A Black Health Strategy, the next stepBy Dr. CHRISTOPHER J. MORGAN
February 16, 2016 was a significant date for Ontarians. On that day the Ontario government passed legislation that formally installs February as Black History Month in the Province of Ontario. Ontario became one of only three provinces in Canada that has such legislation, British Columbia and Quebec being the other two. Black History Month has been established under federal law since 1995, a result of the efforts of several community members and spearheaded by former Member of Parliament, Jean Augustine.
Indeed, in a country as culturally and racially diverse as Canada, it is impossible to have an accurate understanding of the birth, development and future of this great nation without some knowledge of the experience, contribution and impact of Blacks in Canada. Of course the same can be said of Indigenous Peoples, Chinese, South Asian and other communities. Kudos to the provincial Liberals. Also on February 16, Ontario Premier Kathleen Wynne announced the establishment of an Anti-Racism Directorate to address racism in all its forms — including individual, systemic and cultural. According to the press release from the Premier’s Office, the Directorate will aim to: increase public education and awareness of racism to create a more inclusive province, and apply an anti-racism lens in developing, implementing and evaluating government policies, programs and services.
The Anti-Racism Directorate is part of the government’s commitment to fight discrimination and ensure that everyone in Ontario has the opportunity to fulfill their potential and participate equally in society. The Directorate will work with key partners such as businesses, community organizations, educational institutions and the Ontario Human Rights Commission. Michael Coteau will oversee the Anti-Racism Directorate as Minister Responsible for Anti-Racism in addition to his job as Minister of Tourism, Culture and Sport. Many individuals and organizations are pleased with the announcement of the Directorate, including the Ontario Federation of Labour and Colour of Poverty/Colour of Change, who are looking to ensure this initiative undertakes meaningful engagement of community partners and experts in the development of the Directorate’s policies and priorities and that the Directorate is sufficiently funded and given the authority and power to carry out its mandate.
In her comments, Wynne stated in part: “I know that government needs to play a leading role in the fight against racial discrimination and inequality. That is why we are establishing an Anti-Racism Directorate to advance racial equality across Ontario.” The pursuit of racial equality is a noble goal. The challenge has often been how do we get there? The Ontario government deserves to be commended on taking these bold steps.
The pursuit of racial equality must include an understanding of equity. I am reminded of a cartoon I saw years ago which illustrates the difference between equality and equity. The first caption is of three young girls of different heights standing in front of a tall brick wall. On the other side of the brick wall is a baseball game. Only the tallest girl can see over the brick wall and enjoy the game. In the second caption, all three girls are treated equally as they are given a box of the same size and shape to stand on. The tallest girl, who didn’t need the box to see over the wall, was now standing with the top of the wall just above her waist. The second tallest girl, standing on her tip toes on top of the box can just barely see over the wall. The third girl, despite the box and standing as tall as she can, is still several inches from the top of the wall and can’t see anything. In the third caption, the three girls are treated equitably, the tallest girl does not get a box, and the second and third girl gets a box of the appropriate size and shape so that all three girls can comfortably see over the wall and enjoy the game.
Equity acknowledges pre-existing differences or advantages of individuals and seeks to provide unique and specific solution(s) that result in equality in opportunity or outcomes. There is another opportunity at hand for the Ontario government to advance the health and well-being of Ontarians while “pursuing racial equality across Ontario”. The Black Health Alliance is proposing an Ontario Health Equity and Black Health Strategy in support of the Ministry of Health and Long Term Care’s recent discussion paper on primary health care reform, Patients First, a Proposal to Strengthen Patient-Centred Health Care in Ontario. Patients First is the result of an ongoing process of consultation and evaluation of Ontario’s health care system and seeks to make improvements in a number of key areas including, but not limited to, community and home care, public health and population health, integration and management of primary health care services at the local level. One of the goals of Patients First is to improve health equity and reduce health disparities. It is this fundamental objective for which the Black Health Alliance (BHA) has strong recommendations.
Dr. Eric Hoskins, Ontario Minister of Health and Long-Term Care, acknowledges that “not all Ontarians have equitable access to services… that structural issues create inequities”. The Black Health Alliance applauds the commitment of Patients First to improve health care and health outcomes of Ontario’s Indigenous Peoples through meaningful engagement, respectful working relationships and collaborations with Indigenous partners to identify the changes needed to ensure health care services address the unique health needs, in a manner which is culturally appropriate and respectful of their traditional methods regardless of where they are in Ontario. Patients First also identifies Franco-Ontarians and other cultural groups, particularly newcomers, as populations that require culturally appropriate services in order to better address health equity and reduce health disparities. Whereas BHA commends the plans to improve health equity and reduce health disparities as outlined in Patients First, the implementation of an Ontario Health Equity and a Black Health Strategy will go further and be significantly more effective leading to better health outcomes for all Ontarians.
An Ontario Health Equity Strategy (OHES) has as its premise the acknowledgement that health disparities exist between populations and within them. It is aware of the impact culture and the social determinates of health (income/poverty, employment, education, housing) including racism has on health perceptions, behaviour, access, treatment and outcomes. Two fundamental components of the OHES, and of any strategy that aims to improve health equity and reduce health disparities, is the system-wide implementation of ethno-racially and otherwise appropriately disaggregated health data collection and culturally appropriate health service planning and delivery. A Black Health Strategy is needed because Black people of African and Caribbean descent suffer a disproportionate burden of poor health outcomes. Racism and socioeconomic influences weigh heavily on Black populations. Yet, where they exist, culturally appropriate health research, promotion, education and services have been shown to improve access, screening and health outcomes among Black populations. The Community Health Centre has been a particularly effective model for primary care delivery at the local level.
We can no longer adopt the practice of “if we don’t track it we don’t have to act on it”. Ontario’s health care system should be able to provide answers to questions such as: How many Black (African or Caribbean descent) men over the age of 40 participated in prostate screening (PSA or digital exam)? How many were referred for biopsy or to an urologist? What were the outcomes? Can we connect this information to geography, education, socioeconomic status, etc? Were these results similar to non-Black males? Not having the answers to this and hundreds of other similar health related questions creates gaps and weakens our health care system. It’s like trying to fill a bucket with dozens of holes in it. This position is not only irresponsible it is unethical. Today, the Ontario Human Rights Commission is demanding publicly funded bodies collect and report on data that identifies race to ensure equity and fairness in its practices. It is time our health care system does the same.
The timing is ripe for an Ontario Health Equity and Black Health Strategy. It is in keeping with the February 16, 2016 provincial legislation permanently marking February as Black History Month in Ontario and Premier Kathleen Wynne’s recent announcement of an Ontario Anti-Racism Directorate. The MOHLTC is inviting feedback on Patients First, a Proposal to Strengthen Patient-Centred Health Care in Ontario. Interested parties can do so by sending an email to email@example.com or visit www.health.gov.on.ca/en/news/bulletin. The Black Health Alliance will be submitting our proposal and we look forward to the opportunity to work with this government to ensure excellent health care for all Ontarians.
Dr. Christopher J. Morgan is the director of Morgan Chiropractic & Wellness, an interdisciplinary health centre in Toronto and the founder and former president of the Black Health Alliance, a network of community organizations, health professionals and community members working in partnership to advance the health and well-being of the Black community. He can be reached at 416-447-7600 or firstname.lastname@example.org