Case 9 : Achieving Health Equity in Ontario: Increasing Capacity for Relationship Building with Indigenous Communities

Paul Green is concerned that his organization is not meeting the requirements of the modernized Ontario Public Health Standards’ Health Equity Standard after his colleagues ask for direction on working with local Indigenous communities. Under the third requirement of the new Health Equity Standard, all boards of health must engage with Indigenous communities and organizations, which must include the “fostering and creation of meaningful relationships”. As the new Health Equity Manager at Turtle Creek Public Health (TCPH), Paul is tasked with developing a set of recommendations for organizational action. After receiving advice from a colleague, Paul decides that the next step for his organization is to conduct a situational assessment to explore how it may effectively, appropriately, and meaningfully build relationships with local Indigenous communities. However, Paul is unsure about where to begin. What questions should be asked? What important considerations need to be made? By developing an understanding of community histories, current contexts, colonial policies, historical events, social determinants of Indigenous health, and the foundational principles for relationship building with First Nations communities, meaningful partnerships may be cultivated with stakeholders and organizations in Indigenous communities across the province

Case 7 : Integration of FP-MNCH Services to Accelerate Reduction of Maternal and Child Deaths: Bangladesh Experience

Women and children are still dying in alarming numbers from preventable causes. A child born in a low-income country is approximately 18 times more likely to die before the age of 5 than a child born in a developed country. Over a lifetime, a woman’s risk of dying as a result of pregnancy and child-birth in a low-income country is over 40 times higher than in the United States. Ending Preventable Child and Maternal Deaths (EPCMD) by 2035 is one of United States Agency for International Development’s (USAID) top priority health initiatives. Currently, USAID invests 90 percent of its maternal and child resources in the 24 countries that account for 70 percent of maternal and child deaths in the developing world. Bangladesh has made remarkable development progress over the last decade, achieving a sharp decline of maternal mortality ratio (MMR). This case examines the initiatives in Bangladesh to see how they can inform strategies for the other priority countries where USAID is making significant investments in maternal, newborn child health (MNCH)

Case 4 : Returning to Our Roots: Building Capacity in Public Health for Action on the Social Determinants of Health

Canadians are healthier than ever before, and live longer. But improvements in health are not distributed evenly between population groups. In fact, studies show that only 25% of our health is determined by health care and 15% by our genetics. The remaining 60% is determined by factors outside the traditional health care system, such as our income and social status, education, employment and working conditions, social support networks, social and physical environments, and culture. These factors are called the social determinants of health (SDOH). When these conditions are distributed in ways that are unfair, unjust, or avoidable, they are termed health inequities. These determinants can also be protective when everyone is given fair opportunities to access them. Because the SDOH cut across the purview of many sectors, such as education, health, socio-economic and public policy, understanding roles and responsibilities for health equity action remains a challenge. Within the Canadian public sector, difficulty translating health equity rhetoric into action has been noted despite the critical role public health organizations play in reducing health inequities. This case explores the development of organizational capacity to address the social determinants of health in a public health unit

Case 6 : “I know there is hope, even in a world of loss”: A Local Community-Based Intervention to Address Mental Health Challenges Among First Nations Men and Boys

Kieran, a young man from River Rock First Nation (RRFN), is frustrated that there are no evidence-based, culturally-safe, and male-specific mental health resources available at any of the treatment centres he has attended. Kieran and his friend Jake partner with Jade, a recent PhD graduate, to initiate a boys’ and men’s mental health program in the community. Using the information Jade gathered for her PhD as a foundation, as well as drawing on applied research at the Centre for Addiction and Mental Health (CAMH), the team uses a participatory action research approach, including photovoice, to address mental health challenges of boys and men in RRFN. The goal of this case is to provide a platform for the reader to think critically about how mental health concerns can be addressed in Indigenous communities and have meaningful impact using the resources available to the community. This case will also allow students to explore methods that can be employed to build community capacity to develop evidence-based and culturally appropriate programming within a resource-scarce environment. After reading the case, students will start low on the Bloom\u27s cognitive taxonomy pyramid; through class discussions and instructor guidance the learners will advance to a higher cognitive domain

Case 7 : Going Beyond Bike Racks and Pedestrian Crossovers: Achieving Health Equity in School Travel Planning

The Elgin-St. Thomas, London-Middlesex, and Oxford Active and Safe Routes to School (ASRTS) Steering Committee have established a School Travel Planning Equity Working Group. The goal of this group is to use the Government of Ontario’s Health Equity Impact Assessment tool to evaluate current inequities in school travel planning programming – a community-based approach to addressing barriers to and facilitators of walking and wheeling to and from school – by identifying relevant populations, potential impacts, and mitigation, monitoring, and dissemination strategies (Ministry of Health and Long-Term Care, 2018). The goal of the case is to provide readers with the opportunity to evaluate the inequities in current school travel planning by conducting a Health Equity Impact Assessment

Case 3 : Ciguatera Fish Poison: An Emerging Risk Associated with Climate Change?

This case takes place in the Bahamas and surrounds a complex toxic illness, Ciguatera Fish Poisoning (CFP). It discusses how CFP is contracted and where it is most common, as well as prevention and diagnosis methods. It then goes into the context of the Bahamas, setting the stage in terms of health care, health of the population, government, and various employment industries. Due to its location in the Caribbean, the Bahamas has a large number of tourists each year contributing to the number of CFP cases, as well as affecting the local populations in a variety of ways. This case analyzes an environmental health issue, tourism, and social determinants of health

CASE 2: The Silent Epidemic of Gender Inequality in Rwandan Refugee Camps

Ramat Morrison, a public health nurse at Mbeki clinic situated near Rwanda’s Mahama refugee camp, is worried about the rising incidence of unintended pregnancies and sexually transmitted infections among female refugee youth. A community-based program designed to address these widespread sexual and reproductive health challenges has had a low uptake rate by refugee youth since its inception. Ramat now faces a dilemma of which multisectoral approach to adopt to enhance this uptake rate. She has several options she can implement to precipitate change. The role of partnership and collaboration with other refugee organizations and stakeholders is now paramount in reducing the epidemic of gender inequality in Rwandan refugee camps. The goal of the case is to identify the relevant stakeholders required to address the sexual and reproductive health challenges faced by refugee youth in Rwanda’s Mahama Refugee Camp. Additionally, the case provides students with the opportunity to describe the connection between the overall health of marginalized populations such as refugees and the social determinants of health such as gender, culture, and income. Finally, readers are able to explore how cultural values and practices affect the implementation of public health programs

Assessing trauma in a transcultural context: Challenges in mental health care with immigrants and refugees

The growing numbers of refugees and immigrants from conflict-prone areas settling throughout the world bring several challenges for those working in the mental health care system. Immigrants and refugees of all ages arrive with complex and nuanced mental health histories of war, torture, and strenuous migration journeys. Many of the challenges of addressing the health care needs for this growing population of immigrants and refugees are often unfamiliar, and thus practices to address these challenges are not yet routine for care providers and health care organizations. In particular, complex trauma can make mental health assessments difficult for health care organizations or care providers with limited experience and training in transcultural or trauma-informed care. Using a transcultural approach can improve assessment and screening processes, leading to more effective and high-quality care for immigrant and refugee families experiencing mental health disorders. This paper presents findings from an assessment of current mental health services focusing on current practices and experiences with immigrant and refugee patients and families. The difficulties in developing shared understandings about mental health can hinder the therapeutic process; therefore, it is imperative to ensure an effective assessment right from the beginning, yet there is limited use of existing cultural formulation tools from the DSM-IV or DSM-5. The paper outlines current practices, approaches, challenges, and recommendations shared by mental health care providers and program leaders in addressing the mental health care needs of immigrants and refugees. The results from this study demonstrate that there are many challenges and inconsistencies in providing transcultural, trauma-informed care. Respondents emphasized the need for a thorough yet flexible and adaptive approach that allows for an exploration of differences in cultural interpretations of mental health. Our study concluded that ensuring a mindful, reflexive, transcultural, and trauma-informed health care workforce, and a learning environment to support staff with education, resources, and tools will improve the health care experiences of immigrants and refugees in the mental health care system