AFNS

The Dalhousie Global Health Office, in collaboration with the Healthy Populations Institute, The National Collaborating Centre for Determinants of Health and Upstream, hosted the “Health Care Teams Addressing Poverty and Determinants of Health” event on March 3^rd. This event featured three speakers, who shared stories of addressing the social determinants of health in their work, and participated in a panel discussion.

Dr. Hamilton-Hinch, Dr. Forbes and Dr, Meili, our panel for the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Ryan Meili, the Executive Director of Upstream and a family doctor in Saskatoon, shared his experience as both a doctor treating patients in inner city Saskatoon affected by poverty, and as an advocate for health equity. Dr. Cindy Forbes talked about her experiences in advocating for health equity as the President of the Canadian Medical Association. Dr. Barb Hamilton-Hinch provided local context to this global issue, by discussing the barriers to healthcare faced by the African Nova Scotian population. All three speakers had common themes in their work: the need for policy change, the importance of story sharing to drive impact, and of course, the priority of addressing the social determinants of health in healthcare.

Dr. Meili speaking at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili sharing stories from his work with Upstream at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Dr. Meili shared the story of one of his HIV-positive Aboriginal patients who was facing several barriers to proper healthcare access. “She’s not sick with HIV,” Dr. Meili said after introducing us to her story, which was initially puzzling. However, if you take a moment to ponder this statement, it makes a lot of sense. By listening to her story, we learned that his patient has been sick with poverty, historic marginalization, poor living conditions, low education and addictions throughout her life. These factors have contributed to her HIV infection, and subsequent difficulty accessing care. This way of thinking is the fundamental to addressing the social determinants of health, and to the upstream approach. For a refresher on the social determinants of health in Canada, see our blog post from January. To learn about the upstream approach, check out this video created by Upstream, where Dr. Meili acts as the Executive Director. Upstream thinking requires us to reframe the public discourse around addressing the social determinants of health. We should be focusing more resources on the things that have the greatest influence on our health, including income, education, housing and nutrition, rather than pouring our resources into the healthcare system down the line.

Dr. Cindy Forbes, President of the Canadian Medical Association, at the Healthcare Teams Addressing Poverty and Determinants of Health event.

Building a body of evidence, and sharing these findings are both important pieces to guiding policy change. But as Dr. Forbes noted “evidence doesn’t make people feel empathy.” Upstream also aims to share stories through a variety of media in order to creatively engage citizens, showing them they have a personal stake in the social determinants of health. Citizen engagement can lead to a political push for evidence-based, forward-looking policy innovations to address these determinants so people can live longer, fuller and healthier lives.

Dr. Hamilton-Hinch highlighted the importance of not only addressing policy change, but ensuring that power dynamics shift to reflect the diverse makeup of our Canadian population. Dr. Hamilton-Hinch is involved with PLANS (Promoting Leadership in Health for African Nova Scotians) at Dalhousie. PLANS seeks to improve health outcomes within the African Nova Scotian community (about 2.3% of the NS population), while creating mentoring and outreach opportunities. In order to facilitate access to healthcare for African Nova Scotians, Dr. Hamilton-Hinch discussed the need for change in our healthcare system. Change to the way healthcare professionals are educated by challenging curriculum, change to the way healthcare professionals practice in order to reflect cultural proficiency, and most importantly, change in the disparity between the small numbers of African Nova Scotian healthcare professionals and the much larger population they serve.

Dr. Barb Hamilton-Hinch of Dalhousie University, discussing the health of African Nova Scotians at the Healthcare Teams Addressing Poverty and Determinants of Health event.

The Global Health Office would like to thank Dr. Meili, Dr. Forbes and Dr. Hamilton-Hinch for sharing their stories with over 80 attendees. The stories you have shared will go on to impact the way that we approach our learning, practice and advocacy.

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Photo credit: enrichproject.org

The first Global Health Rounds of 2016 took place on January 20^th in the Sir Charles Tupper Medical Building. Global Health Rounds is a free public lecture series, focused on highlighting and discussing the global health activities at Dalhousie, as well as contemporary global health challenges, with leaders in the field. These sessions are offered monthly and anyone is welcome (and encouraged) to attend. Speaker and location details will be posted on the Global Health Office Website, Facebook, Twitter and Instagram.

January’s Rounds, led by Dr. Ingrid Waldron, was entitled “Race, Place & Waste: Exploring the Health Effects of Environmental Racism in African Nova Scotian & Mi’kmaw Communities.” Dr. Waldron discussed the Environmental Noxiousness, Racial Inequities and Community Health – or ENRICH – Project, which aims to better understand the effects of environmental racism in African Nova Scotian and Mi’kmaw communities, and to support their struggles against it. Dr. Waldron’s talk drew a crowd of more than forty students, faculty, health professionals and community members. We hope to see just as much enthusiasm for February Global Health Rounds: Health & Wellness of African Nova Scotians. Check out (and share) the Facebook event for more information, and to indicate your interest and plans to attend.

Some of the January Global Health Rounds attendees. We had to open a second room connected by video-conference because there were so many people!

What is Environmental Racism?

The first time I heard about environmental racism was in a 2013 article by Vice News about The Chemical Valley [1]. The Aamjiwnaang First Nations reserve near Sarnia, Ontario, home to about 850 Chippewa, sits surrounded by harmful chemical plants that produce gasoline and synthetic rubbers, among other materials. Why are these plants located next to a First Nations reserve, rather than in the midst of a middle class, primarily white neighbourhood? How do race and class shape where hazardous industries are located?

Dr. Waldron’s research in environmental racism seeks to answer these types of questions in Nova Scotia, while assessing the health impacts and working toward policy solutions. In Nova Scotia (and globally), there is a disparate location of hazardous industrial polluters in communities of colour, First Nations, in remote areas and among the working poor. The ENRICH project began with community consultations in the spring of 2012. Consultations took place in Yarmouth-Acadia First Nations, Eskasoni First Nation, Membertou First Nation, Lincolnville, and other affected communities. The concerns that were identified among these communities include (but are not limited to) fear of water and soil contamination, high rates of cancer, asthma and fetal anomalies and social nuisances such as loud noises, increased insects and mammals. Some women feel that their reproductive choices are limited, not wanting to expose a child to the aforementioned effects of environmental racism.

Dr. Waldron noted that environmental racism is an intersectional issue. Low income white communities also experience environmental racism, but their issues are often addressed more quickly. When there are multiple factors impacting the lack of power to be protected and heard (race, place and class) due to a history of forced displacement, social marginalization and destruction of culture and language, environmental racism worsens. Despite pushback from these communities who are affected by landfills and dangerous industries, there is a common response: in order to have grounds to remove them, there must be concrete, scientific proof that they are causing harm. The burden of this proof often falls on the communities, but it should be shifted to those responsible for environmental racism.

Bill 111

Communities experiencing the health and social impacts of environmental racism shouldn’t have to wait for 100% proof and validity to have their issues addressed. Dr. Waldron’s work, in collaboration with MLA Lenore Zann, culminated in presenting Bill 111, An Act to Address Environmental Racism, in the Nova Scotia Legislature.

In 2015, Bill 111 made it to second reading, but did not pass. Dr. Waldron is not discouraged, as the bill has introduced to the issue of environmental racism to many who were otherwise unaware. Bill 111 was featured in The Huffington Post, The Chronicle Herald, and is now on the record as being debated in the Nova Scotia Legislature [2]. She plans on introducing the bill again in the near future.

Future Directions

Dr. Waldron’s current work includes working with a dedicated team to develop an all-applicable Environmental Bill of Rights, stating that everyone has the right to clean air and clean water; the right to live, work, learn and play in healthy and sustainable places, among other standard rights that those impacted by environmental racism are not always afforded.

The Global Health Office would like to thank Dr. Waldron for her eye-opening talk about environmental racism, a pressing local and global health issue. To learn more about the ENRICH Project, you can visit their website [3].

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