February 20 is the UN’s World day of Social Justice. Social justice is a philosophy that everyone deserves equal rights and opportunities. Along with equity, social justice is a fundamental prerequisite for health, and a key component of health promotion. We can’t achieve good public health outcomes without taking action to ensure all members of our community have access to an equitable lived experience. This means that public health must have a social justice lens.
Health disparities are created by inequities. The social determinants of health (SDOH), such as racism, Indigeneity, income, gender discrimination, and other factors, create conditions and inequitable circumstances which disproportionately impact Black, Indigenous, and People of Colour (BIPOC) populations, the 2SLGBTQ+ community, people living in poverty, people who use drugs, and many more.
Since the pandemic, we have seen firsthand how these injustices have adversely impacted the health of equity deserving groups here in BC and across Canada. Here are some examples:
Race
Racism is an idea created by humans that creates a hierarchy of value based on Whiteness. Anti-Black racism has been brought to the forefront by the persistent murders of Black men and women, and the history of Black lives being undervalued is extensive. This history, along with policies, institutions, legal norms, among other factors, creates deeply rooted structural racism. Indigenous peoples in Canada disproportionately experience poverty, homelessness, lack of access to rights, and have poorer health outcomes. We still have the Indian Act — a federal law created in 1876 and largely unchanged that perpetuates paternalism, colonialism, and racism — another example of structural racism.
“Indigenous and racialized peoples generally experience higher rates of poverty, precarious and under employment, discrimination and systemic disadvantages within housing, education, and public health systems. Directly and indirectly, racism harms health and causes premature death.”
National Collaborating Centre for Determinants of Health, “Let’s Talk Racism and Health Equity”
In Canada, the findings of the unmarked graves of children across the country over the last few years have begun to shine much-needed light on our dark history of residential schools — settings of abuse and intentional assimilation, where thousands died from malnourishment or disease. We may never know the true numbers or immense scope of this tragedy.
This historical and ongoing colonization, control, and oppression of Indigenous Peoples has created a pervasive lack of trust in government and related institutions, including public health. It has created ongoing health and socioeconomic disparities, poorer health outcomes, and extensive inequities.
With COVID-19, these inequities have only been further exacerbated. The pandemic more adversely affected people with lower incomes, and across North America, COVID-19 has disproportionately affected more racially diverse neighbourhoods.
By not collecting racial data for COVID-19 patients, Canada has largely ignored the relationship between race and health, and how structural and systemic discrimination impacts access to care, making it difficult to respond and to assess health status across populations. In countries where data is collected, evidence shows that Black, Asian, and Minority Ethnic (BAME) groups were more likely to die from COVID-19 than the general population. Across the healthcare system, there is an unequal pattern of care based on race. In order to support health equity and a socially just healthcare system, we have to collect and examine this data.
Whether it’s at a systemic level, discrimination associated with race and epidemics, or through interpersonal attacks and direct violence, racism is impacting the health of our communities.
The Overdose Crisis
The intersection between the toxic drug poisoning crisis and COVID-19 has led to a significant increase in overdose deaths. Since it was first declared an emergency, over 16,000 people have died from toxic drugs in BC. Why? In part, due to stigma that leads people to use drugs alone. Underlying this is social injustice. Harmful laws and bad drug policies target people who use drugs and keep them in a cycle of criminalization, poverty, and discrimination. Especially now, when the overdose crisis is in its’ 8th year as a public health emergency, we need to advocate for equity and social justice.
2SLGBTQ+ Rights
June is Pride Month because in June 1969, a three-day uprising (the Stonewall Riots) in New York City launched the gay rights movement. Yet 2SLGBTQ+ people still experience discrimination and poorer health outcomes. Conversion therapy, or sexual orientation and gender identity and expression change efforts (SOGIECE), is still happening. We’re slowly moving the dial forward (the Canadian government has amended the criminal code to prohibit causing another person to undergo conversion ‘therapy’, regardless of age or consent) but the negative health consequences for people who have experienced this remain largely unaddressed. The views that heteronormativity and binary gender are the norm, remain harmfully pervasive in our world.
When we speak we are afraid our words will not be heard or welcomed. But when we are silent, we are still afraid. So it is better to speak.
Audre Lorde
These are just a few examples of how social justice and public health must be aligned to protect our communities. There are multiple forces that intersect and shape inequities; the SDOH do not occur in a vacuum. We must consider the complexities of interacting conditions in order to change systems, structures, and policies, and create a truly just world.
What we see in the world around us right now does not reflect a socially just view. We need to change the reflection. We are trying to make that change by creating a campaign to address the inequities that were only heightened during the pandemic for people already made vulnerable by systemic barriers to and determinants of health, such as poverty, criminalization, and colonialism. You can support this important work by donating to Your Health, Our Commitment.