, particularly for racialized group members Discrimination also varied by other socio-demographic characteristics Racial discrimination was negatively associated with health outcomes 17

18. Limitations Aggregating racialized groups could mask heterogeneity between groups Representativeness Measure of discrimination primarily assessed interpersonal discrimination Possible time lag between exposure to discrimination and health outcomes 18

19. Implications More research is needed examining the prevalence and health consequences of racial discrimination in Canada Research is needed testing interventions aimed at eliminating discrimination Programs/policies are needed to address racial discrimination and reduce the associated poorer health outcomes 19

20. Contact Donna Ansara dansara@toronto.ca Thank-You! 20

21. Definitions Racial discrimination is "any distinction, conduct or action, whether intentional or not, but based on a person’s race, which has the effect of imposing burdens on an individual or group, not imposed upon others or which withholds or limits access to benefits available to other members of society" (Ontario Human Rights Commission, 2005). 21