Place, Health, and Diversity

Learning from the Canadian Experience

Melissa D. Giesbrecht, Valorie A. Crooks

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317080558
• Edition: 1
• Topic: Medicine
• Subtopic: Health Policy

Although health equity and diversity-focussed research has begun to gain momentum, there is still a paucity of research from health geographers that explicitly explores how geographic factors, such as place, space, scale, community, and location, inform multiple axes of difference. Such axes can include residential location, age, sex, gender, race/ethnicity, culture, religion, socio-economic status, marital status, sexual orientation, education level, and immigration status. Specifically focussing on Canada's rapidly changing society, which is becoming increasingly pluralized and diverse, this book examines the place-health-diversity intersection in this national context. Health geographers are well positioned to offer a valuable contribution to diversity-focussed research because place is inextricably linked to differential experiences of health. For example, access to health care and health promoting services and resources is largely influenced by where one is physically and socially situated within the web of diversity. Furthermore, applying geographic concepts like place, in both the physical and social sense, allows researchers to explore multiple axes of difference simultaneously. Such geographic perspectives, as presented in this book, offer new insights into what makes diverse people, in diverse places, with access to diverse resources (un)healthy in different ways in Canada and beyond.

1 Place, Health, and Diversity in Canada

Melissa D. Giesbrecht

Valorie A. Crooks

Jeffrey Morgan

DOI: 10.4324/9781315600598-1

“Diversity is the one true thing we all have in common” (Anonymous)

In recent years, use of the word “diversity” has grown tremendously in multiple contexts (Juanita Johnson-Bailey, 2008; Angelini, 2011). This word appears regularly in public media via magazines, advertising slogans, social networking sites, and television, as well as in the scholarly literature. Ideas surrounding the concept of diversity also have become the focus of many public events that aim to increase awareness and celebrate difference, such as pride parades and multicultural fairs. In addition, governmental initiatives and policies have begun embracing the term through various implementations such as the Canadian Multiculturalism Act, 1988, and the vast number of existing employment policies focused on enhancing diversity in the workplace. Despite the popularity of the term, there is no single agreed-upon definition of “diversity.” Traditionally, and still today, diversity tends to be associated with culture: more specifically, the languages, values, rules, and beliefs that have been shared, learned, and transmitted throughout generations by specific groups (Hankivsky et al., 2009). In other cases, diversity is used in relation to tolerance and acceptance, eliciting ideas of inclusion or racial and gender differences. Others associate the word with issues of power and inequity, and therefore view it as conjuring affirmative measures designed to insure the representation of minority or marginalized groups. In academia, the term is increasingly ubiquitous.

Although conceptualizations vary widely, for researchers there is a general consensus regarding the significance of acknowledging time, place, and more specifically, context in relation to how diversity is understood, operationalized, and applied. As such, diversity can be seen as a broad lens through which researchers focus on the scale, place, and characteristics that are most relevant and meaningful to the issue, problem, population, or research question at hand. In keeping with this, the conceptualizations of diversity used by authors throughout this collection are diverse, yet collectively focused on the specific context of the research topic being explored; they also all broadly conceptualize diversity as being all the ways in which people and places are both at once unique and different from others (Alberta Health Services, 2011). Therefore, considering that this book is focused on exploring the intersection of diversity, health, and place, we conceptualize diversity as encompassing the multiple, fluid, and relational ways in which differences intersect to influence experiences of health, and the health outcomes of people and population groups in place (James, 2000; Alberta Health Services, 2011).

The Canadian Context

In this book, the focus of diversity is not solely on difference, but also on recognizing and identifying those commonalities shared among particular population groups, places, and contexts. For example, the contributing authors showcase a particular commonality: the contemporary Canadian context. As such, all the diversity-based studies in this collection are anchored geographically, allowing for the examination of those shared, yet unique, aspects of the Canadian landscape that shape diverse health experiences. In other words, the focus of each chapter is situated within this broad yet shared geographic, political, historical, cultural, economic, and social context. This is important to consider, as Canadians experience particular expressions of diversity that are shaped by the country’s contexts (Angelini, 2011). It is this situated place-in-the-world that directs the way that Canadians live, including their understandings, views, and experiences of health, health care, and health outcomes (Kearns, 1993; Hankivsky and Christoffersen, 2008). At the same time, this situatedness is informed simultaneously by the multiple axes of difference that shape people’s social and physical locations, which collectively make up a society’s diversity. Thus, although the landscape of Canada shares broad national-level characteristics relative to the global scale, it is also inextricably diverse within its national borders. Today, the Canadian context continues to evolve, and as a result is becoming increasingly pluralized and diverse (Angelini, 2011).

Collectively, Canadians’ everyday lived experiences are shaped by the physical geography in which they live. Canada is the world’s second largest country, and due to its sheer vastness, it is painted with diverse landscapes and climates ranging from arctic and maritime to prairie and temperate rainforest. From east to west, Canada encompasses ten provinces, three territories, six time zones, and reaches the Atlantic, Pacific and Arctic Ocean coastlines. According to the 2011 census, Canada is becoming increasingly urbanized, with most of the country’s 33 million inhabitants living in urban areas (Statistics Canada, 2011). However, more than 6.3 million Canadians live outside cities, throughout rural and remote regions (Statistics Canada, 2011). Together, all Canadians share the reality of living on lands that historically were home to a rich and diverse Indigenous people (as discussed in greater detail in Chapter 3): among them myriad bands and tribes, each with their own rich cultures, spiritual practices, and languages. Despite a direful recent history of colonialism, the Aboriginal population of First Nations, Inuit and Métis peoples remain an active part of Canada today. With the exception of Canada’s Indigenous peoples, the remaining population shares a history of immigration at some point in time, and even today Canada continues to boast the highest percentage of foreign-born citizens out of all G8 nations (Evans, 2013). In 2014 alone, Canada welcomed more than 260,000 newcomers to the country, which has created a multicultural society of mixed languages, cultures, and religions (Immigration, Refugees and Citizenship Canada, 2016). Demographically similar to many other countries in the global North, currently the population of Canada is experiencing a rapid overall increase in age whereby, over the next two decades, close to one in four people in Canada will be aged 65 years or over (Statistics Canada, 2014). Importantly, these shared Canadian experiences, among many others not mentioned here, result in very unique and diverse experiences for Canadians at the provincial, regional, neighborhood, community, and individual levels – particularly in regard to experiences and understandings of health, health care needs, and access to such care.

Within Canada, eligibility for, access to, and availability of health care services are not universal; rather, they are largely dependent on where one lives (Williams and Kulig, 2012), a reality that is expanded upon in Chapter 10. This is because of the decentralized nature of the Canadian health care system, and the associated roles and responsibilities of various levels of government in regard to providing such care (Carstairs, 2005). Specifically, it is the individual provincial and territorial governments which have primary responsibility for the delivery of health care services as legislated by the Canada Health Act, 1984, while smaller regional authorities hold responsibility for administering these services. The Canada Health Act sets out the primary objective of Canadian health care policy as it relates to the provision of public services, which is “to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers” (Health Canada, 2010, n.p.). Through this Act, the federal government supports the publicly funded health care system through transfer payments to the provinces and territories, health policy creation that falls within its jurisdiction, and some other health care-related activities (Carstairs and MacDonald, 2011). The federal government also has a direct service delivery role for certain populations: First Nations on reserve and Inuit people, military members and veterans, refugee protection claimants, and inmates of federal penitentiaries (Carstairs and MacDonald, 2011). The federal government can provide leadership to the provinces through the creation of policy directives, and also administer health-related programs. Although the federal government plays a major role in the funding of health care in Canada, it is the provincial and territorial governments that are responsible for providing local leadership and setting the overall direction for the health systems that fall under their jurisdiction. For example, in the province of British Columbia, this involves the provincial government undertaking actions such as policy creation and enactment, legislative changes, and allocating funds to organizations and individuals who provide services. As such, the provincial government is responsible for legislative changes that are necessary to improve services that fall within the scope of the public health care system (British Columbia Ministry of Health, 2006).

In the remainder of this chapter we provide a broad overview of the concepts of health, place, and diversity from a Canadian perspective. We also review key developments in existing research focused on diversity and health, and discuss how health geographers are well positioned to address this knowledge gap regarding the interconnections of health, place, and diversity. We conclude by providing an overview of the book. Ultimately, this chapter emphasizes that in order to gain a more nuanced understanding of how health and/or health care is experienced in Canada and beyond, place must be considered in relation to the diverse social conditions and unique socioeconomic, political, cultural, and historical axes that shape people’s lived realities.

Diversity and Health

From the international reach of the World Health Organization (WHO) to the micro-realm of local municipal governance, the consideration of diversity in prevailing institutional constructions of health transcends geographic scale, and represents a significant paradigm shift that is continuously evolving. Differing from the previous positivist and biomedical conceptions, health today is commonly understood as being much more than the mere absence of disease; instead, it is thought of as a complete state of social, physical, and mental well-being (World Health Organization, 2014). This framing increases the complexity of what it means to be healthy, or experience good or bad health outcomes, by emphasizing the social construction and subjective nature of health. As such, a diverse range of understandings of what constitutes health – from scales of the individual to particular population groups, regions, and beyond – have emerged in recent decades (Kearns and Collins, 2010).

In Canada, a social understanding of health was first advocated for in a national report written by Lalonde (1974), “A New Perspective on the Health of Canadians.” In this report, Lalonde stated that: Here, Lalonde emphasized the critical role that physical and social environments (or determinants) play in shaping the health of Canadians, effectively calling for a diversity perspective to be employed (Coburn et al., 2003). Since this time, Canadian conceptions of health have continued to evolve, resulting in the development of frameworks that encompass diversity, particularly those social determinants that have been found to directly or indirectly shape health and health-related opportunities, choices, decisions, and outcomes (Public Health Agency of Canada, 2011). Such frameworks have since been adopted within Canada through, for example, the Public Health Agency of Canada’s listing of the social determinants of health facing Canadians (discussed further in Chapter 2), as well as international health agencies such as the WHO.

[T]‌he traditional view of equating the level of health in Canada with the availability of physicians and hospitals is inadequate … there is little doubt that future improvements in the level of health of Canadians lie mainly in improving the environment, moderating self-imposed risks and adding to our knowledge of human biology. (1974, p. 18)

Despite the common recognition that social and environmental factors play a critical role in shaping health, and acknowledging the role that diversity plays in health, no universal framework has been developed to encompass these diverse determinants. Instead, health agencies at various levels tend to prioritize differing social determinants, again emphasizing the critical role of context and the need to adapt such perspectives to the issues, questions, or population groups at hand. As the WHO states, “action on the social determinants of health should be adapted to the national and sub-national contexts of individual countries and regions to take into account different social, cult...

Table of contents

• Cover
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Tables
• List of Contributors
• Acknowledgments
• 1 Place, Health, and Diversity in Canada
• 2 Frameworks, Lenses, and Tools: Approaches to Conducting Diversity-based Health Geography Research
• 3 From Embedded in Place to Marginalized Out and Back Again: Indigenous Peoples’ Experience of Health in Canada
• 4 Exploring the Intersections Between Violence, Place, and Mental Health in the Lives of Trans and Gender Nonconforming People in Canada
• 5 “I’m a Better Person When I’m Working”: Supportive Workplaces, Mental Illness, and Recovery
• 6 Spaces and Places: Engaging a Mixed-methods Approach for Exploring the Multiple Geographies of Pedestrian Injury
• 7 Countermapping Inner City “Deprivation” in Winnipeg, Canada
• 8 When Is Helping Hurting? Understanding and Challenging the (Re)production of Dominance in Narratives of Health, Place, and Difference in Hamilton, Ontario
• 9 Constructing the Liberal Health Care Consumer Online: A Content Analysis of Canadian Medical Tourism and Harm Reduction Service Provider Websites
• 10 Lived Experience in Context: The Diverse Interplay between Women Living with Fibromyalgia and Canada’s Health Care System
• 11 Aging, Gender, and “Triple Jeopardy” Through the Life Course
• 12 Does the Compassionate Care Benefit Adequately Support Vietnamese Canadian Family Caregivers? A Diversity Analysis
• 13 Conclusion: Ways Ahead in Diversity-based Health Geography Research
• Index