A Diagnosis for Equity: A Dialogue on Mental Health, Addictions, Chronic Disease, and Sexual Health...

CASSA-CAMH Conference A Diagnosis for Equity: A Dialogue on Mental

Health, Additions, Chronic Disease, and Sexual Health in South Asian Communities

Nasim Haque MD. DrPH.

Wellesley Institute

October 24, 2011

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Panel Discussion: Health Equity in South Asian Communities

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October 24, 2011

www.wellesleyinstitute.com/sjtinitiative.com

1. What does health equity mean in your sector?

2. What are some of the health disparities that affect South Asian communities in your sector?

3. How can all sectors work together?

Questions to address

WHO WE WORK WITH

Our Research Interest: neighbourhood & its influence

on immigrant health & wellbeing i.e. SDoH

S J T C o m m u n i t y Fo r u m & E x p o : M a rc h 2 0 , 2 0 0 8

© Wellesley Institute

10/31/201

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Population & Neighbourhood •14,666 Residents on 0.23 km2 of Land

•64,636 People / km2

•(Unofficial Estimate: 25,000)

•64% Immigrants

•18 Aging High-Rise Buildings

•Over 50 languages spoken

St. James Town

Of 64% ̴ 20% S.Asians ̴ 20% Filipino ̴ 9 % Chinese


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Health equity is: “Fair” distribution of:

• Health • Health care resources • Opportunities according to population need

Equal opportunities to economic and social conditions to all

population irrespective of CAGEs The notion is based on the principle of social justice

What is Health Equity?

October 24, 2011


Average Income of South Asians by Gender and

Agegroups vs. Overall Canadian population - by age group and sex,

(Census 2001)

$10,286

$34,712

$40,199

$23,970

$31,396

$8,971

$22,350 $22,857

$15,012

$19,511

$11,273

$40,450

$46,955

$27,935

$36,865

$9,046

$26,306 $26,767

$19,461

$22,885

15 to 24 25 to 44 45 to 64 65 and over Total

South Asian Men

South Asian Female

Overall Canadian Men

Overall Canadian Female

Rate of Preventive Health Services Utilization by

South Asians vs. White

78.4%

44.7%

65.7%

88.4%

83.6%

29.2%

48.4%

66.7%

General Practitioner Prostate-Specific Antigen Blood Test Mammogram Pap smear

White

South Asian

(CCHS 2001)

Prevalence Rate of Heart Disease by Ethnic Group

Ontario, 1996-2007

5.1% 5.2%

3.2% 3.4%

5.4% 5.2%

3.8%

2.5%

4.7%

5.2%

2.7%

4.2%

White South Asian Chinese Black

All

Male

female

(CMAJ, MAY 18, 2010:182(8))

Age-adjusted, Sex-Specific Prevalence Rate of Diabetes Among Recent Immigrants by Region of Origin vs. Long-

Term Residents of Ontario

CMAJ May 18, 2010 182(8)

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A few examples from our research in St. James Town

Research Question:

“What impact do neighbourhood factors have on your health and wellbeing?”

St. James Town Initiative

October 24, 2011


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This tiny tunnel connects one of the poorest neighbourhoods in Canada, St. James Town, to one of the most affluent, Rosedale. The short journey of crossing the bridge is actually painful, arduous, and for the most part, impossible for the most, if not all, of the individuals living in SJT. Despite being highly educated, newcomers have difficulty gaining recognition, and consequently, employment (SJT resident)

ECONOMIC ATTRIBUTES


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As a child, one way I kept myself occupied with my time was through playing basketball. It not only

kept me off the streets, but also wasted the majority of my time, keeping me active. If more

community programs ran such activities, it would bring the community closer and keep children off

the streets away from any type of violence. These activities are strengths in our community as children are kept away from trouble. (Youth,SJT. 2010)

PHYSICAL ATTRIBUTES


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Food Quality

How much can we trust our food supply? We don’t only care about the price of goods, we also pay attention to our health. We want to get good service when we go to the supermarket.

ECONOMIC ATTRIBUTES


The fruit stand within the neighbourhood is a delight to the residents. Having access to familiar foods is very important for the well-being of new immigrants. It is a source of strength when feeling alone or isolated in a new place.

Findings: Social Support

Impact of migration & settlement

“Since the place is too small here, we don’t move around much at home…….Also when we’re stuck within the walls of our homes we feel an emptiness in life that causes a lot of depression. ….We feel some kind of loneliness.”

(Tamil female)

Experience of discrimination as a stressor and barrier to accessing services

“When I visited a dentist, the doctor looked at me in a suspicious manner….I was asked many questions …….It was insulting my self-respect”

(South Indian resident)

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• Need to broaden our lens

• Appreciate that many factors contributing to health are outside the direct realm of health service domain

• Recognize that living conditions, working conditions, education, social cohesion and government policies influence individual and community health

• Emphasize: Health is everyone’s business.

How to Tackle Health Equity

October 24, 2011


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How to Tackle Health Equity

October 24, 2011


Need to restructure our questions. For example, instead of asking: (1) How can we promote healthy behaviour (indv. responsibility)? Equity question: How can we plan and restructure neighbourhoods to ensure healthy spaces and places? (2) How can we reduce disparities in the distribution of diseases? Equity question: How can we eliminate inequities in the distribution of resources and power that shape health outcomes? (3) What social programs and services are needed to address health disparities? Equity question : What types of institutional, and social changes are necessary to tackle health inequities?

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Short- and long-term actions are required :

• Make local and sub-population level data readily available

• Focus on groups experiencing major barriers to health

• Promote equal opportunities for all people to be healthy

• Distribute social and economic resources in a manner that will improve health equity across subpopulations

• More collaboration between public and private sectors

• More cross- and multi-sectoral collaboration

Achieving Health Equity

October 24, 2011 | www.wellesleyinstitute.com/sjtinitiative.com

20 September 23,2011 | www.wellesleyinstitute.com/sjtinitiative.com

• These speaking notes, reports using Photovoice and other participatory research methodologies, and policy briefs aimed at advancing health equity and social determinants of health are available on our site at www.wellesleyinstitute.com and www.sjtinitiative.com

• My email is [email protected]

Following - Up

http://www.wellesleyinstitute.com/

http://sjtinitiative.com/

mailto:[email protected]

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ST. JAMES TOWN INITIATIVE

THANK YOU

For more info, visit www.SJTinitiative.com or www.wellesleyinstitute.com

A Diagnosis for Equity: A Dialogue on Mental Health, Addictions, Chronic Disease, and Sexual Health...

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