Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and Substance Use with
In Chapter 1 - Break down barriers:
While Canada is officially a multicultural society in which all cultures are equally valued, in practice it often falls far
short of this ideal. For example:
- In the Ethnic Diversity Survey conducted by Statistics Canada in 2002, 20% of people aged 15 and over who were part of a visible
minority said they felt that they had experienced discrimination or unfair treatment sometimes or often in the five years
prior to the survey because of their ethnicity, culture, race, skin colour, language, accent or religion.
- Ethno-racial minorities face greater economic hardship than other Canadians and are disproportionately represented in jobs
with long hours and low pay.
In health promotion with ethnocultural communities, racism and discrimination have to be taken into account. The barriers
created by racism and discrimination exist in all aspects of life, not just healthcare—education, employment, justice, government,
housing—and these in turn have an impact on health.
In the end, health promotion is about ensuring people have the power to make healthy choices. This power comes not only from
knowledge about health issues but also from having equal access to economic and political resources. Effective health promotion,
therefore, must include initiatives that aim at breaking down the systemic barriers faced by ethnocultural communities in
all sectors of society.
- Source: Statistics Canada “Ethnic Diversity Survey--2002,” The Daily, 29 Sept. 2003. Accessed April 2007.
- Source: Jacqueline Oxman-Martinez and Jill Hanley, “Health and Social Services for Canada’s Multicultural Population: Challenges for Equity.” Heritage Canada, Canada 2017 Policy Forum, 13 July 2005. Accessed April 2007.
Community Health in Action: Real Stories --"Racism is wrong." (Canada)
This account of one woman's experience with racism in her workplace shows how racism and discrimination can have an impact
on mental health.
To learn more about the effects of racism and discrimination:
Fulfil the spirit of the Ottawa Charter
At first, challenging racism and discrimination may seem to be outside the scope of health promotion. There is growing recognition,
however, that good health, including (and perhaps especially) good mental health, is not only a result of an individual's
habits but also the environment in which he or she lives.
The first International Conference on Health Promotion took place in Ottawa in 1986. Out of this conference came the Ottawa
Charter for Health Promotion, a plan for action to achieve “Health For All by the year 2000 and beyond.” (PDF) The Charter defined health promotion as:
“. . . the process of enabling people to increase control over, and to improve, their health. To reach a state of complete
physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy
needs, and to change or cope with the environment. Health is therefore, seen as a resource for everyday life, not the objective
of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore,
health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being.”
By this definition, health promotion needs to go beyond changing individual behaviours to creating conditions in which people
and communities are more able to enjoy “complete physical, mental and social well-being.”
To learn more:
Build community capacity
Community capacity-building means helping a community increase its ability to solve its own health problems. The capacities
to be built include the knowledge, skills, community participation, leadership and resources needed to deal with community
Working with community partners to develop a health promotion initiative in mental health or substance use for ethnocultural
communities gives the opportunity not only to improve the effectiveness of the initiative but also to build community capacity.
This means the process of developing the initiative can produce positive outcomes, as well as the initiative itself.
When you and your partners are planning your initiative, keep capacity building in mind. Include in your plans ideas about
how your partners can continue to build on the results of the initiative after it has ended.
Also remember to use this opportunity to build your own capacity, as well as that of the organization you represent, to address
the needs of ethnocultural communities in the areas of mental health and substance use.
"Going through the process of adapting the LRDG brochure highlighted our own assumptions we had about our clients and community.
Thus, further enhancing our understanding of culture and alcohol use."
-Maria J. Benevides, MSW,RSW, Portuguese Mental Health and Addiction Service.
* Source: “Capacity Building for Health Promotion: More Than Bricks and Mortar,” by the Ontario Prevention Clearinghouse, Spring 2002.
To learn more about capacity building:
Work with ethnocultural communities
People in ethnocultural communities are the best sources of information about the barriers they face. Working with them to
produce a health promotion initiative will achieve far more effective results than attempting to create one with little or
no input from the community.
The process of working together and involving community members in a health promotion project also can help to achieve the
main goal of health promotion: enabling people to increase control over their health.
There are some challenges to working effectively with ethnocultural communities, but with some preparation they can be overcome.
Become aware of your own culture and way of seeing things
We may never think about the things we say and do every day—they just seem to be logical and “common sense” to us. One of
the pleasures of working with people of different cultures is learning that there are different ways of doing things, all
of which seem logical and sensible to the people doing them. Challenges arise, however, when one person or group of people
believes their way is the best way or the only way to do things.
When you work with people whose culture and first language is different from yours, it is likely that misunderstandings will
arise from time to time. One way to prevent these misunderstandings from turning into serious problems is to become more aware
of your own culture and think about how it has shaped your way of seeing and doing things. It is important to recognize that
other people may have other ways of understanding, communicating and learning.
Some other steps you can take to enhance your work with people of different cultures:
- put aside assumptions
- be flexible
- listen more, talk less
- when problems arise, rather than make judgments, recognize the possibility of misunderstanding.
To learn more about cross-cultural communication:
Partner with community-based agencies
In many ways, creating health promotion initiatives with ethnocultural communities is no different from creating them with
other specific communities and audiences. One major difference, however, is language. Many people in ethnocultural communities
do not speak either official language or simply feel more at ease communicating in their own language, especially when it
comes to sensitive issues such as mental health and substance use problems.
If you do not speak the community’s language, it may be difficult to work with the community to create the initiative. One
way around this difficulty is to partner with one or more agencies already established in the community. The staff in community-based
agencies tend to understand both the mainstream culture and their community’s culture. They can therefore act as a bridge
between you and the community. They also have the community’s trust, which is probably the most important factor in the success
of a health promotion initiative.