2022-06-23 EZ Equity in Action Newsletter

June/July 2022 / Juin/Juillet 2022 Nova Scotia Health / Santé Nouvelle-Écosse Eastern Zone Diversity & Inclusion “EQUITY IN ACTION” “Equité en Action” NEWSLETTER Bulletin A Message from our Chairperson Welcome to our June/July newsletter! Each newsletter is a culmination of many hours discussing material, writing, and editing! Thank you to Sansriti Saxena and Michelle Helliwell for contributing and thank you to Garry Dart for the information on the pronoun campaign. Thank you to the newsletter team of the Eastern Zone Diversity and Inclusion committee - Aron Ashton, Celeste Gotell, Cyril MacDonald, Danielle Murphy, and Soroush Moghaddam! There are no designated positions in the Eastern Zone to support our work, so each member participates because they are passionate about the work of Diversity, Equity, Inclusion, Reconciliation, and Accessibility! Thank you to all committee members who continue to help with advocacy work on top of their regular positions. Special thanks also to Krista Smith who has taken on the co-chair role on our committee. Krista is the Director of Integrated Health in the Eastern Zone. Please see the complete list of members at the end of this newsletter! I believe there will be many changes ahead for this important work as our original framework below has come to an end. Stay tuned for updates from both our committee and others in the organization. Please take the time this summer to read the material contained in this newsletter. There is so much to learn to create safe and welcoming spaces for the communities we serve. On behalf of the Eastern Zone committee I ask each of you to continue to learn more and never stop asking “How can we make everyone feel welcomed and safe in our organization?” I hope you have a wonderful summer. Karen MacKinnon The Diversity & Inclusion Framework 1. Culturally competent person and family-centered care and services 2. Diverse Workforce 3. Engagement and partnership with diverse communities 4. Organizational leadership, decision-making and policy 5. Equity through data collection and research

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 2 In This Issue  A Message from Our Chairperson ……. 1  Policies Simplified ……………………... 6  From Here to There …………………. 2  Pronouns Campaign - prideHealth …….. 7  Education Opportunities …………….. 3  Dates to Remember …………………… 9  Notable Mentions …………………… 4  Best Practices ………………………… 5 From Here to There By: Sansriti Saxena* Peddhapati / Wikimedia Commons / CC-BY-SA-2.0 / I immigrated to Canada from India seeking new job opportunities in 2008. I arrived in BC then moved to Ontario, PEI, and Newfoundland before finally moving to Nova Scotia in 2013. I found the environment and community of Antigonish incredibly welcoming. As a result, my family and I ended up building a house in town. Travelling across the globe for many years, I always wondered about finding a place that would be tranquil for my growing family; finally found it in Antigonish. Furthermore, I come from a culture (South Asian) that is very different. For example, in India, Diwali is celebrated; it is known as the Festival of Lights. A couple of popular foods eaten are butter chicken and chicken tikka masala. I have always made sure I carried and passed on the taste and ethnicity of my culture to my kids. I still travel and show them the core places in my home country, help them learn the language while they are young, and taste the food of where they originated from. I feel fortunate to have found a place that has plenty of beautiful scenery and where everyone greets each other when walking by. I also feel grateful for the opportunity to work as a nurse (when I grew up, I always wanted to help people who are sick and vulnerable) and join the Diversity Committee to help further efforts to generate diversity and Sarah Stierch / Wikimedia Commons / CC-BY-4.0 / inclusiveness in our workplace. * Sansriti is a member of the Eastern Zone Diversity and Inclusion Committee and an LPN at St. Martha’s Regional Hospital.

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 3 Education Opportunities Listen to the recorded webinar Series 3 in the Black History Series 4 in the Decolonization “Whiteness and Health Equity” Learning Journey is now live on Learning Journey has begun and is hosted by the National the Impact Organizations of NS also on the IONS website. You can Collaborating Centre for the website (IONS). Sessions are still sign up for the remaining Determinants of Health in March recorded so you can view them at sessions or watch them at a later 2021. your own pace. Series 3 focuses on, date as they are recorded. Series 4 is Webinar: Let’s Talk: Whiteness and “Perspectives from the Front Line.” entitled, “Now What-Incorporating health equity | National Black History Learning Journey - Reconciliation Learning into Our Collaborating Centre for IONS - Impact Organizations of work and everyday lives.” Determinants of Health (nccdh.ca) Nova Scotia Decolonization Learning Journey - IONS - Impact Organizations of Nova Scotia JUNE IS NATIONAL INDIGENOUS HISTORY MONTH  Did you know June 21st, the summer solstice is National Indigenous Peoples Day? Use the interactive map on this site to find activities happening in our province and across the country. https://www.canada.ca/en/canadian-heritage/campaigns/celebrate-canada/indigenous-peoples-day.html  Did you know that on April 7th legislation was introduced to recognize Mi’kmaw as Nova Scotia’s first language? The legislation will take effect on October 1st, Treaty Day. https://novascotia.ca/news/release/?id=20220407003  Did you know there are 13 First Nation Communities in Nova Scotia? https://novascotia.ca/abor/aboriginal-people/community-info/

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 4 Notable Mentions In this edition we would like to acknowledge Diversity, Equity and Inclusion initiatives within Nova Scotia Health. A huge thank you to the Health Promoters with Mental Health and Addictions, the Community Health Board team and Volunteer Services staff for taking on this important work! Read more about their work below. We challenge other departments to actively work to bring more diversity, equity and inclusion to their work. If there is something you are doing in your work area please let us know by contacting our committee chair for future inclusion in our newsletter. Project One: Health Promoters with Mental Health and Addictions and Community Health Board Team The Health Promoters with Mental Health and Addictions and the Community Health Board team in Eastern Zone have teamed up to help increase the public’s awareness and understanding of the connection between poverty, poor health outcomes and its impact on communities in the Eastern Zone. Over the last few months we have been meeting regularly to come up with creative ways to get the word out to show the connections to poverty, to explore the mental health impact attached to experiencing poverty and the resulting poor health outcome, and to build an understanding and facilitate a greater awareness of our work. To date, we have produced two infographics and two postcards that have been shared to many partners and on social media. The links are below: https://online.pubhtml5.com/qkgt/ohuz/ https://online.pubhtml5.com/qkgt/qqup/ https://online.pubhtml5.com/qkgt/wquw/ https://online.pubhtml5.com/qkgt/vfza/ Project Two: Volunteer Services Volunteer Services has developed a new team within the provincial Volunteer Services team to focus solely on EDIRA (Equity, Diversity, Inclusion, Reconciliation, and Accessibility). This team will focus on how we recruit, support, and encourage volunteers from marginalized communities. We hope to create a more welcoming and supportive environment for all of our volunteers and believe there needs to be a strong foundation for equity and justice in our team and services. Our team will formulate more ways to show our volunteers that we support and strive for a more inclusive and welcoming place for them to volunteer. In addition, we will create training opportunities tailored for our volunteers who would like to be better versed on EDIRA.

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 5 Best Practices As part of our committee’s best practices work Institutionalized racism: When differential access to the currently focused on racism in healthcare, we are goods, services, and opportunities in the system is provided sharing our reflection on a comprehensive review based on race. Systemic racism is normative, often codified in article by Nadha Hassen et al.i, which outlines the our institutions of custom, practice, and law, and rarely various types of racism in healthcare settings and questioned or addressed. It manifests as inherited different levels of intervention according to the disadvantage. This type of racism is evident as inaction in the literature. If you are interested in obtaining the face of need. Examples include, but not limited to, lack of complete article, please contact Library Services. access to treatment for a specific condition for a specific Systemic Racism in Healthcare group, location of health services in predominantly white communities, and racialized communities being In 2022, one might assume that racism no longer exists. underrepresented in management and senior leadership roles Some of the horrific examples of the past, such as Black and in the healthcare system. Indigenous people and children being subjected to medical Personally mediated racism: When there is prejudice experiments, Indigenous women being sterilized, and and discrimination among people, and where assumptions are deportation of immigrants with disabilities may no longer made about people’s abilities, motives, and actions based on take place. However, racism continues to affect the delivery their race. This type of racism can be intentional as well as and utilization of our processes through the lasting impact of unintentional. It manifests as lack of respect, suspicion, colonialism and slavery. Contemporary false beliefs about devaluation, scapegoating, and dehumanization. Examples biological differences have resulted in racial bias in pain include, but not limited to, negative views and assumptions assessment and treatment recommendations between White about people with substance use disorder, and different and Black patients ii, white patients are prescribed access to pain management or screening based on race. significantly more analgesics compared to Black patients (74% versus 57%) in the emergency department for bone Internalized racism: When negative attitudes, beliefs, and fractures iii, and black Canadian women are under-screened actions taken on by people of a racialized group about their for cervical and breast cancer. iv Following their research, own abilities and intrinsic worth. This type of racism involves Nadha Hassen and her team state clearly that, today, within accepting limitations to one's own full humanity, including healthcare institutions racism is pervasive and present one's spectrum of dreams, right to self-determination, and everywhere, and healthcare “Organizations should avoid range of allowable self-expression. It manifests as an further entrenching harmful dynamics and putting resources embracing of white norms, self-devaluation, resignation, into trying to assess whether racism exists within their helplessness, and hopelessness. Examples include, but not organizations.”v It does. limited to, people of a certain race or group not seeking help The National Collaborating Centre for Determinants of because of their past experience in the health system and Health defines systemic racism as “policies and practices within feeling there is not anyone that can help them. institutions such as regulations and standard ways of operating that lead Since racism is systemic and exists on multiple levels, how do to racially biased outcomes and experiences”. vi If one looks even we address it? It needs to be addressed and targeted from deeper, we also come to understand that racism is multiple levels. United Nations Children’s Fund’s (UNICEF) multi-layered and occurs on a variety of levels. Camara Social Ecological Model (SEM) identified five levels from Phyllis Jones defines three levels of racism vii: where racism must be targeted, and anti-racist interventions must occur: Continued on page 8

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 6 Policies Simplified Using Gender Neutral Terminology in Policy Writing By: Michelle Helliwell, Manager, Policy Office, Nova Scotia Health Language is always evolving. The “Queen’s English” is a myth. Turns out, that’s not overly complicated either! Sex is biology, and Words are introduced into the lexicon all the time, while others fade gender is socially defined (and always evolving…just like language). away because they don’t suit our current context, they simply fall We have terms for anatomy to help clarify what we’re talking about out of fashion, or we have agreed that they are harmful. This is a in a policy that is clear. When we are speaking about procedures good thing. Most fluent English speakers would not recognize the that focus on parts of the body, or risks that may be associated with language spoken by the first Queen Elizabeth of England, living at reproductive organs or pregnancy, we can focus on the patient and the end of the sixteenth century. English looked different and the patient factors that come into play, rather than a gender role would sound very different to your modern ear. The wonderful For example: diversity of local accents and dialects amongst those who speak the same language in our beautiful little province is evidence of how Instead of: If the Breastfeeding mother is not able to language develops within local communities. The English spoken in provide consent, consent must be obtained from Baddeck is different than the English spoken in Lunenburg County. the father or identified substitute decision maker Similarly, every Acadian community has phrases unique to the for the child. (Assumes cis-gendered parents, heterosexual people from that area. parents, two parent household). At the Policy Office, we care a lot about words and about writing. Try: If the Breastfeeding parent is not able to provide We spend a lot of time labouring over phrases, wording, and even consent, consent must be obtained from another comma placement to ensure that what’s on the page conveys the parent or identified substitute decision maker for intent of the policy. Our goals for Nova Scotia Health policies are the child. clarity, accessibility, and importantly, that they do not cause harm. Misused words can cause harm. For many of us who have been that may or may not be appropriate for that patient. culturally centered—white, cis-gendered, able-bodied people— When writing policy, a Policy Lead will edit your document to harm can be caused by the words we use because what is ensure that the language used meets this standard. Once you get considered “normal” and “universal” actually isn’t. Over the past used to writing in this style, you’ll find it’s not that difficult. five years, the Policy Office has been working to break away from What is the Policy Office? The Policy Office is a small department these norms to embrace language that embraces all of us. with a big responsibility—to ensure that policies are robustly For example, did you know that all policies written at Nova Scotia developed, written to a standard, and approved by the appropriate Health are written with gender neutral terminology? The use of the authority. We touch every policy written in Nova Scotia Health and pronoun “They” has been standard at Nova Scotia Health since edit those policies using a particular style and voice to ensure they 2015. It’s a simpler term than “s/he” or “he/she” which is still are consistent in tone and word choices so there isn’t confusion exclusive and clunky in a sentence. Using singular pronoun “they” from one document to the next. is grammatically correct and has been adopted by style guides such as APA (American Psychological Association). Did you know that the Policy Office has a Pronouns may be easy, but what about pregnant women or women style guide to inform how policies are written undergoing HRT? Or men having a testicular exam? To be and edited? You can find it, and lots more completely transparent, this is something that has taken us a little about policy at our Library Subject Guide longer to negotiate and in earlier policies, you will see we didn’t (https://library.nshealth.ca/policy/ always get this right. But, as the saying goes “When you know writing_developing#s-lg-box-15999581) better, you do better” (Maya Angelou) and re-editing those policies to address that potentially harmful language is something we are If you have questions about Policy, please tackling one policy at a time. reach out to the Policy Office at [email protected].

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 7 Pronouns Campaign - prideHealth prideHealth, with support from a QEII Foundation Comfort and Care Grant, has recently launched a pronouns campaign to reinforce the importance of health care workers throughout Nova Scotia Health using pronouns. The campaign includes a pronouns poster and a helpful tip sheet for using pro- nouns and gender-inclusive language. Please print and post these important resources in your work. area.  Did you know that Pride Month has a rich history in Canada and around the world? Read more about how the Pride Movement came about. https://www.queerevents.ca/canada/pride/history  Did you know that the LGBTQ2S+ community is less likely to seek treatment for an eating disorder, mental health disorder or a substance use disorder due to fear of rejection and discrimination? https://discoverymood.com/blog/lgbtq-pride-month/ Newsletter Committee Aron Ashton Celeste Gotell Cyril MacDonald Danielle Murphy Karen MacKinnon Lisa McNeil-Campbell Soroush Moghaddam Diversity & Inclusion Committee Members Aron Ashton Celeste Gotell Christine Villneff Cyril MacDonald Danielle Murphy Debbie Glabay Karen MacKinnon Karla Chisholm Krista Lauff Krista Smith Linda Parris Lisa McNeil-Campbell Sansriti Saxena Soroush Moghaddam

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 8 1. Individual level These levels of intervention clearly give us a basis for taking 2. Interpersonal level action. How can you contribute? Please reflect on the 3. Community level following questions and think about the role you can play in 4. Organizational level taking transformative actions. 5. Policy level 1) What practices can I personally change to Nadha Hassen et al. have concisely summarized each combat racism? intervention as follow: 2) What connections can I make in the community Individual-level interventions transform individuals’ to inform my work? behaviour and attitudes through knowledge. These forms of interventions include self-reflection tools, unconscious bias 3) Can I identify policies that need to change, and training, and Implicit Association Tests that seek to make how do I advocate for their implementation? individuals aware of stereotypes about different racial groups that are unconsciously formed. We hope this article has provided you with new knowledge and has inspired you to think of ways to combat racism in Interpersonal-level interventions cultivate interactions our healthcare system. If you have any feedback please reach between providers, patients, and the provider–patient out to Karen MacKinnon, Committee Chair. relationship that seek to address racial health disparities, mitigate harmful practices for racialized populations, or REFERENCES address racist comments by clients. i Hassen, N., Lofters, A., Michael, S., Mall, A., Pinto, A. D., & Rackal, J. Community-level interventions focus on developing (2021). Implementing anti-racism interventions in healthcare settings: a meaningful relationships between the healthcare organization scoping review. International journal of environmental research and public health, 18 and populations that the healthcare setting serves or the (6), 2993. geographic community that the organization is situated within. Community-level interventions establish ongoing, ii Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial meaningful partnerships with racialized communities, bias in pain assessment and treatment recommendations, and false beliefs including Black, Indigenous, and other racialized groups to about biological differences between blacks and whites. Proceedings of the begin to address racism in healthcare. National Academy of Sciences, 113(16), 4296-4301. Organizational-level interventions focus on structures iii Todd, K. H., Deaton, C., D’Adamo, A. P., & Goe, L. (2000). Ethnicity and processes within an organization, including creating a and analgesic practice. Annals of emergency medicine, 35(1), 11-16. consultation group, amending human resources policies, hosting workshops and conferences to effect organizational iv Nnorom, O., Findlay, N., Lee-Foon, N. K., Jain, A. A., Ziegler, C. P., change. Scott, F. E., Rodney, P. & Lofters, A. K. (2019). Dying to learn: A scoping review of breast and cervical cancer studies focusing on Black Canadian Policy-level interventions focus on policies, regulations, women. Journal of Health Care for the Poor and Underserved, 30(4), 1331-1359. processes which include frameworks, policies, guidelines, and recommendations at a system level. These interventions are v Hassen, N., Lofters, A., Michael, S., Mall, A., Pinto, A. D., & Rackal, J. intended to provide broad-level mandates or guidance for (2021). Implementing anti-racism interventions in healthcare settings: a uptake by stakeholders. scoping review. International journal of environmental research and public health, 18 (6), 2993. vi National Collaborating Centre for Determinants of Health (NCCDH). Let’s Talk: Racism and Health Equity. 2018. Available online: https:// nccdh.ca/images/uploads/comments/Lets-Talk-Racism-and-Health- Equity-EN.pdf (accessed on 03 June 2022). vii Jones, C. P. (2000). Levels of racism: a theoretic framework and a gar- dener's tale. American journal of public health, 90(8), 1212.

Volume 5 Equity in Action Newsletter / Equité en Action Bulletin Page 9 Dates to Remember—July 2022* Date Holiday/Observance Link to Further Information 1 Canada Day 8 Day of Arafah (Muslim) https://www.canada.ca/en/canadian- 9 Martyrdom of Bab (Baha’i) heritage/campaigns/canada-day.html 9 Nunavut Day https://thepilgrim.co/day-of-arafah/ 9-13 Eid al-Adha (Muslim) https://bahaiteachings.org/remembering-the-martyrdom- 13 Asalha Puja / Dhamma Day (Buddhist) of-the-bab/ 13 Guru Purnima (Hindu & Jain) https://nationaltoday.com/nunavut-day/ 14—24 Halifax Pride Festival 15 World Youth Skills Day https://islamonline.net/en/eid-al-adha-hajj/ 18 Nelson Mandela Day 24 Pioneer Day (Mormon) https://blogs.bl.uk/asian-and-african/2019/07/asalha- 30 1st day of Muharram (Muslim) puja-or-dhamma-day-the-start-of-the-buddhist-lent.html 30 World Day Against Trafficking in Persons https://pujayagna.com/blogs/hindu-festivals/guru- 30 International Day of Friendship purnima https://www.halifaxpride.com/ https://unevoc.unesco.org/wysd/World+Youth+Skills+Day https://www.mandeladay.com/ https://www.loc.gov/item/today-in-history/july-24/ https://www.islamic-relief.org.uk/islamic- calendar/muharram/the-islamic-year/ https://www.unodc.org/unodc/en/endht/index.html https://www.un.org/en/observances/friendship-day * Prepared and produced by the Eastern Zone Diversity & Inclusion Committee * The EZ Diversity and Inclusion Committee make every effort to recognize all dates of significance in our monthly calendars and acknowledges that we may also miss some. Please reach to our committee chair to include something in future editions.