1. Josephine Etowa, RN, PhD; Wanda T. Bernard, RSW, PhD; Brenda Beagan, PhD; Faculty of Health Professions, Dalhousie University, Halifax, NS, Canada Presented at: Canadian Public Health Association 2008 Annual Conference Halifax, NS, Canada: Held on June 1- 4, 2008 Inequities in Health and Health Care for Black Women

2.  To investigate the experiences of health and well-being among midlife African Canadian women in Nova Scotia, with particular attention to how they are affected by menopause and the ideological construct, “the Strong Black woman.”  To examine how time, resources and sense of entitlement affect their participation in activities that promote health and well- being  To develop community supported, culturally appropriate health education materials  To foster collaborative research partnership between community, policy maker and academics in the field of Black people’s health research

3. Research Methods  Triangulation of qualitative and quantitative methods was used to create a comprehensive picture of menopause and mid-life health of women of African descent in Nova Scotia.  Qualitative approaches included interviews, workshops and focus groups  Quantitative methods included five standardized assessment instruments  Research involved eight Black communities in Halifax Metro of Nova Scotia

4.  Access to Health Care Information ◦ Most of the women expressed the need for greater sharing of information about midlife health ◦ Conflicting information was often provided by health care professionals ◦ Doctors were more helpful regarding “physical aspects” of menopause than the emotional aspects. ◦ Interview process was very educative (questionnaire)  Lack of research  Lack of policy to ensure knowledge production

5. Lack of cultural competence evident in:  Nature of interaction with health care providers  Policies  Professional knowledge

6. Experiences of Racism  Individual ◦ Racism is constantly, constantly with me. It’s part of who I am. It’s my skin. It’s my children. I've lived it all my life. And I can’t escape it. From the time I go out, get up in the morning to go outside the door, once you step outside the door – it’s on. And it could be out there in any shape, form, whatever.  Internalized ◦ Racism is a destructive force as it affects Black women personally and through the many subtle ways it manifests itself when individuals internalize it.

7.  Access to Goods and services ◦ Differential access to resources including employment opportunities. ◦ It is both action and Inaction in the face of need  Under representation of Black health professionals ◦ “ There were no Black nurses … no doctors … I think everybody was White ”  Policy to guide effective care across racial boundaries ◦ It is perpetrated through entrenched policies which leaves certain groups of people socially, economically and politically disadvantaged.

8.  Internalization of Negative Stereotypes ◦ Avoidance ◦ Denial ◦ Being critical of self and others  Health Impact ◦ Race-related stress ◦ Burnout ◦ Depression  I was on anti-depressants because of experiencing post-traumatic stress disorder through an incident of racism which lingered for years”.

9.  Individual coping mechanisms  Spirituality ◦ What helped me was turning to the Lord and being spiritually uplifted and realizing that my life was important.  Health promotion activities (exercises)  Learning about and recognizing ones own background ◦ Picking one’s battle & Stepping back  Social Support Networks  Church  Friends  Family

10.  Social Support Networks: ◦ I’m around ladies who talk openly about it all the time, and we are always sharing information…The atmosphere is a lot more accepting because we know what each other is dealing with. When one is not feeling good, we know what’s up with them and vice versa…”  Lifestyle Changes ◦ Exercise “How good we’ve been about taking care of our bodies as we’ve been growing.. tried to be conscious about our diet and exercise...my body has a good foundation …to help fight it off.”

11.  Racism is concern of 96% of study participants  Over the years, the accumulation of racism related stress resulting from pent-up anger, frustration, humiliation and fear undermines Black women’s health. ◦ Everyday as a Black person, your race comes to the forefront. There’s no inclusion, there’s no representation, and there’s no input  83% of study participants actively participate in efforts to eliminate racism.

12.  Health care professionals such as nurses and physicians need to be aware of their own values especially when these are at odds with recipients of health care.  Black women place great significance in God or their belief in some form of spirituality as a way of dealing with racism and other life stressors. ◦ What helped me was turning to the Lord and being spiritually uplifted….  There is a need to be innovative in the incorporation of multicultural and racial discourses as part of core curriculum, and the focus of research and policy ..

13.  Racism exist in health care and is a determinant of health  Although marginalized groups maybe sicker and may have greater health care needs, they have less access to culturally competent health services  Improving health care services for this populations requires actions beyond the role of individual health care professionals  It requires addressing larger systemic health issues through policy changes