Josephine Etowa, RN, PhD; Wanda T. Bernard, RSW, PhD; Brenda Beagan, PhD; Faculty of Health

Professions, Dalhousie University, Halifax, NS, Canada

Presented at:Canadian Public Health Association 2008 Annual Conference Halifax, NS, Canada: Held on June 1- 4, 2008

Inequities in Health and Health Care for Black Women

Purpose To investigate the experiences of health and well-being

among midlife African Canadian women in Nova Scotia, with particular attention to how they are affected by menopause and the ideological construct, “the Strong Black woman.”

To examine how time, resources and sense of entitlement affect their participation in activities that promote health and well-being

To develop community supported, culturally appropriate health education materials

To foster collaborative research partnership between community, policy maker and academics in the field of Black people’s health research

Research Methods Triangulation of qualitative and quantitative

methods was used to create a comprehensive picture of menopause and mid-life health of women of African descent in Nova Scotia.

Qualitative approaches included interviews, workshops and focus groups

Quantitative methods included five standardized assessment instruments

Research involved eight Black communities in Halifax Metro of Nova Scotia

Results Access to Health Care Information

◦ Most of the women expressed the need for greater sharing of information about midlife health

◦ Conflicting information was often provided by health care professionals

◦ Doctors were more helpful regarding “physical aspects” of menopause than the emotional aspects.

◦ Interview process was very educative (questionnaire)

Lack of research

Lack of policy to ensure knowledge production

Cultural Competence

Lack of cultural competence evident in:

Nature of interaction with health care providers

PoliciesProfessional knowledge

Manifestations of RacismExperiences of Racism Individual

◦ Racism is constantly, constantly with me. It’s part of who I am. It’s my skin. It’s my children. I've lived it all my life. And I can’t escape it. From the time I go out, get up in the morning to go outside the door, once you step outside the door – it’s on. And it could be out there in any shape, form, whatever.

Internalized◦ Racism is a destructive force as it affects Black

women personally and through the many subtle ways it manifests itself when individuals internalize it.

Systemic Racism

Access to Goods and services ◦ Differential access to resources including employment

opportunities.◦ It is both action and Inaction in the face of need

Under representation of Black health professionals◦ “There were no Black nurses…no doctors…I think everybody was White”

Policy to guide effective care across racial boundaries◦ It is perpetrated through entrenched policies which

leaves certain groups of people socially, economically and politically disadvantaged.

Impact of Racism Internalization of Negative Stereotypes

◦ Avoidance◦ Denial◦ Being critical of self and others

Health Impact◦ Race-related stress◦ Burnout◦ Depression

I was on anti-depressants because of experiencing post-traumatic stress disorder through an incident of racism which lingered for years”.

Coping with Racism Individual coping mechanisms Spirituality

◦ What helped me was turning to the Lord and being spiritually uplifted and realizing that my life was important.

Health promotion activities (exercises) Learning about and recognizing ones own background

◦ Picking one’s battle & Stepping back Social Support Networks Church Friends Family

Coping with racism… Social Support Networks:

◦ I’m around ladies who talk openly about it all the time, and we are always sharing information…The atmosphere is a lot more accepting because we know what each other is dealing with. When one is not feeling good, we know what’s up with them and vice versa…”

Lifestyle Changes ◦ Exercise“How good we’ve been about taking care of our bodies

as we’ve been growing.. tried to be conscious about our diet and exercise...my body has a good foundation …to help fight it off.”

Discussion Racism is concern of 96% of study

participants Over the years, the accumulation of racism

related stress resulting from pent-up anger, frustration, humiliation and fear undermines Black women’s health.◦ Everyday as a Black person, your race comes to

the forefront. There’s no inclusion, there’s no representation, and there’s no input

83% of study participants actively participate in efforts to eliminate racism.

Implication Health care professionals such as nurses and

physicians need to be aware of their own values especially when these are at odds with recipients of health care.

Black women place great significance in God or their belief in some form of spirituality as a way of dealing with racism and other life stressors.◦ What helped me was turning to the Lord and being

spiritually uplifted….

There is a need to be innovative in the incorporation of multicultural and racial discourses as part of core curriculum, and the focus of research and policy

..

Conclusion Racism exist in health care and is a determinant of

health

Although marginalized groups maybe sicker and may have greater health care needs, they have less access to culturally competent health services

Improving health care services for this populations requires actions beyond the role of individual health care professionals

It requires addressing larger systemic health issues through policy changes