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FRAMEWORK ON ANTI-RACISM, ANTI-OPPRESSION AND EQUITY:

ACTORING THE

ETERMINANTS OF

EALTH ON

ERVICES

ELIVER

FOR SURVIVORS OF VIOLENCE IN CANADA: PERSISTING INEQUITIES

IN THE ORGANIZATION OF SERVICE OF SURVIVORSOF VIOLENCE

IN CANADA

QUADRO SOBRE O ANTI-RACISMO, A ANTI-OPRESSÃO E A EQUIDADE:

ASPECTOS DOS DETERMINANTES DA SAÚDE EM SERVIÇOS OFERTADOS

PARA SOBREVIVENTES DE VIOLÊNCIA NO CANADÁ: PERSISTINDO

DESIGUAlDADES NA ORGANIZAÇÃO DO SERVIÇO DE SOBREVIVENTES DE

VIOLÊNCIA NO CANADÁ.

Leena Masoud

ESUMO

Apresentamos neste artigo aspectos dos determinantes da saúde em serviços ofertados para

sobreviventes de violência no Canadá.

PALAVRAS-CHAVE: Anti-Racismo, Anti-opressão, Equidade, Saúde em serviços ofertados para

sobreviventes, violência no Canadá.

ABSTRACT: We present in this article aspects of the determinants of health services offered to

survivors of violence in Canada.

EYWORDS

Anti-Racism, Anti-Oppression and Equity, Services Deliver for Survivors, Violence in

Canada

Quadro sobre o anti-racismo, a anti-opressão e a equidade: Aspectos

dos determinantes da saúde em serviços ofertados para sobreviventes de violência

no Canadá: Persistindo desigualdades na organização do serviço de sobreviventes

de violência no Canadá.

INTRODUCTION

The Peel Institute on Violence Prevention (PIVP) is an interdisciplinary

and intersectorial collaborative initiative among agencies in the Region of Peel,

the province of Ontario, Canada working toward the eradication of all forms of

violence.

1 Masters of Public Health. Peel Institute on Violence Prevention Peel, Ontario – Canada. masoud.leena@

gmail.com

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MASOUD, L.

Objectives of the Institute

•

Engage in policy analysis on current responses to violence and

conduct academic and participatory action research on best-

practices for the treatment and prevention of violence

•

Enhance the capacities of community-based agencies by developing

program evaluation tools to ensure that survivors of violence have

access to seamless, interdisciplinary services and support

•

How to Achieve the Objectives

•

Mobilizing regional resources and sectors with expertise in the

areas policy making, programs and services, development and

implementation, community advocacy, and development and

evaluation

•

Utilizing human resources development, innovative programs and

services, participatory community development, policy analysis,

and evaluation methodologies with the objectives of minimizing

the disparity across population sub-groups, ensuring fairness and

accessibility to services and programs, and reducing violence

•

Close collaboration between services providers and individuals

with

the lived experience of violence

•

Establishing leadership focused on violence prevention

The institute recognizes that inequities are present in the day to day

lives of individuals in the Region of Peel, and that health and social service

agencies have not yet been able toeliminate the inequities seen across the diverse

populations of this region. Diversity is a prominent characteristic of Region of

Peel. According to the most recent census of 2011 provided by Peel Data

Centre Peel has a population of 1.3 million, the second highest population in

Ontario, where 50% are immigrants and 56.8% visible minorities (CENSUS,

2011). The top countries of birth for immigrants are India, China, Pakistan and

the Philippines; for instance, 52.5% of Brampton’s recent immigrants

were

born in India, and Mississauga residents have an average of 3.7 ethnicities

(CENSUS, 2011). Additionally, eight different languages, apart from English

and French, are spoken in Peel homes; yet interestingly, no city is the same

within Peel (CENSUS, 2011). Punjabi is the top language in Brampton, Urdu in

Mississauga, and Italian in Caledon (CENSUS, 2011). The diversity seen across

Peel requires a multifaceted approach to delivering health and social services,

which should recognize the unique experiences and needs of each individual or

group. Ultimately, such efforts are aimed to make the Region of Peel a more just

and equitable society.

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Life conditions greatly influence health of an individual and overall

population health. People’s life conditions include where they are born, grow,

live, work, and age (WHO, 2012). These societal factors are shaped by the

distribution of money, resources, and power at the local, national, and global

levels, and ultimately, are

the social determinants of health

. Social determinants

of health can be classified as distal, intermediate, and proximal. Distal refers to

the historic, social, political, and economic factors that are impacting health

outcomes, while intermediate refers to the community infrastructures, systems,

resources, and capacities impacting health outcomes. Lastly, proximal factors

are the ones most immediate to the individual such as, health behaviours and

physical and social environment (READING; WIEN, 2009).

Social determinants can impact health on multiple levels—physical,

mental, spiritual, emotional—and have distinct impacts on distinct populations

(READING; WIEN, 2009). The complexity of these social factors is they create

health problem, which when left unaddressed, may lead to further social difficulties.

Diagram 1 –

Social Determinants of Health and Well-being

GENDER

Gender has become an underlying basis for discrimination in many

societies (WHO, 2010). Women and girls have unfortunately bornethe

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majority of the negative health effects from the socially constructed modes

of masculinity, although men and boys too suffer from adverse health

consequences (WHO, 2010).

In numerous societies, women and girls have difficult accessing resources,

and thus, access to power and prestige (WHO, 2010). There are also too often

limitations in attaining education, as well as, respected and well paid types of

employment (WHO 2010). Altogether, these limitations underline women’s social

disadvantage and lower social status, which exposes them to numerous health risks

(WHO, 2010). A study using multivariate analyses of Canadian National Population

Health Survey data shows gender differences in health, measured by self-rated health,

chronic illness, distress, and functional health (DENTON et al., 2004). Psychosocial

and social structural health determinants were overall more important for women

than men, while behavioural determinants of health were more important for men

(DENTON et al., 2004). Gender-based health inequalities result from varying social

locations of men and women, their varying lifestyle behaviours, and their varying

number and levels of chronic stressors (DENTON et al., 2004). Interestingly, Denton

et al. (2004) noted significant gender differences persisted even after controlling for

structural, behavioural, and psychosocial exposures.

Furthermore, Trans is a terminology used to include a diverse group of

people that have gender identity different from the main societal expectations (BAUER

et al., 2009). Trans includes people that are gender queer, transsexual, transgender,

and transitioned (BAUER et al., 2009). Several research studies and needs assessment

reveal day-to-day challenges faced by this sidelined group in society. Some of these

challenges include ability to access appropriate health care services, and social services

such as, addiction services, homeless shelters, and sexual assault services (BAUER

et al., 2009). Additionally, they often face direct discrimination and harassment in

institutions and social environments (BAUER et al. 2009). The LGBTIQ—lesbian,

gay, bisexual, transsexual, intersexed, and questioned queer—youth are an underserved

group that has increased healthcare needs as they face greater risks to their health and

well-being relative to the heterosexual youth (DYSART-GALE, 2010).

RACE

Race is used to refer to social groups that often share an ancestry and

cultural heritage (WHO, 2010). The process of creating races as different, real,

and unequal in manner that it impacts social, economic, and political life is called

Racialization (LEVY et al., 2013). In the process of constructing race, one group

benefits by dominating other groups; this can be done either directly or indirectly

through varying types of racism.

Racism is a concern for Canadian society, as racialized differences

are evident in employment, education, and housing. For instance, the 2010

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nationally representative public opinion poll of 1,707 participants showed that

38 percent of all respondents and 58 percent of respondents between ages 18 to

24 witnessed a racist episode in the past year (LEVY et al., 2013). Furthermore,

there were 1,332 hate crimes reported to the police in 2011, of which 52 percent

were motivated by ethnicity or race, and a little over half happened in Ontario

(LEVY et al., 2013).

RACISM

Racism, a social determinant of health, is the main cause of racialized

health inequities that is expressed through multiple pathways (VISSANDJEE

et al., 2001; LEVY et al., 2013). For instance, racism causes stresses, including

stress of discrimination; this psychological impact then initiates detrimental

biological and physiological processes in the endocrine, immune, and

cardiovascular systems (BOURASSA et al., 2004; LEVY et al., 2013). More

extensive research in United Kingdom and United States has continued to find

racialized groups experiencing poorer health outcomes compared to non-

racialized groups in terms of higher rates of poor or fair self-rated health, higher

infant mortality rate, and higher blood pressure and diabetes (LEVY et al.,

2013). While Canadian research is more limited, it continues to find chronic

diseases such as, high blood pressure and diabetes to be more common in some

racialized groups (LEVY et al., 2013).

Analysis of Canadian Community Health Survey (CCHS) data reveals

worst health outcomes for some racialized groups in the following:

•

Overweight or obesity (people who identified as Black)

•

High blood pressure (people who identified as Black, Latin

American, Multiple ethno-racial identities, Other)

•

Pain or discomfort (people who identified as Black)

The East or Southeast Asian group had a better health outcome

than non-racialized groups on the health indicator of overweight and obesity.

The CCHS and Neighbourhood Effects on Health and Well-being (NEHW)

data analysis showed no differences among racialized and non-

racialized

groups in depressive symptoms of self-rated health, and self-rated

mental health

(LEVY et al., 2013).

Furthermore, racism limits socioeconomic opportunities for racialized

groups. In every province of Canada, Canadians of colour experience higher

unemployment, under-unemployment rates, and lower-incomes (GRAHAM,

2004). Labour force was the most common area in which people reported

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experiencing racial discrimination in an analysis of Statistics Canada in 2002,

and such stresses as in employment can lead victims of racism to begin to adopt

unhealthy behaviours as a coping mechanism (LEVY et al., 2013).

OLONIALISM

: T

NGOING

OCIAL

XCLUSION

Colonialism is defined as the governing influence or control of a nation

over a dependent people, territory, or country, and it can also be defined as the

policy or system that is used by a nation to maintain or advocate such influence

control (CZYZEWSKI, 2011). Colonialism results in social exclusion, which

is where certain groups are denied full, equal opportunity to participate

Canadian life. The people who are more likely to experience social exclusion

Canada are Aboriginal Canadians, recent immigrants, Canadians of colour,

women, and people with physical and mental disabilities; a number of areas in

Canadian society neglect such populations by limiting their access to economic,

social, and cultural resources (MIKKONEN; RAPHAEL, 2010). Canadians that

are socially excluded have higher unemployment rates or earn lower wages, less

access to social and health services, less educational opportunities, and less of

an influence in political decision-making (MIKKONEN; RAPHAEL, 2010).

Ultimately, social exclusion can develop a sense of hopelessness, powerlessness,

and depression, which further decrease chances of inclusion within society

(MIKKONEN; RAPHAEL, 2010).

On the other hand, a social safety net can be advantageous to health; it

provides numerous types of programs, benefits, and support to protect individuals

during life changes which affect health (MIKKONEN; RAPHAEL, 2010).

Although Diagram 1has helped to shed light on some very important

social determinants of health, it fails to capture the complexity of life experiences

caused by multiple interacting social identities of individuals and power relations.

It does not identify a comprehensive list of determinants in a ranking order,

nor does it define how each determinant should be interpreted and measured

in a policy and research studies (HANKIVSKY; CHRISTOFFERSEN, 2008).

As a result, a wholesome understanding of unjust disparities in health and social

inequalities is still lacking.

This analysis of relationship between health and social determinants

is too general. What is needed is an understanding of the multiple intersecting

social identities (e.g. race, gender, socioeconomic status, violence) that contribute

to the complexities of health disparities for populations that have especially been

historically oppressed, and an understanding of how systems of privilege and

oppression resulting in racism, sexism, and other inequalities cross at the macro

social-structural level to maintain disparities (BOWLEG 2012; COLE, 2009;

VIRUELL-FUENTES et al., 2012).

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We can say that the overall health and well-being status of an individual

cannot be determined by looking at only one determinant of health and well-

being, but rather, in order to fully understand the status of an individual, multiple

determinants impacting the individual must be recognized.

The key question in intersectionality is Who has power and control over

whom? In Canadian society, the power to influence social norms has rested with

white, able-bodied, heterosexual, middle-class men; therefore, Euro-centric

values or white culture has been the norm again to which all other groups have

been compared (HANKIVSKY; CHRISTOFFERSEN, 2008). Intersectionality

requires looking at historically oppressed and marginalized groups—racial

minorities, women, people of low-income and disabilities—within their own

contexts rather than how far they have deviated from the norms of white-middle

class people (BOWLEG, 2012).

Diagram 2.

Intersectionality of Social Determinants of Health and Well-being

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NTERSECTIONALITY AND

IOLENCE

Although it is overall accepted that abuse against women occurs

across social classes, races, geographic regions, and diverse societies (GILL;

THERIAULT, 2005; JEWKES, 2002; MICHALSKI, 2004), a closer look at

the complex relationship between violence and other social factors shows that

some women are at a greater risk than others due to systemic oppressions such

as, sexism and classism. In an effort to attain a healthy community for all,

violence prevention, especially against women, needs to be addressed. A closer

understanding between violence and social determinants of health and well-being

is essential in order to deliver more equitable services that are appropriate for the

needs of each individual in our community.

ENDER AND

ACE

NTERSECTIONALITY

Race and gender are intersected in such a way that one identity alone

cannot explain the unequal outcomes without understanding the relative

intersection of the other.

In another study, being an ethnic minority posed a greater health risk

than the other social constructs of gender and income, and being a female was a

greater risk factor than low-income (WAMALA et al., 2009). Being a minority

and a female had greater impact on health than income-level.

Sexism and racism are also influential factors in employment

opportunities. For instance, compared to Canadian men, Canadian women

are less likely to be employed, and, in the pre-retirement age of 55-64, their

income is barely over half that of men (STATISTICS CANADA, 2005). When

race intersects with gender, it creates even higher rates of unemployment among

women who are Indigenous, African Canadian and immigrant. Women’s relative

higher poverty rates are a result of inadequate structural systems of Canadian

society. The chronic stresses of poverty, combined with everyday stresses of racism,

sexism, and impacts of colonialism have a grave negative impact on physical and

mental health.

ENDER

, R

ACE

AND

IOLENCE

NTERSECTIONALITY

The unfortunate experience of domestic violence is primarily rooted

in gender and rooted in racialization of other determinants of health and well-

being such as, socioeconomic status. For countries all over the world, violence is

a major public health problem (DAHLBERG et al., 2002). According to World

Health Organization’s World Report on Violence and Health (2002) violence by an

intimate male partner or husband is the most common form of violence against

women, whereas, violence by stranger or acquaintance is the more common

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form of violence for men. Violence against women includes behaviours such as,

stalking, sexual harassment, forced marriages, domestic violence, rape, trafficking,

and

female genital mutilation. Although men may also be impacted by such forms

of violence, women continue to be the primary victims of these abuses, thus,

making gender a key health determinant of violence.

While there is no debate about the negative consequences of violence on

women’s overall health, there is controversy over the role social inequities play

making women more susceptible to violence.

Throughout Canada members of racialized groups appear to have worse

circumstances than members of non-racialized groups (LEVY et al., 2013). While

data shows that the two groups have comparable levels of education, the historic

income analysis shows increasing income inequalities between racialized and non-

racialized groups (LEVY et al., 2013). Therefore, victimization is associated more

so with populations which are socially and economically isolated, as is the case

for blacks who are disproportionately represented in socially disadvantaged

communities (RENNISON; PLANTY, 2003).

The relationship between social determinants of health and victimization

of women is a complex one; there is not one determinant of health that is most

linked with violence against women but rather multiple determinants of health are

interwoven together to create circumstances resulting in domestic violence. For

instance, the direct and indirect health impacts of intimate partner violence are

mediated by factors like stress, social support, and self-care agencies (PLICHTA,

2004). However, gender is a key factor that cannot be ignored in understanding

the link between violence and health outcomes

To begin with, service providers’ interventions should address

victimization from either a causal or a consequential direction. When a woman

accesses economic support, a referral system to a social service agency may

also need to be implemented as her decline in economic status may have been

due

to the victimization; on the other hand, agencies serving women of low

socioeconomic status should be aware of victimization as a causal possibility

of their status and should be prepared to provide referrals to a social service

agency (BYRNE, et al., 1999). Thus, it may be most beneficial for a woman

to receive both social and economic support simultaneously with the hope of

preventing revictimization.

Current literature shows intimate partner violence or domestic

violence as a serious concern among the Aboriginal community and especially for

Aboriginal women (CAMPBELL, 2007; PALETA, 2008; WOOD; MAGEN,

2009). In Canada, Aboriginals are three times more likely to be victims of spousal

violence, which does not suggest that it is more inherent to their culture but

rather indicates the oppressed and underprivileged status they endure in Canada

(GILL; THERIAULT, 2005). The male-domination of societies and the historic

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context of colonialism have contributed to the oppression of Aboriginal women

(MOFFITT et al., 2013).

Colonization introduced the patriarchal nature of North American

society among the Aboriginal communities, which removed the Aboriginals from

their established egalitarian culture that offered men and women equal power in

the economy; in the post-colonial society, however, Aboriginal men had difficulty

enforcing patriarchy in the midst of socio-economic downturn as women became

the primary wage earners (MOFFITT et al., 2013).

EQUITY FRAMEWORK OF DETERMINANTS OF HEALTH AND WELL-BEING

The following Equity Framework of Determinants of Health and Well-

being prioritizes gender and race as key determinants of health that together play

a central role in the experiences of everyday life of an individual. Gender and race

often cannot be ignored at the intersection of other social determinants of health

and well-being. Additionally, the intersection of any proximal, intermediate, and

distal determinants should result in optimal health in all of its aspects—physically,

emotionally, spiritually, and mentally. The intersection of social determinants in

this model goes to further indicate an array of experiences that can result from

various life experiences. Thus, all life experiences are equally valuable and must be

equally addressed in the community.

Diagram 3 –

Equity Framework

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QUITY IN

ERVICE

ELIVERY

NEQUALITY VS

. I

NEQUITY

Inequality is merely the difference between individuals or population

groups, and may not necessarily be unjust. However, when these differences

between individuals and population groups are preventable and avoidable, it makes

those differences unfair and unjust. This unjust inequality is defined as inequity. For

instance, women generally live longer than men, which is likely due to biological

sex differences; therefore this is not inequitable. However, in cases where women

have the same or lower life expectancy as men, inequity persists due to the social

conditions reducing the seeming natural longevity advantage of women (WHO

2007). Inequities are seen across social determinants of health and well-being and

are maintained by an unequal distribution of economic and social resources, along

with power and prestige across social hierarchies. A distinction has to be made

between the social factors influencing health and well-being and the distribution

of the social determinants through the social processes (BRYANT et al., 2011).

This distinction is essential because even after improvements in health and health

determinants have been made, social disparities continue (GRAHAM, 2004).

For example, the last thirty years have seen great improvements in

health determinants such as, declining smoking rates and rising living standards,

and improvements in people’s health such as, life expectancy. Nevertheless, these

improvements have not broken the association between social disadvantage and

premature death, nor the greater link between socioeconomic position and health

(GRAHAM, 2004). A more in-depth analysis is needed to understand the health

inequities seen across the populations, which are not reflected in the health

determinant model portrayed in diagrams one and two. These diagrams do not

identify any social processes that play a role in maintaining inequities. By using

these models to define both health and health inequity, it obscures the difference

between the social factors that impact health and the social processes that define

their unequal distribution.

ROLE OF HEALTH AND SOCIAL SERVICE ORGANIZATIONS

Health and social service organizations are well-intended to eliminate

social injustices in their communities. Although the organizations’ intent is to be

impartial and provide just service to all individuals who seek their assistance, it

is important to be cognizant of the fact that such organizations do not exist in

a vacuum and are vulnerable to indirectly adopting systems of oppression that

are present in the larger society to which they belong and serve (COLLINS;

BARNES, 2014). If organizations are internally structured according to systems

of domination like racism, classism, and sexism and adopt the norms and values

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of the dominant culture in their organizational policies and practices, then they

cannot successfully promote services that reflect empowerment, diversity, and

sustainable social justice (PERKINS et al., 2007; COLLINS; BARNES, 2014).

a consequence of not looking at their internal inequities, Collins; Barnes

(2014) state that the health and human service may “alienate, silence, and create

continual need for services in marginalized communities (p.74).” In order to

prevent this, organizations need to carefully look at how they allow access to

services, coordinate care, and provide continuous care in line with the principles

of equity across determinants of health and well-being.

ACCESS

According to Ontario’s Local Health Integration Network (2014),

accessibility is “the ability, opportunity and means to approach, consult, and

utilize an organization’s services and organizational structure.” Equity in access

then implies that every individual in the community has the ability to, the

means to and the opportunity to attain the needed health and human services,

regardless of their gender, race, ethnicity, socioeconomic status, religion, or other

socially created constructs or circumstances. Unfortunately, barriers in accessing

health care are filled with oppressive practices that are embedded in systemic

oppressions such as, racism, sexism, and classism; altogether these function

“within complex public service systems, with their inherent densely connected

networks” (MCGIBBON; MCPHERSON, 2011, p. 76).

By limiting equal access to resources across a population, health will

inevitably suffer in some populations more than others (WHO 2007). Across

social groups there are differences in levels of stress, frustration, deprivation,

and access to resources to deal with negative life circumstances. It is argued that

while people with higher socioeconomic positions have access to more resources

to better cope with life stressors, those of lower socioeconomic status lack such

resources, causing them to be more strongly affected by negative life events

(WINNERSJO et al., 2012). Such differences in access to resources may also

help to explain why victims of violence of low socioeconomic status report higher

odds of poor health than those of high socioeconomic status and are non-violence

victims (WINNERSO et al., 2012). Furthermore, racism also restricts access to

care. For instance, African Canadians and Aboriginal Canadians face continuous

barriers in access to care that includes discrimination and racism at point of care

(MCGIBBON; BASSETT, 2008, FISH, 2007, KARLSEN; NAZROO, 2002).

Interventions aimed at increasing access to material resources to

historically marginalized groups is a required effort to address historical oppression

and promote community well-being; despite this effort, inequities have persisted

due to the fact that dominant groups and institutions control how, when,

and whether marginalized groups access resources through the programs and

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policies reflective of their values and experiences (COLLINS; BARNES, 2014).

Essentially a close look is needed at the processes of these oppressive systems and

how determinants of health and well-being operate within them rather than just

looking at the consequences of oppressive systems such as, discrimination, health

disparity rates and so forth. The former will help us to better understand the

persisting inequities between different groups of a population.

CONTINUITY AND COORDINATION OF CARE AND SERVICES

Continuity of care and services is how an individual experiences a series

of care/services over a period of time as linked and coherent; this occurs when

separate and distinct elements of care/service are connected and are maintained

and supported over time (HAGGERTY et al., 2013). However, segmenting the

delivery of care and segmenting the delivery of services has increased rapidly due

to changes in treatments and specializations, causing individuals to seek care from

various types of providers from various types of settings. As a result, an increased

interest in continuity of care/service stems from concerns regardedin cases such

the following (GULLIFORD et al., 2006):

•

Client-centredness

•

Quality of care/service in chronic or long-term cases and conditions

•

Fragmentation in delivery of care and services

Different organizations have defined continuity of care/service in various

perspectives; while some definitions concentrate on the relationship between patients

and physicians and clients and service providers over time, others define it in terms

of the coordination and consistency between different settings and different staff

members (GULLIFORD et al., 2006). Continuity of care and service is essentially

concerned with quality of care, which is rooted in client-centeredness. In order to

ensure satisfactory continuity of care and services for all groups of people, equity is

an important value that cannot be overlooked when providing the best quality of

care possible. Numerous continuity of care definitions reveal two core concepts—

continuity of care as ‘continuous caring relationship’ and continuity of care as a

‘seamless service’ (GULLIFORD et al., 2006).

Continuous Caring Relationship: the primary service provider

focuses on the needs of a client whom he/she may know well; the focus is on

interpersonal care

•

To what extent are the client’s consultations concentrated in the

hands of one or a small number of professionals?

•

Quality of client-professional relationship

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•

How personal is the care?

•

Is it tailored to individual needs?

•

Is there a concern for the ‘whole person’? Is the illness

being managed in the context of thepatient’s life?

Seamless Service:

this aspect of continuity of care focuses on quality of

teamwork, the degree of communication, consistency, and coordination among

varying service providers or specialists; interpersonal continuity is not the primary

focus (GULLIFORD et al., 2006)

Ultimately, continuity and coordination in the delivery of care and

services are valuable if they lead to increased client satisfaction and more equitable

outcomes in determinants of health and well-being.

CONCLUSION

What is the Goal?

•

To incorporate anti-oppressive and equitable practices in health

and social service agencies of Peel in order to eliminate inequities

experienced by Peel’s diverse populations

The goal can be met by reorganizing the services in Peel so that they are

all-inclusive and reflective of the diverse population of this region. The current

system of delivering health and social services focuses primarily on the average,

white Canadian and does not account for the diversity of experiences of the

people of this region.

THE APPROACH

In order to achieve the goal, the Peel health and social organizations are

encouraged to do the following:

Collectively standardize systems for collecting data and sharing

the data

•

This will require the following:

•

Collecting information on the same key demographics and

determinants of health and well-being

•

Identifying best methods for data collection

•

Developing a procedure and location to share data and

maintaining most updated information

Framework on Anti-Racism, Anti-Oppression and Equity

Artigos/Articlesw

Revista do Instituto de Políticas Públicas de Marília, Marília, v.3, n.2, p. 25-42, Jul./Dez., 2017

Redesign the services to reflect the diversity of experiences in Peel

and according to the demographic diversity revealed in the data

A full understanding of the unique experiences of the diverse populations

coming to seek services is essential to developing the most efficient services.

Diagram 4

is a useful tool to begin to understand the diversity of experiences

in Peel. This begins by developing communication with the populations

served and identifying how many determinants of health and well-being

simultaneously play a role in the status of their health and well-being. The

communication should begin with the current population being served and

can be developed by the following means:

•

One-on-One interviews

•

Focus Groups

•

Surveys

The communication methods ultimately should help to yield the

following information:

•

Note patterns of experiences and identifywho is having these

similar experiences?

•

Create subpopulations according to these experiences

•

Identify which or how many determinants of health and well-

being have intersected to create that experience for them?

•

How many of these determinants of health and well-being are

having a direct impact on each other or have a cyclic relationship?

•

What services can be provided for this unique experience?

•

How to implement continuity of care and coordination of care

to gain the client’s confidence?

Communication with those seeking services needs to be an on-going

process in order toidentify new experiences, for which the most-appropriate set

of services can be provided.

Train the staff to recognize and manage the diversity of experiences

The staff should be trained to understand the diverse set of experiences

that the clients may bring forth at their organization, and how to

provide the appropriate and matched set of services for each.

MASOUD, L.

Revista do Instituto de Políticas Públicas de Marília, Marília, v.3, n.2, p. 25-42, Jul./Dez., 2017

Evaluate the organization’s programs and services

Evaluation of the programs and services in essential in order to

determine whether the needs of the diverse populations are being met andto

ensure thatthe Region of Peel is working towards a more equitable society

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Submitted: 10/12/2017

Accepted: 30/01/2018