Week 5: Equity in Health Promotion: Decolalinzation

The coin model

top of the coin - privilege
bottom of the coin - oppression
coin = metaphor for social structure
eg.
- heterosexuality is on top of the coin,
- homosexuality is below the coin

The intersection of the coin model

a single coin does not represent all privilege or all oppression. Each coin represents a specific system of inequality

The gorilla and the coin model

The gorilla video is used as a metaphor to symbolize what is there but we don't see unless we look for it. The goal of the coin model article was to help people fine tune their capacity to see the gorilla (the injustice that exists at the bottom of the coin)

The applied framework for health promotion

Domain 1:Reflection
Domain 2: Planning
Domain 3: Action

Combination of all 3 domains = full engagement in decolonial processes

Purpose of the decolonial framework

the framework intends to encourage
practitioners to recognize the structural impacts of colonization and to engage with impacted communities to
achieve health equity

current climate

the inequalities that exist in our society

policy and law

how these are informed and by whom they are informed

education

what gets taught, how it is taught, and how that information is used

systems and structures

Hierarchies and access to power and privilege

health disparity

heart disease
- heart disease rates for indigenous people are as much as 50% higher than in non-indigenous populations

covid-19
- black people are more likely to die from covid

Birth
- black women died in pregnancy-related causes at a rate 3 times higher than white women

lack of EDI: Impacts on health systems

Jordans principle

a principle that ensures there is substantive equality and that there are no gaps in publicly-funded health, social and education programs, services and supports for first nations children. According to the Canadian human rights tribunal

Transphobia

has been described as an "irrational fear of, aversion to, or discrimination against people whose gendered identities, appearances, or behaviours deviate from societal norms" This includes transgender, transsexual, transitioned, and gender-queer people, as well as some two-spirit people.

poor health outcomes for trans individuals

- greater risk for HIV
- disproportionately experience homelessness and
poverty
- poorer mental health
- 25 times more likely to attempt suicide

individual-level barriers

- mistrust in relation to health care providers, services
and institutions
- lack of access through knowledge of systems and cost
of care
- mental health
- gender dissonance
- lack of support and isolation

Interpersonal-level barriers

- provider competency in transgender health issues
- social inclusion
- shortage of providers and specialists who focus on , or are comfortable with, providing care for transgender individuals

organizational-level barriers

- unsafe physical healthcare environment
- medical paperwork that is not inclusive
- lack of programs and services tailored to the needs of transgender people

societal/institutional barriers

- "institutional erasure"
- lack of trans-specific training for health professionals
- inconsistent access to gender affirming surgery

Ottawa charter for health promotion 1986

'health promotion is the increase of enabling people to increase control over and to improve, their health. To reach a state of 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."

prerequisites for health

food
income
a stable eco-system
peace
shelter
education
sustainable resources
social justice and equity

how health promotion can support EDI

- advocate
- enable
- mediate

structural approach to health equity

- Evidence-based decision making
- social determinants of health
- community engagement