1. The Impact of Racism on Health and Well-Being NSASW Annual Convention Wanda Thomas Bernard May 2011 © 2011 Thomas Bernard, W.

2. Building an Equitable World: Where do we Start? Building an Equitable World: Where do we Start? Strengthening Social Work Practice by Addressing Inequities in the Social Determinants of Health Strengthening Social Work Practice by Addressing Inequities in the Social Determinants of Health

3. Outline Intro..my interest in this topic- the personal and the professional Intro..my interest in this topic- the personal and the professional Research studies/key findings Research studies/key findings Key issues in health care system Key issues in health care system Inequities in health Inequities in health The Impact of Racism on Health The Impact of Racism on Health Racism as a Social Determinant of Health Racism as a Social Determinant of Health Social work role Social work role

4. Research Studies OTM OTM RVH RVH RACISM AND MENTAL HEALTH RACISM AND MENTAL HEALTH END OF LIFE CARE AND ANS END OF LIFE CARE AND ANS IMMIGRANT HEALTH PROFESSIONALS IMMIGRANT HEALTH PROFESSIONALS

5. KEY RESEARCH FINDINGS Impact of racism on health and access to health care Impact of racism on health and access to health care Lack of access to culturally relevant and culturally responsive health care Lack of access to culturally relevant and culturally responsive health care Canada does not collect health data by race- implications Canada does not collect health data by race- implications living with oppression can and does predetermine one’s life chances living with oppression can and does predetermine one’s life chances

6. Key Findings cont’d Research in other areas shows that health conditions such as high blood pressure, heart disease, stroke and diabetes affect Black people disproportionately Research in other areas shows that health conditions such as high blood pressure, heart disease, stroke and diabetes affect Black people disproportionately Marginalized populations have limited access to jobs, housing, education and the services they need to be healthy (DOH) Marginalized populations have limited access to jobs, housing, education and the services they need to be healthy (DOH)

7. Top Health System Issues/ inequity Long wait times for acute care services Long wait times for acute care services Long waits in emergency rooms Long waits in emergency rooms Lack of beds in hospital and nursing homes Lack of beds in hospital and nursing homes Access to health services—two tiered system Access to health services—two tiered system Costs of health care… Costs of health care… Population health crises—inactivity, type two diabetes, heart problems, obesity in children and youth Population health crises—inactivity, type two diabetes, heart problems, obesity in children and youth

8. Inequities in Health social determinants of health as identified by Health Canada (2001): social determinants of health as identified by Health Canada (2001): Income and social status (poverty) Income and social status (poverty) Social support networks (isolation and marginalization; age) Social support networks (isolation and marginalization; age) Education, employment/working conditions (poverty, race, ability) Education, employment/working conditions (poverty, race, ability) Social environments Social environments Physical environments Physical environments Personal health practices and coping skills Personal health practices and coping skills Healthy child development Healthy child development Biology and genetic endowment Biology and genetic endowment Health services Health services Gender and culture Gender and culture (Racism and oppression) (Racism and oppression)

9. Impact of Inequities barriers to access, including feeling disrespected by health care professionals and administrative staff in health centres Community Action on Homelessness (2009). barriers to access, including feeling disrespected by health care professionals and administrative staff in health centres Community Action on Homelessness (2009). Higher rates of racism related stress, and stress related illnesses like hypertension, diabetes and heart diseases RVH 2010 Higher rates of racism related stress, and stress related illnesses like hypertension, diabetes and heart diseases RVH 2010

10. Impact of Racism on Health from RVH data Self-Esteem Self-Esteem Racism is trauma – true trauma numbs you... you do not recognize it (racism) it is happening to you anymore... Racism is a mental health Issue. Black Female (Halifax Qualitative Interview)

11. Impact of Racism cont’d Physical / Emotional Physical / Emotional Racism takes place in the workplace and in the schools... There are people who are suffering nervous breakdowns, high blood pressure, stomach problems, ulcers. Black Male (Toronto Qualitative Interview)

12. Impact of Racism cont’d Emotional Emotional It is frustrating... For me. I am always on guard, always performing, always sort of tense because you are not on an even playing field... (racism) is frustrating and depressing you know, it makes me feel negative, it makes me feel pessimistic about the world because you know, you feel like you do not belong. Halifax Female (Qualitative Interview)

13. Impact of Racism cont’d... sometimes I feel down and out, depressed and Inadequate, doubtful of myself... it hurts worse than when somebody actually hits your or you are physically assaulted. Because it goes with my consciousness, my psyche, and my physical makeup. Halifax Female – Qualitative Interview

14. Impact of Racism from OTM study Many experienced racism in terms of their access to services – which are not culturally competent – and in terms of treatment – (ie.) not getting acceptable levels of service – eg. hysterectomies – in one community ½ of the Black women – many very young – given hysterectomies without alternatives or truly informed consent – is this a form of genocide? OTM 2006 Many experienced racism in terms of their access to services – which are not culturally competent – and in terms of treatment – (ie.) not getting acceptable levels of service – eg. hysterectomies – in one community ½ of the Black women – many very young – given hysterectomies without alternatives or truly informed consent – is this a form of genocide? OTM 2006

15. Can there be Equity in Health Care? The notion of more equity in health system holds PROMISE of what could be The notion of more equity in health system holds PROMISE of what could be The second stage of medicare, has great promise because of the Focus on PREVENTION! The second stage of medicare, has great promise because of the Focus on PREVENTION! Those who are making policy decisions about health must apply a Equity framework Those who are making policy decisions about health must apply a Equity framework

16. Envisioning Solutions— OTM 2006 New and improved health care services New and improved health care services More affordable, more accessible, better quality More affordable, more accessible, better quality Services for Black women Services for Black women Services for youth Services for youth Services for seniors Services for seniors Information and education Information and education Black professionals and services Black professionals and services

17. Making Health Policy Inclusive For whom? For whom? By and with whom? By and with whom? How? How?

18. How to make Policy and Practice Inclusive and Equitable Paradigm shift in who is providing care Paradigm shift in who is providing care Paradigm shift in how care is provided Paradigm shift in how care is provided Paradigm shift in how we access information regarding health and health status of marginalized groups Paradigm shift in how we access information regarding health and health status of marginalized groups Paradigm shift in who is developing policy and planning for health programs Paradigm shift in who is developing policy and planning for health programs

19. Social Determinants of Health as identified by Health Canada (2001): Income and social status (poverty) Income and social status (poverty) Social support networks (isolation and marginalization; age) Social support networks (isolation and marginalization; age) Education, employment/working conditions (poverty, race, ability) Education, employment/working conditions (poverty, race, ability) Social environments Social environments Physical environments Physical environments Personal health practices and coping skills Personal health practices and coping skills Healthy child development Healthy child development Biology and genetic endowment Biology and genetic endowment Health services Health services Gender and culture Gender and culture

20. What is Missing from HC List? Racism and Oppression Racism and Oppression Given what you have heard, and given what you know about race oppression, what do you think about this exclusion? Given what you have heard, and given what you know about race oppression, what do you think about this exclusion?

21. The Role of Social Work How do you see your role in the journey to make the heath care system a more equitable system for ALL? How do you see your role in the journey to make the heath care system a more equitable system for ALL? How does inequity in health impact your practice? How does inequity in health impact your practice?

22. The Role of Social Work Equity in health should be about reducing inequities in health Equity in health should be about reducing inequities in health Equity in health should be about improving accessibility Equity in health should be about improving accessibility Equity in health should be about improving patient centredness Equity in health should be about improving patient centredness Equity in health should be about improving population health for ALL… Equity in health should be about improving population health for ALL…

23. Role of Social Work Individual Actions Individual Actions Institutional Actions Institutional Actions Systemic Actions Systemic Actions Political Actions Political Actions

24. SW Addressing inequities in Health Where do we start? Where do we start? What practices are social What practices are social workers engaged in that help to address inequities? Are you leading the change you want to see?