“Imagine an expansive river with a very high waterfall at its source. At the bottom of this waterfall, along its banks are hundreds of people working tirelessly trying to save people in the river, many of whom are struggling to keep afloat. As the countless bodies are pulled out of the water, one person looks up and observes an ostensibly endless parade of bodies falling down the waterfall. Curious about what she observes, she runs upstream. One of the rescuers sees her running and yells out, “Where are you going? We need your help down here to save these people.” As she continues to make her way up, she yells back, “I’m heading upstream to find out why so many people are falling into the river.”
As a health promotion practitioner, I have always cherished this parable. It really speaks to my value of social justice and the need to address the root causes of poor health and quality of life beyond an individual’s control. As much as I love the story, I always felt there was something missing. A better ending would sound like this, “I’m heading upstream to find out why so many people are falling into the river, but more importantly why are so many of them Indigenous and racialized?”
Decades of research have shown us that Indigenous and racialized individuals continue to have poorer health outcomes than their non-Indigenous and non-racialized counterparts. More recently, COVID-19 shone an even brighter light on these disparities, underscoring the higher mortality rates of racialized and impoverished Canadians compared to their counterparts. With the 10-year anniversary of the Okanagan Charter approaching in 2025, we have an opportunity to redress the persistent health disparities that continue to adversely impact Indigenous and racialized communities on our campuses.
The Okanagan Charter: An International Charter for Health Promoting University and Colleges, invites postsecondary schools to integrate health into every facet of campus culture and to lead health promotion action and collaboration at both local and global levels. We have witnessed some success since its inception in 2015. The implementation of the UBC wellbeing strategic framework and the initiation of the Canadian health promoting universities and colleges network with over 45 institutions pledging to advance health promotion are two formative examples of these aspirations.
However, universal health promotion aspirations are not sufficient. I am advocating for a transformative shift from health promotion to health equity promotion, where equity and social justice, as named in the Okanagan Charter, are at the centre of the calls to action. Rather than embedding just health, let’s embed health equity into all aspects of campus culture, across the administration, operations and academic mandates. I am proposing two new calls to action:
- Acknowledge and redress the health inequities that exist on our campuses.
- Decolonize and diversify health promotion on our campuses.
Call to action 1: acknowledge and redress the health inequities that exist on our campuses
We need not look any further than the research being conducted on our own campuses to see that health inequities continue to persist amongst historically and persistently marginalized groups of students. A recent study, conducted at the University of Toronto, found that racialized students reported poor general health compared to their white peers. A similar trend is observed in the treatment rates of university students experiencing mental health problems, with the largest disparities stemming from race and ethnicity, and international student status. Together, these findings highlight the necessity of transitioning from broad-based, universal health promotion initiatives that address the wellbeing of the whole population to more intentional ways of working with Indigenous and racialized groups to reduce health inequities. Adopting a health in all policies approach (HiAP) approach, one that recognizes the roots of health in economic and institutional policies, as well as acknowledging the multitude of stakeholders involved in decisions that impact the health of a campus, is key. One of the tools to support HiAP is the health impact assessment (HIA) used to examine the potential health effects of a policy, initiative, or program on a population, especially on historically and persistently marginalized groups.
Call to action 2: decolonize and diversify health promotion on our campuses
At its core, health promotion is about social justice. It embodies a hope in action to achieve health equity through empowering individuals and communities to address the colonial legacy and racism that continues to push Indigenous and racialized bodies down the waterfall into the river. We need to decolonize health promotion. P. Paul Chandanabhumma and Subasri Narasimhan offer a framework to facilitate this process that asks us to first decolonize our mindset, acknowledging the continuous repercussions of colonialism, specifically the colonial structures in place that continue to cause poverty and poor health amongst Indigenous and racialized people. We need to examine and challenge current health promotion practices, acknowledging who they have been developed by and for. Therefore, it is essential for us to prioritize the perspectives and voices of Indigenous and racialized peoples, inviting them to participate in meaningful dialogue to reimagine and revive health promotion, honouring the ways in which communities have been caring for their health and wellbeing long before the introduction of public health.
I know that many of us are already committed and engaging in this work, as can be seen by the number of institutions who are signatories of both the Okanagan Charter and the Scarborough Charter on anti-Black racism and Black inclusion in higher education. With that, I am asking all campuses that have signed on to be part of the Canadian Health Promoting Universities and Colleges Network to redress the health inequities on our campuses and commit to decolonizing health promotion, to ensure that Indigenous and racialized groups are co-leading, if not leading this work and to allocate the necessary resources to support and sustain these efforts. As a health equity promoter, but more importantly as a racialized mother, my hope for the next 10 years is that we won’t have so many Indigenous and racialized bodies drowning in the river and that we can all just enjoy the view of the waterfall!