What would it take for health promotion to take structural racism seriously?

Defining equity, its determinants, and the foundations of equity science

Advancing equity as a priority is increasingly declared in response to decades of evidence showing the association between poorer health outcomes and the unfair distribution of resources, power, and wealth across all levels of society. Quandries present, however, through incongruence, vagueness and disparate interpretations of the meaning of equity dilute and fragment efforts across research, policy and practice. Progress on reducing health inequities is, in this context, unsurprisingly irresolute. In this article, we make a case for equity science that reimagines the ways in which we (as researchers, as systems leaders, as teachers and mentors, and as citizens in society) engage in this work. We offer a definition of equity, its determinants, and the paradigmatic foundations of equity science, including the assumptions, values, and processes., and methods of this science. We argue for an equity science that can more meaningfully promote coherent alignment between intention, knowledge and action within and beyond the health sciences to spark a more equitable future.

Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation

Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.

Activism and immigrant women's mental health and wellbeing: Building Canadian service provider capacity in the settlement and mental health sectors

In this qualitative community-based research, we explore service providers' use of activism-based resources and the supports they need to use activism as a tool to promote the mental health and wellbeing of racialized immigrant women. 19 service providers working in settlement and mental health services in the Greater Toronto Area, Canada, participated in one of three focus groups. We analyzed the data using a postcolonial feminist lens. Service providers' understandings of activism, strategies for promoting client mental health and wellbeing, and organizational barriers shaping their practice emerged as relevant. We offer recommendations for building activism-based resources, programs and services that include collaborations with racialized immigrant women communities and action at the organizational level to support service provider practice.

Holding no-one back: The Nutrition Equity Framework in theory and practice

Equity remains poorly conceptualised in current nutrition frameworks and policy approaches. We draw on existing literatures to present a novel Nutrition Equity Framework (NEF) that can be used to identify priorities for nutrition research and action. The framework illustrates how social and political processes structure the food, health and care environments most important to nutrition. Central to the framework are processes of unfairness, injustice and exclusion as the engine of nutrition inequity across place, time and generations, ultimately influencing both nutritional status and people's space to act. The NEF illustrates conceptually how action on the socio-political determinants of nutrition is the most fundamental and sustainable way of improving nutrition equity for everyone everywhere, through 'equity-sensitive nutrition'. Efforts must ensure, in the words of the Sustainable Development Goals, that not only is "no one left behind" but also that the inequities and injustices we describe do not hold anyone back from realising their right to healthy diets and good nutrition.

Public health moves to innocence and evasion? Graduate training programs' engagement in truth and reconciliation for Indigenous health

OBJECTIVES

Indigenous peoples are the first peoples of what is now called Canada. Canadians have benefitted from their largesse and contributions in a myriad of ways that remain unacknowledged. Indeed, ongoing colonization and systemic anti-Indigenous racism in all quarters of our society have had heinous impacts on their health and well-being. Despite this reality and multiple calls for redress, Indigenous health is still missing from the Core Competencies for Public Health in Canada, having obvious implications for public health training programs and subsequent practice. Our objective in this paper is to critically explore the reasons behind institutional apathy for reconciliation in Indigenous health.

METHODS

Interviews were conducted with 19 leaders in Canadian Graduate Public Health Programs (CGPHPs) at 15 universities to explore the extent to which CGPHPs engage with Canada's 2015 Truth and Reconciliation Commission's Calls to Action to address Indigenous health. We used thematic discourse analysis to illuminate the landscape and make recommendations.

RESULTS

Participants agree that Indigenous health is important, but our data reveal an uneven landscape for addressing the Calls to Action. Curriculum was limited though we noted modest positive change. On the whole, the non-Indigenous (white) professoriate still needs to educate themselves while not all see the need to do so. Many deflected responsibility. Yet anecdotally, there is desire among CGPHP students who are already unsettling themselves to see such competency in their training.

CONCLUSION

It is a settler evasion to claim lack of expertise, to express a desire to limit the burden on Indigenous academics, and to stand on the sidelines of institutional inertia. Our findings are a call to CGPHPs to do better.

Weight stigma and obesity-related policies: A systematic review of the state of the literature

Weight stigma is an important issue colliding with obesity-related policies; both have population health and social impacts. Our aim was to conduct a systematic review of the peer-reviewed literature that combined the concepts of stigma, obesity, and policy. We searched PsycINFO, Medline, Scopus, and Google Scholar for peer-reviewed articles amalgamating terms relevant to stigma, obesity, and policy. Of 3219 records identified, 47 were included in the narrative synthesis. Two key types of studies emerged: studies investigating factors associated with support for obesity-related policies and those exploring policy implementation and evaluation. We found that support for nonstigmatizing obesity-related policies was higher when obesity was attributed as an environmental rather than individual problem. An undercurrent theme suggested that views that blame individuals for their obesity were associated with support for punitive policies for people living in larger bodies. Real-world policies often implicitly condoned stigma through poor language choice and conflicting discourse. Our findings inform recommendations for policy makers that broader socioecological stigma-reduction approaches are needed to fully address the issue of weight stigma in obesity-related policies. Efforts are needed in the research and policy sectors to understand how to improve the design and support of nonstigmatizing obesity-related policies.