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Conference Report: Health Equity and Diversity: Local Realities and International Perspectives. Stimulating Change
By Narda Razack
19 Jul 05 – This conference was held June 10-12, 2005 at the Ontario Institute for Studies in Education. The purpose of the conference was to “stimulate the provision of holistic, accessible and equitable health care and services to marginalized and racialized communities in the city of Toronto, by building local and international partnerships to support systemic change through education and capacity building”. The conference focused on providing opportunities for community stakeholders, researchers, educators, health practitioners and advocates to gather information and knowledge and help shape an agenda of change and to advance the public policy agenda in relations to urban health and diversity. The conference also broadly promoted social justice, human rights, client empowerment, and best practices to improve service delivery to diverse and marginalized populations. Another very critical objective and closely related to the work of our union was to generally advance the social justice and sustainable equity agenda with a view to developing action plans and recommendations. Facilitators at each session were given the task to develop two action plans to recommend to the conference planning committee.
Councilor Joe Milhevic brought greetings from the Mayor and stressed the importance of Public Health and the accessibility of a Human Rights agenda for mental health.
The Plenary Session on Saturday was delivered by the Executive Director of Sistering: A Woman’s Place, which is a multi-service organization for marginalized, poor and homeless women. Her topic was titled “Beyond Representation and Target Populations. Toward Building and Delivering Inclusive Integrated health Care System.” She began by saying that we are at a critical juncture regarding the quality and response to health care services. The public-private question of mental health linked with the conference theme. She shared statistics on the immigrant population and stressed that 45% were unable to speak English or French and of 36.9 immigrant families, 58% were in the poverty range. There is a shortage of health care providers for Aboriginal peoples and the quality of health care is a commodity since racism and privilege underscore accessibility to adequate care. Change is imperative and recommendations included:
- intervention strategies for had to reach groups
- staffing
- funding
She also noted that there should be adequate information on health care and any initiative needs to consider intersections and focus on an inclusive approach to delivery.
The Plenary Session was titled “Racism is a public health issue” and four speakers discussed specific areas. The first speaker noted the following:
- deterioration in quality of life
- poverty racialized and feminized
The imperative is for public health to note the following for racialized peoples:
- higher risk of depression and suicide
- higher risk for addiction and violence
- higher blood pressure
- lower birth weight
- higher infant death rates
- shorter life span
- higher risk of anxiety, depression, psychosis
Another presenter spoke of the media and the racialization of diseases and that policy results in different outcomes for people from different groups. Research on the social determinants of health was discussed with reference to urban youth. He noted that 85% of youth live in the urban areas – age 12-14 and referred to this as ‘The Perfect Storm” since they constitute the fastest growing group in Toronto, second in Miami, and third in L.A.
One panel session I attended focused on “Evaluating mandatory diversity training for physicians in an urban hospital.” This particular presentation was of interest as diversity training is the approach of many organizations to promote understandings of people from different cultures. These approaches tend to focus on understanding the ‘other’ and not on the personal and larger systemic issues on power and privilege. The presenters were quick to point out that their research was based on a mere three hours of diversity training with physicians at a local university. The focus was on cultural competence and doctors do recognize that patterns of care were discriminatory. Fifty six percent of doctors receive no diversity training. The question raised was: How do physicians understand their role in perpetuating systemic inequalities in health care?
The conference encouraged discussion on a Toronto People’s Charter on Health and Diversity and several stages were identified as being critical to achieving this goal. Some of these were:
- public education
- health promotion
- service and support
- research
- advocacy
- community development
- institutional accountability – service delivery, human resources, etc.
- funding
There was a draft summary of the charter which was announced at the end of the conference to build a degree of consensus to move the agenda along. The hope was to formally adopt the document as the Toronto People’s Charter on Health and Diversity within three months after the conference. This charter will serve as a common reference point for planning and advocacy for endorsers and supporters that emerge from the conference.