Recent developments in the United States of America have shone the light on the issue of systemic racism in Canada, including within the healthcare system. As governments and health organizations implement strategies to promote health equity, it is important to understand the relationships between systemic racism, determinants of health and health inequalities at the national and local levels. This blog will explore these relationships with a focus on Anti-Black Racism and strategies to achieve health equity in the Province of Alberta.
Determinants of Health, Health Inequalities and Health Equity
Determinants of Health are “the broad range of personal, social, economic and environmental factors that determine individual and population health” (Government of Alberta [GOA], 2020). These include income and social status, employment and working conditions, education and literacy, childhood experiences, physical environments, social supports and coping skills, healthy behaviours, access to health services, biology and genetic endowment, gender, culture and race / racism (GOA, 2020). Health Inequity refers to differences in the health status of individuals or populations (termed health inequalities) which are unfair, unjust, and modifiable (GOA, 2020). Achieving Health Equity requires the removal of unfair systems and policies to reduce inequalities and increase access to opportunities and conditions conducive to health (GOA, 2020). Systemic racism is one example of these unfair, unjust, and modifiable factors, which must be eliminated to achieve health equity.
Discrimination .......... is often invisible to those who do not feel its effects.
According to Abdillahi & Shaw (2020), “Discrimination against Black people is deeply entrenched and normalized in Canadian institutions, policies, and practices and is often invisible to those who do not feel its effects”. When people think of racism, overt acts usually come to mind. However, unconscious bias plays a significant role in the persistence of systemic racism. This must be taken into consideration when implementing strategies to promote health equity. Among its many impacts on society, racism negatively impacts individuals’ access to quality healthcare, housing, and education; access to gainful employment and career advancement opportunities, and the ability to earn a sustainable income (Abdillahi & Shaw, 2020).
Inequitable access to education, income, employment, housing, and food security are key drivers of health inequities (Abdillahi & Shaw, 2020). In Canada for example, Black tenants commonly experience discrimination from landlords, which creates a barrier to safe and healthy housing (Abdillahi & Shaw, 2020). Inadequate housing is associated with poor health outcomes because of injuries, pest issues, poor air quality and other unsafe conditions. Experiences of racism also affects the health-seeking behaviours of racialized populations or individuals. When people continuously experience negative attitudes, disrespect, poor quality of care, and other manifestations of racism in the healthcare sector, this diminishes trust in the system, and impairs the ability to access and fully utilize available health resources. In addition, systemic discrimination reduces access to material and social resources that are crucial to maintain good health (Abdillahi & Shaw, 2020).
In 2013, the National Collaborating Centre for Determinants of Health (NCCDH) released a report on a case study of Alberta Health Services (AHS), the fully integrated health system responsible for health service delivery in the Province of Alberta (AHS, 2020).This case study, describes the processes, challenges and successes in establishing a province-wide health equity strategy (NCCDH, 2013). The process involved capturing the right evidence to support implementation; engaging broadly across the organization; establishing the framework for health equity; building foundation by gaining senior leadership support; developing common ownership of health equity over time; and building health equity leadership capacity (NCCDH, 2013). It is noteworthy that one of the highlighted steps to integrate health equity action within the organization included “developing cultural competency, with a focus on Aboriginal cultures” (NCCDH, 2013). This is an acknowledgement of the negative impact of racism on determinants of health.
Challenges with establishing a province-wide strategy include: implementing such a sweeping change across a whole province; managing expectations; limitations on the availability of accurate and accessible local data; developing strong, clear, common language; and potential stress on limited resources and supports (NCCDH, 2013). However, the following factors contribute to successful implementation of the health equity strategy: a strong, central mandate; credible, broad leadership, staff willingness to learn and a strong spirit of cooperation and collaboration within AHS and between stakeholders (NCCDH, 2013).
Despite the successes achieved so far, health inequities still exist in Alberta. The AHS Population and Public Health Transformational Roadmap released in February 2020, indicates that in Alberta, health inequities exist between the highest and lowest income groups on several health outcomes including a four year difference in life expectancy at birth, a significant difference cancer death rates, and injury mortality (AHS Population, Public & Indigenous Health SCN, 2020). This roadmap also acknowledges that “wide disparities in health outcomes and factors that influence health also exist between communities across Alberta” (AHS Population, Public & Indigenous Health SCN, 2020).
Moving Forward
A concerted effort is required to root out systemic racism. This starts with understanding and acknowledging the existence of systemic racism, and then moving beyond rhetoric or the usual condemnations of racism to concrete action. This action must include actively engraining a culture of diversity and inclusion at all levels within the healthcare system. This action must also emanate from grassroots to leadership levels, from frontline healthcare professionals to senior leadership and from all levels of government. Eliminating systemic racism would bring us a step closer to achieving health equity and reducing the strain on the Canadian Healthcare System.
References
Abdillahi, I. & Shaw, A. (2020). Social Determinants and Inequities in Health for Black
Canadians: A Snapshot. Public Health Agency of Canada.
Alberta Health Services. (2020). About AHS.
Government of Alberta. (2020). Social determinants of health and health inequalities.
National Collaborating Centre for Determinants of Health. (2013). Leadership for Health
Equity: Alberta Health Services - Establishing a Province-Wide Social Determinants of
Health and Health Equity Approach. Antigonish, NS: National Collaborating Centre for
Determinants of Health, St. Francis Xavier University.
Population, Public and Indigenous Health Strategic Clinical Network. (2020). Population
and Public Health Transformational Roadmap February 2020. Alberta Health
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