Power and privilege in Saskatoon and Toronto: Recognition of racism as foundational element of social determinants of health

Speaking recently at an event hosted by the Wellesley Institute, Dr. Cory Neudorf  leans forward in his seat when asked a question related to the social determinants of health (SDOH) of people of colour and Aboriginal peoples. It’s not what you expect from a public servant, and his answer shows the commitment he has to making real changes to the health of all city residents and the depth needed to accomplish that.

As Chief Medical Health Officer for  Saskatoon Health Region, Neudorf has steered the prairie city to a broad public buy-in for attacking poverty. He has moved the discussion of public health from personal behaviours towards a recognition of the systemic and policy barriers which can keep groups of  the region’s residents in poverty.

Early analysis showed the three drivers for poor health outcomes in Saskatoon, when Aboriginal Status is controlled for, are income inequality, education, and age. So how, then, I ask, does race play into a public health agenda?

Neudorf response is nuanced. Admittedly, these discussions are controversial, he said, because if other factors account for poor health outcomes, then some will argue there is no need to focus on Aboriginal status or Race (or other social demographics) as a factor for consideration.

In contrast Neudorf argues these social demographics are foundational elements that run across all the other determinants of health, so that our conversations about policy and program interventions have to be re-framed to build on them. Far more than simply naming them, Neudorf says, we have to talk about how racism is systemic and institutionalized, and why, simply, there are different prospects for people, not because of their race, but because of racism.

Neudorf explains the discussion has only started as te Saskatoon community has done some qualitative work to explore how racism impacts social determinants of health. They hope to determine when targeted responses are appropriate compared to broader population-based responses (or when both are in order).

Neudorf also explained the equity audits the regions health systems were undergoing. An important equity test for the system is to look not at the health pathways for a “typical” patient, but instead at the flow-through of all patients.

In sum, he says, these conversations are about inclusion.

Toronto’s Chief Medical Officer David McKeown, also in attendance, agreed with Neudorf and elaborated, focusing on the position of Toronto immigrants. Racism, McKeown explained, has to be named as an important confounder of health patterns. During earlier comments, McKeown also pointed to need to examine the various dimensions of inequity that make specifically tailored responses important.

These comments, by their admission, were not new points — activists and some academics have been making these points for years (eg. Colour of Poverty/Colour of Change campaign and their call for disaggregated data). What has shifted, though, is that those, closer to power, are now saying the same things too. It’s an optimistic turn.

(For more information about the session, see another post I wrote on the Wellesley Institute website. Neudorf’s presentation is also available there in video format. For more on what others have said on the topic, see below in More.)

The Global City: Newcomer Health in Toronto 2011

Roundtable on Socio-Economic Determinants of Health, Conference Board of Canada

Healthy People, Healthy Performance, Healthy Profits: The Case for Business Action on the Socio-Economic Determinants of Health, Conference Board of Canada report, 2008

Developing a Canadian Economic Case for Financing the Social Determinants of Health, Canadian Policy Research Network, 2007

A New Way to Talk About the Social Determinants of Health, Robert Wood Johnson Foundation

CPHA and the Social Determinants of Health: An Analysis of Policy Documents and Statements and Recommendations for Future Action, Manzano & Raphael, 2010 (provides analysis for levels of research on SDOH showing how public health discourses have moved beyond individual behaviours and need now to move towards recognition of power dynamics and towards advocacy)

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