Addressing anti-Black racism within public health in North America: a scoping review.

OBJECTIVES: The syndemic that is COVID-19 and the disproportionate policing of Black communities have recently generated mass social consciousness of the anti-Black racism (ABR) pervading health, social, and cultural institutions. However, little is known about the implementation of public health measures addressing ABR in an evolving pandemic context. The objective of this scoping review is to provide an overview of public health initiatives undertaken to address ABR across North American jurisdictions between December 2019 and June 2022. METHODS: A search for public health initiatives was conducted in June 2021 across MEDLINE, Ovid Embase, EBSChost, CINAHL, SocINDEX, and Google.ca. Included initiatives were those focussing on Black, African diasporic, or African American communities in the North American context. Community-led action, as well as initiatives in primary healthcare care, academic journals, and those broadly focused on racialized communities, were excluded from this review. SYNTHESIS: Seventy-five articles were included in this review, suggesting that ABR emerged as a public health priority. Strategies and action plans to address structural ABR were the most common types of initiatives observed (n = 21), followed by programs or interventions (n = 16), budget allocations or investments (n = 8), task forces (n = 7), guidance and recommendations for organizational capacity (n = 8), action-oriented declarations of ABR as a public health crisis (n = 8), and legislation and mandates (n = 7). Initiatives were largely cross-cutting of two or more socioeconomic themes (n = 23), while organizational change was also common (n = 16). Gaps in the current literature include a lack of community participation and outcome measurement for actions identified, which limit institutional accountability to communities of interest. CONCLUSION: This research provides insights on public health accountability to social justice. This research outlines activities in upstream interventions, organizational transformation, and resource allocation in shaping anti-racist change, and require evaluation and input from those whom initiatives are intended to serve.

Provincial implementation supports for socio-demographic data collection during COVID-19 in Ontario's public health system.

SETTING: The Ontario government implemented a regulatory change to mandate the collection of socio-demographic (SD) data for individuals who tested positive for COVID-19. This change was informed by evidence of COVID-19's disproportionate impact on marginalized communities and calls for broader collection of SD data. Given the scarcity of similar efforts, there is a significant knowledge gap around implementing standardized SD data collection in public health settings. INTERVENTION: Public Health Ontario provided collaborative support for the implementation of SD data collection, grounded in health equity principles, evidence, and best practices. We supported the addition of SD fields in Ontario's COVID-19 data collection systems, issued data entry guidance, hosted webinars for training and learning exchange, and published a resource to support the data collection process. The current focus is on building sustainability and quality improvement through continued engagement of public health units. OUTCOMES: By November 28, 2020, almost 80% of COVID-19 cases had information recorded for at least one SD question (individual questions, range 46.8-67.0%). We hosted three webinars for the field, and the data collection resource was viewed almost 650 times. Practitioners continue to express needs for support on applying equity principles to data analysis and interpretation, and community engagement on data collection and use. IMPLICATIONS: Sharing knowledge on responsive implementation supports in collaboration with the field and using current evidence and guidance will strengthen public health practice for SD data collection. Laying this groundwork will also improve the likelihood of success and sustainability of these equity-focused efforts.

RéSUMé: LIEU: Le gouvernement de l'Ontario a appliqué une modification réglementaire exigeant la collecte de données sociodémographiques (SD) sur les personnes testées positives pour la COVID-19. Cette modification découle des preuves de l'impact disproportionné de la COVID-19 dans les populations marginalisées et appelle à une collecte élargie des données SD. Comme les démarches similaires sont rares, il y a de grandes lacunes au sujet de la mise en œuvre de la collecte de données SD standardisées dans les milieux de la santé publique. INTERVENTION: Santé publique Ontario a collaboré à la mise en œuvre d'une collecte de données SD ancrée dans les principes, les données probantes et les pratiques exemplaires de l'équité en santé. Nous avons appuyé l'ajout de champs SD dans les systèmes ontariens de collecte de données sur la COVID-19, fourni des orientations sur la saisie des données, organisé des webinaires de formation et d'échange de connaissances et publié un document à l'appui du processus de collecte de données. La priorité est actuellement accordée au renforcement de la durabilité et à l'amélioration de la qualité grâce à la participation continue des bureaux de santé publique. RéSULTATS: Au 28 novembre 2020, pour près de 80 % des cas de COVID-19, il existait des informations sur au moins une question SD (questions individuelles, intervalle de 46,8 à 67,0 %). Nous avions organisé trois webinaires pour le personnel de terrain, et notre document sur la collecte de données avait été consulté près de 650 fois. Les praticiens continuent à nous demander de l'aide pour appliquer les principes d'équité à l'analyse et à l'interprétation des données et pour faire participer les communautés à la collecte et à l'utilisation des données. CONSéQUENCES: Le partage des connaissances sur les supports de mise en œuvre adaptés, en collaboration avec le terrain et en faisant appel aux connaissances et aux orientations actuelles, renforcera la collecte de données SD dans la pratique en santé publique. En posant ces bases, nous améliorons aussi les chances de réussite et la durabilité de ces démarches axées sur l'équité.

Unmet Health Care Needs for Syrian Refugees in Canada: A Follow-up Study.

Unmet health care needs are under explored among refugees. Previously we found unmet health care needs in Syrian refugees may be higher than in the general Canadian population (Oda et al. CMAJ Open 5(2):E354-E358, 2017; Oda et al. J Immigr Minor Health, 2018. https://doi.org/10.1007/s10903-018-0780-z). This follow-up study with Syrian refugees who entered Canada between July 2015 and July 2016 aimed to understand if there are changes in unmet health care needs 6 months to a year after baseline collection. The number reporting unmet needs was high (42.6%). Although some refugees had their needs met, unmet health needs persist, and it seems that they are linked with sponsorship pathway and post-migration socio-economic position. While caution should be used generalizing these results, they do suggest that greater coordination between services may be needed as many of the refugees report unmet needs within months of arriving and continue to report needs after being here for a period up to 2 years.

A patient and family data domain collection framework for identifying disparities in pediatrics: results from the pediatric health equity collaborative.

BACKGROUND: By 2020, the child population is projected to have more racial and ethnic minorities make up the majority of the populations and health care organizations will need to have a system in place that collects accurate and reliable demographic data in order to monitor disparities. The goals of this group were to establish sample practices, approaches and lessons learned with regard to race, ethnicity, language, and other demographic data collection in pediatric care setting. METHODS: A panel of 16 research and clinical professional experts working in 10 pediatric care delivery systems in the US and Canada convened twice in person for 3-day consensus development meetings and met multiple times via conference calls over a two year period. Current evidence on adult demographic data collection was systematically reviewed and unique aspects of data collection in the pediatric setting were outlined. Human centered design methods were utilized to facilitate theme development, facilitate constructive and innovative discussion, and generate consensus. RESULTS: Group consensus determined six final data collection domains: 1) caregivers, 2) race and ethnicity, 3) language, 4) sexual orientation and gender identity, 5) disability, and 6) social determinants of health. For each domain, the group defined the domain, established a rational for collection, identified the unique challenges for data collection in a pediatric setting, and developed sample practices which are based on the experience of the members as a starting point to allow for customization unique to each health care organization. Several unique challenges in the pediatric setting across all domains include: data collection on caregivers, determining an age at which it is appropriate to collect data from the patient, collecting and updating data at multiple points across the lifespan, the limits of the electronic health record, and determining the purpose of the data collection before implementation. CONCLUSIONS: There is no single approach that will work for all organizations when collecting race, ethnicity, language and other social determinants of health data. Each organization will need to tailor their data collection based on the population they serve, the financial resources available, and the capacity of the electronic health record.