Chapter 1 - Break Down Barriers: Think about the effects of racism and discrimination

Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and Substance Use with Ethnocultural Communities

While Canada is officially a multicultural society in which all cultures are equally valued, in practice it often falls far short of this ideal. For example:

• In the Ethnic Diversity Survey conducted by Statistics Canada in 2002, 20% of people aged 15 and over who were part of a visible minority said they felt that they had experienced discrimination or unfair treatment sometimes or often in the five years prior to the survey because of their ethnicity, culture, race, skin colour, language, accent or religion.
• Ethno-racial minorities face greater economic hardship than other Canadians and are disproportionately represented in jobs with long hours and low pay.

In health promotion with ethnocultural communities, racism and discrimination have to be taken into account. The barriers created by racism and discrimination exist in all aspects of life, not just healthcare—education, employment, justice, government, housing—and these in turn have an impact on health.

In the end, health promotion is about ensuring people have the power to make healthy choices. This power comes not only from knowledge about health issues but also from having equal access to economic and political resources. Effective health promotion, therefore, must include initiatives that aim at breaking down the systemic barriers faced by ethnocultural communities in all sectors of society.

1. 1. Source: Statistics Canada “Ethnic Diversity Survey--2002,” The Daily, 29 Sept. 2003. Accessed April 2007.
   2. Source: Jacqueline Oxman-Martinez and Jill Hanley, “Health and Social Services for Canada’s Multicultural Population: Challenges for Equity.” Heritage Canada, Canada 2017 Policy Forum, 13 July 2005. Accessed April 2007.

Example:
Community Health in Action: Real Stories --"Racism is wrong." (Canada)
http://www.opc.on.ca/stories/index1.html
This account of one woman's experience with racism in her workplace shows how racism and discrimination can have an impact on mental health.

To learn more about the effects of racism and discrimination:

• Tolerance.org, “Hidden Bias: A Primer” (USA)
• University of Victoria: “Cultural Safety, Module 2: Peoples’ Experiences of Oppression” (Canada)
• Malcolm Shookner et al., An Inclusion Lens: Workbook for Looking at Social and Economic Exclusion and Inclusion (Canada)
• Community Tool Box: “Healing from the effects of internalized oppression.” (USA)
• Tackling Health Inequities Through Public Health Practice: A Handbook for Action .  The National Association of County & City Health Officials and Ingham County Health Department. Richard Hofrichter, ed. 2006. PDF. (USA)

Fulfil the spirit of the Ottawa Charter

At first, challenging racism and discrimination may seem to be outside the scope of health promotion.  There is growing recognition, however, that good health, including (and perhaps especially) good mental health, is not only a result of an individual's habits but also the environment in which he or she lives.

The first International Conference on Health Promotion took place in Ottawa in 1986. Out of this conference came the Ottawa Charter for Health Promotion, a plan for action to achieve “Health For All by the year 2000 and beyond.” (PDF) The Charter defined health promotion as:

“. . . the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.”

By this definition, health promotion needs to go beyond changing individual behaviours to creating conditions in which people and communities are more able to enjoy “complete physical, mental and social well-being.”

To learn more:

• The Ottawa Charter for Health Promotion

Work with ethnocultural communities

People in ethnocultural communities are the best sources of information about the barriers they face. Working with them to produce a health promotion initiative will achieve far more effective results than attempting to create one with little or no input from the community.

The process of working together and involving community members in a health promotion project also can help to achieve the main goal of health promotion: enabling people to increase control over their health.

There are some challenges to working effectively with ethnocultural communities, but with some preparation they can be overcome.

Become aware of your own culture and way of seeing things

We may never think about the things we say and do every day—they just seem to be logical and “common sense” to us. One of the pleasures of working with people of different cultures is learning that there are different ways of doing things, all of which seem logical and sensible to the people doing them. Challenges arise, however, when one person or group of people believes their way is the best way or the only way to do things.

When you work with people whose culture and first language is different from yours, it is likely that misunderstandings will arise from time to time. One way to prevent these misunderstandings from turning into serious problems is to become more aware of your own culture and think about how it has shaped your way of seeing and doing things. It is important to recognize that other people may have other ways of understanding, communicating and learning.

Some other steps you can take to enhance your work with people of different cultures:

• put aside assumptions
• be flexible
• listen more, talk less
• when problems arise, rather than make judgments, recognize the possibility of misunderstanding.

To learn more about cross-cultural communication:

• University at Albany, School of Public Health. “Exploring Cross-Cultural Communication.” Free self-guided tutorial, requires registration. (USA)
• Health Canada: “‘Certain Circumstances’ Issues in Equity and Responsiveness in Access to Health Care in Canada—Part IV Toward Cultural Competence.”
• Toward a More Perfect Union in an Age of Diversity: A Guide to Building Stronger Communities through Public Dialogue: “Working on Common Cross-Cultural Communication Challenges” (USA)

Partner with community-based agencies

In many ways, creating health promotion initiatives with ethnocultural communities is no different from creating them with other specific communities and audiences. One major difference, however, is language. Many people in ethnocultural communities do not speak either official language or simply feel more at ease communicating in their own language, especially when it comes to sensitive issues such as mental health and substance use problems.

If you do not speak the community’s language, it may be difficult to work with the community to create the initiative. One way around this difficulty is to partner with one or more agencies already established in the community. The staff in community-based agencies tend to understand both the mainstream culture and their community’s culture. They can therefore act as a bridge between you and the community. They also have the community’s trust, which is probably the most important factor in the success of a health promotion initiative.

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