The marathon of health equity and public health: My journey as an undergrad
Guest blogger Sarah Ngunangwa
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 progression in provision of healthcare in Tanzania, much remains to be done to improve the overall living conditions of all citizens. Addressing health equity and social justice is 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, my courses provided a window through which I could learn to act on my passion for social justice, especially through Service Learning. It was during lectures that I’d think of how a certain concept could be applied in the community, and it was in discussions with professors and other students that I could challenge my ideas. I always thought I could take action and see results in a short time span. However, I quickly learned that mobilizing action on health equity and social justice was not going to happen overnight. We need tools to move the knowledge we have 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 (NCCDH) 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 used the Make Food Matter toolkit as an example of a knowledge mobilization tool to explore the barriers and enablers that public health practitioners experience in addressing health equity and in the use of knowledge mobilization tools to advance health equity.
What we found was very interesting! Lack of shared understanding of health equity, limited human and financial resources, and working in siloes were some of the barriers. Whereas strong community relationships, availability of knowledge mobilizations tools, and having 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 strong tools available. The barriers to using tools were quite practical - being overwhelmed with too many, feeling they were not really applicable to their work, and not feeling informed enough on how to use the tools meant that the tools might be there but are not used at all.
Through my research experience I learned to make realistic strategies and have realistic expectations both professionally and personally. Inequities are usually a result of longstanding social problems and as such, addressing them may take a long time. That is not to say it can’t be done! Solutions often lie with the individuals who live through the realities of inequity. We ought to invite them to participate in the action and follow their lead. I have had a glimpse of the barriers in the path to health equity - it is not an easy path but there are enablers. In a way I have lost the rose-colored view of public health work - it takes a very long time to see tangible results, and as an equity champion in public health you are expected to wear so many different hats. However, I know there is hope to addressing equity because I have met the army of practitioners who are ready and willing to act. We, including myself, are done planning, we are beyond talking, and we are ready for action.
During my honours research, I started to understand what it means to do “invisible” work. I participated in a number of food action and advocacy activities (the Make Food Matter social media campaign, Antigonish County Adult Learning Association (ACALA) Food for Thought seniors’ program) that helped me understand the work that awaits me. It was those moments when I interacted with public health professionals that inspired and motivated me. It was like going behind the scenes and seeing 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 as well as a tireless, diverse army. The public health system has this army - the interdisciplinary teams and the dedication from its professionals.
Working on this research has been very thought-provoking - I have learned the importance of employing a number of 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’s not a one-person or one-institution (i.e. government) show. I am looking forward to being part of this work.
Do you have thoughts on barriers and facilitators to using knowledge mobilization tools and addressing health equity in public health? We'd like to hear from you! Send us your thoughts and ideas, or start a conversation in the Health Equity Clicks: Community.
Ngunangwa, S. (2016). Honours thesis: Identifying barriers and enablers to addressing health equity in public health practice. St. Francis Xavier University Department of Human Nutrition, Antigonish NS.