The marathon of health equity and public health: My journey as an undergrad
Sarah Ngunangwa, Dianne Oickle
I have always been passionate about promoting social justice. Growing up in Tanzania, I witnessed equity imbalances and was part of the United Nations (UN) Youth Clubs working to raise awareness and support UN goals and initiatives at the ground level. Although there has been positive progress in health care delivery in Tanzania, much remains to be done to improve overall living conditions of all citizens. Health equity and social justice are being addressed in many countries all over the world, and being an equity champion or change agent means having the sheer will to act and develop a plan with realistic timelines.
As a human nutrition honours student at St. Francis Xavier University, I learned to act on my passion for social justice, especially through service learning. During lectures, I would imagine how a certain concept could be applied in the community. In discussions with professors and other students, I challenged my ideas. For example, I always thought I could take action and see results right away. However, I quickly learned that mobilizing action on health equity and social justice does not happen overnight. We need tools to translate our knowledge into action, as well as champions to keep the spirit of action alive in all public health professionals.
My honours thesis was titled Identifying barriers and enablers to addressing health equity in public health practice. The project team included myself and three co-supervisors: Dr. Doris Gillis (St. FX Department of Human Nutrition), Dianne Oickle (National Collaborating Centre for Determinants of Health) and Christine Johnson (Nova Scotia Health Authority). I conducted three focus groups involving a total of 15 public health practitioners from three regions of the Nova Scotia Health Authority. We examined Make Food Matter, an example of a knowledge mobilization toolkit through which we could explore barriers and enablers facing public health practitioners as they address and advance health equity. The Make Food Matter toolkit provides resources designed to promote collaboration among stakeholders and support communities in five main action streams: community dialogue; social innovation; advocacy; policy; and, effective communication. Tools can be tailored and used for initiatives at multiple action levels to address food security issues in the community.
What we found was very interesting! A lack of shared understanding of health equity, limited human and financial resources, and working in silos were some of the barriers. On the other hand, strong community relationships, availability of knowledge mobilization tools, and engaged health equity champions were enablers to addressing health equity in public health practice. When it came to the use of knowledge mobilization tools specifically, the enablers were similar — having equity champions and solid tools available. The barriers to using tools were quite pragmatic — being overwhelmed with the number available, feeling like they were not applicable to the work, and not being adequately informed on how to use the tools.
Through my research experience, I learned to create and manage realistic strategies and expectations — both professionally and personally. When I took off my rose-coloured glasses, so to speak, I saw the many barriers that lie along the path to health equity. The result of longstanding social problems, inequity takes time to fix. That is not to say it can’t be done! Solutions often lie with the individuals who live through the realities of inequity. We must include them in the action and follow their lead. Even though it can take time to see tangible results, and equity champions in public health are pulled in many directions by the different hats they must wear, I know there is hope. I have met so many practitioners who are ready, willing and capable to act. We, myself included, are done planning, are beyond talking, and we are ready to act.
By participating in food action and advocacy activities, such as the Make Food Matter social media campaign and a Food for Thought seniors program with the Antigonish County Adult Learning Association, I gained a better understanding of the work that awaits me. It was those moments when I interacted with public health professionals that inspired and motivated me. As I peeked behind the scenes, I saw that public health work is a non-stop, continuous marathon where the route may change at any time. You make decisions and have to be open to changing them as new information becomes available. Addressing health equity requires continuous energy being put into the work by a contingent of tireless and diverse professionals.
Working on this research has been very thought-provoking. It has taught me the importance of employing multiple lenses when viewing social issues, having several contingency plans in my back pocket, and working as one part of a whole. Setbacks are to be expected, but strong alliances with our colleagues and communities can activate a domino effect on factors influencing equity. Health equity demands collaborative effort — it is not a one-person or one-institution (i.e. government) show. I look forward to being part of this work.