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Removing Barriers: Efforts to Promote Inclusion, Diversity & Social Justice in Health

A. Need to Address Barriers
B. The Response - The Work of the Removing Barriers Committee
i) Inclusion
ii) Diversity
iii) Social Justice
iv) The Symposium
C. References

- submitted by Brian Hyndman [] of The Health Communication Unit

Removing Barriers: Efforts to Promote Inclusion, Diversity and Social Justice in Health

A) The Need to Address Barriers in Health Services

Canada's health care system has long been recognized as one of the best in the world. Over the past thirty years, Canadians have enjoyed universal access to quality health care services. The success of the Canadian health care system can, to a large extent, be attributed to the principles enshrined in the Canada Health Act: universality, comprehensiveness, accessibility, portability and public administration.

Canada has also been a world leader in the development and implementation of health promotion programs and policies addressing the broad determinants of health. For example, Canada played a key role in the development of the WHO Healthy Cities project and the expansion of Healthy Cities principles and concepts to smaller communities. Canada also played host to the First International Conference on Health Promotion in 1986. The document resulting from this event, The Ottawa Charter for Health Promotion, has gained worldwide acceptance as a blueprint for the development of health promotion strategies.

In spite of these successes, Canada's health services have not been responsive to the needs of marginalized or underserved groups. One of the most pressing priorities is the need to develop more accessible and appropriate health services for low income Canadians and the homeless, who suffer from the greatest health inequalities. Other groups, such as ethnoracial communities, First Nations groups, people with disabilities, gays and lesbians and people with significant serious illnesses (e.g., HIV/AIDS), also experience health inequities arising from systemic barriers to health care and health promotion programs.

Focusing on the needs of marginalized, underserved groups is especially critical at a time when sweeping health care restructuring is taking place across the country. As Masi (1998) notes, proposed primary health care reforms may significantly alter the ways in which primary care is delivered across Canada. There is a danger that these changes, if not carefully planned, may increase the barriers to access currently experienced by marginalized groups. For example, deinstitutionalization and early discharge policies have often been implemented in the absence of community-based support services. This has resulted in greater health inequities among marginalized groups, such as the homeless and people in need of mental health or addictions services.

Over the past decade, there have been a number of efforts to address barriers to health care and health promotion services. For example, the Canadian Council on Multicultural Health has focused on the ethnoracial and cultural dimensions of health care. Other organizations have also advocated systemic reforms to better meet the needs of marginalized populations. Still other organizations have "walked the walk" by removing internal barriers to participation. The adoption of an antiracism strategy by the Ontario Public Health Association in 1992 is one such example.
These efforts have led to a growing awareness of the need for collective, integrated action to promote equity and access in the Canadian health care system. An integrated, rather than fragmentary, approach is needed to foster effective, long-lasting change (Masi, 1998).

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B) The Response: The Work of the Removing Barriers Committee

In 1997, the Removing Barriers Committee, an ad-hoc group of individuals with a variety of backgrounds and expertise across Canada, launched a national initiative to address access and equity issues in the Canadian health care system. This group focused on the three key determinants of health services that meets the needs of marginalized groups:

Inclusion - An endeavour to ensure that all voices are heard, and no one is excluded in health and health reforms.

Diversity - An acknowledgment that Canadians come from diverse backgrounds, lifestyles and characteristics.

Social Justice - An effort to reduce inequalities, and address issues of the more vulnerable or marginalized.

The Removing Barriers Committee identified the need to bring together community groups, health professionals and organizations from a range of settings in a forum focused on diversity, inclusion and social justice in health services. The forum was planned as a venue for the development of recommendations addressing the needs of Canadians experiencing the greatest health inequities.

A pre-symposium workshop, Health, Healing and Social Justice: Beginning the Dialogue, was the first component of the initiative undertaken by the Removing Barriers Committee. The workshop, which was held in Toronto in May 1998, assisted in the identification of issues, objectives and recommendations for the Removing Barriers Symposium.

The second component was the Removing Barriers Symposium held in Toronto on June 18-20, 1998. The Symposium involved over 240 people from across Canada, including representatives from health service organizations, agencies, institutions and community groups.

The symposium featured twenty five workshops addressing aspects of diversity, inclusion and social justice in health services. Topics addressed in the workshops included Native Health, Pregnancy and Drug Use, Anti-racism/Discrimination in Health Care, HIV Issues, Inner-City Health and Organizational Change.

Participants in each workshop were asked to develop recommendations specific to their objectives and needs. By the end of the Symposium, a comprehensive list of 79 recommendations outlining the steps needed to promote diversity, inclusion and social justice in health services had been developed.

Proceedings of the Removing Barriers Symposium have been published **. This document, which includes the keynote addresses, workshop abstracts and recommendations, is a valuable resource for those interested in the planning and implementation of equitable, accessible and appropriate health programs for marginalized groups. Other complementary resources are described in the ensuing sections of the Bulletin.

Health promoters have long embraced the concepts of diversity, inclusion and social justice. In an atmosphere of increasing fiscal restraint and large-scale restructuring, we are challenged to ensure that these principles are not abandoned . Failure to do so will result in greater health inequalities and the perpetuation of inadequate health services for those who have been hardest hit by budget cutbacks and current health care reforms. Inclusion, diversity and social justice should be viewed as integral principles for the development of a health care system that better serves the needs of all Canadians.

C. References:

Masi, R. (1998, Ed.) Removing Barriers: Inclusion, Diversity and Social Justice in Health
Downsview, ON: Removing Barriers Committee.

Proceedings of the Removing Barriers Symposium
** A limited number of copies are available. Cost: $12.50 plus $2.50 Handling and Mailing. Cheques should be made payable to Removing Barriers, #406-1017 Wilson Ave, Downsview, ON. M3K-1Z1.