Cassa camh conference 24 oct2011

CASSA-CAMH Conference A Diagnosis for Equity: A Dialogue on Mental Health, Additions, Chronic Disease, and Sexual Health in South Asian Communities Panel Discussion: Health Equity in South Asian Communities Nasim Haque MD. DrPH. Wellesley Institute October 24, 20111

Questions to address 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? October 24, 20112 www.wellesleyinstitute.com/sjtinitiative.co m

WHO WE WORK WITH SJT Community Forum & Expo: March 20, 2008 Our Research Interest: neighbourhood & its influence on immigrant health & wellbeing i.e. SDoH© Wellesley Institute

St. James Town Of 64% ̴ 20% S.Asians Population & ̴ 20% Filipino ̴ 9 % Chinese 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 10/ 4 •Over 50 languages spoken 31/© Wellesley Institute 201

What is Health Equity?Health equity is:“Fair” distribution of: • Health • Health care resources • Opportunities according to population needEqual opportunities to economic and social conditions to all population irrespective of CAGEsThe notion is based on the principle of social justice5 October 24, 2011 www.wellesleyinstitute.com/sjtinitiative.com

Average Income of South Asians by Gender and Agegroups vs. Overall Canadian population - by age group and sex, $46,955 $40,450 $40,199 $36,865 $34,712 $31,396 $27,935 $26,767 $26,306 $23,970 $22,350 $22,857 $22,885 $19,511 $19,461 South Asian Men $15,012 South Asian Female $11,273 Overall Canadian Men $10,286 Overall Canadian Female $9,046 $8,971 15 to 24 25 to 44 45 to 64 65 and over Total(Census 2001)

Rate of Preventive Health Services Utilization by South Asians vs. White 88.4% 83.6% 78.4% 65.7% 66.7% 48.4% White 44.7% South Asian 29.2% General Practitioner Prostate-Specific Antigen Blood Test Mammogram Pap smear(CCHS 2001)

Prevalence Rate of Heart Disease by Ethnic Group Ontario, 1996-2007 5.4% 5.2% 5.2% 5.2% 5.1% 4.7% 4.2% 3.8% 3.4% 3.2% All 2.7% Male 2.5% female White South Asian Chinese Black(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 OntarioCMAJ May 18, 2010 182(8)

St. James Town Initiative A few examples from our research in St. James Town Research Question:“What impact do neighbourhood factors have on your health and wellbeing?”10 October 24, 2011 www.wellesleyinstitute.com/sjtinitiative.com

ECONOMIC ATTRIBUTESThis tiny tunnel connects one of the poorest neighbourhoods in Canada, St. James Town, to oneof 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, andconsequently, employment (SJT resident) 10/31/2011 11 © Wellesley Institute

PHYSICAL ATTRIBUTES •As a child, one way I kept myself occupied with my time was through playing basketball. It not onlykept me off the streets, but also wasted the majority of my time, keeping me active. If morecommunity programs ran such activities, it would bring the community closer and keep children offthe streets away from any type of violence. These activities are strengths in our community aschildren are kept away from trouble. (Youth,SJT. 2010) © Wellesley Institute

ECONOMIC ATTRIBUTES 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.10/31/2011 13 © Wellesley Institute

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

Findings: Social SupportImpact of migration & settlement“Since the place is too small here, we don’t movearound much at home…….Also when we’re stuck withinthe walls of our homes we feel an emptiness in life thatcauses a lot of depression. ….We feel some kind ofloneliness.” (Tamil female)

Experience of discrimination as a stressor and barrier to accessing services“When I visited a dentist, the doctor looked atme in a suspicious manner….I was asked manyquestions …….It was insulting my self-respect” (South Indian resident)

How to Tackle Health Equity• 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. 17 October 24, 2011 www.wellesleyinstitute.com/sjtinitiative.com

How to Tackle Health EquityNeed 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 neighbourhoodsto ensure healthy spaces and places?(2) How can we reduce disparities in the distribution of diseases?Equity question: How can we eliminate inequities in thedistribution of resources and power that shape health outcomes?(3) What social programs and services are needed to address healthdisparities?Equity question : What types of institutional, and social changesare necessary to tackle health inequities? 18 October 24, 2011 www.wellesleyinstitute.com/sjtinitiative.com

Achieving Health EquityShort- 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 October 24, 2011 |19 www.wellesleyinstitute.com/sjtinitiative.com

Following - Up • 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 nasim@wellesleyinstitute.com20 September 23,2011 | www.wellesleyinstitute.com/sjtinitiative.com

ST. JAMES TOWN INITIATIVETHANK YOUFor more info, visit www.SJTinitiative.com or www.wellesleyinstitute.com10/31/2011 21

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Cassa camh conference 24 oct2011

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