 Hi everybody, we're just going to give it another minute or so for people to get in. Okay, and we're going to get started here. Welcome everyone. My name is Adelina Ittena. I'm the Associate Director of the Health Law Institute at Delhousey and the Professor at the Schulich School of Law. And I am pleased to welcome you to another seminar in our Health Law Institute Speakers Series. This year the series is focused on justice, diversity, and equity, and we have a fantastic speaker today that I'm very, very pleased to introduce in a second until but before that I do want to mention a couple of housekeeping rules. First of all, this seminar is recorded. Now the audience members are not going to be captured in the video, but you can access it if you want to rewatch or share it on the Schulich School of Law YouTube channel. Secondly, we do have closed captioning at the bottom of your screen. You will see a button that says closed captioning or CC. Please make sure you turn it on should you need or want to use the subtitles. And finally, the questions today will be can be posed through the Q&A function. And again at the bottom of the screen you're going to see a Q&A tab. Feel free to use and ask questions throughout the event. At the end after Sharon finishes her talk I'm going to come back and fill the questions. You will be able to see the questions that other ask and you'll be able to vote on them if you're interested in the answer so that way they will jump at the top of my list and I'll be able to prioritize those questions. Now without any further ado, I am going to introduce our speaker today. We are very pleased to welcome Ms. Sharon Davis Murdoch. She is a social justice champion. She's retired from the Nova Scotia Public Service and Sharon's political science background and public policy experience inform her work in the community. Among her public policy accomplishments was the development of the first provincial guidelines for culturally competent primary healthcare in Canada. Sharon received the Premier's Awards of Excellence in 2007 and 2015. In 2018 Sharon received the Inspiration Award from the Dalhousie School of Public Administration, awarded to public servants who have demonstrated a superior dedication and commitment to mentoring, coaching and inspiring students and public servants over the course of their careers. Sharon now works at the community level and is a founding member and the co-president of the Health Association of African Canadians. Additional to that role, she now serves as co-manager to the Association of Black Social Workers and Health Association of African Canadians, COVID-19 response and impact team. She's also an advisor to the Halifax Immigrant Partnership and Secretary of the Dartmouth General Hospital Foundation Board. Now Sharon is also the president of Shamar Dovan. Maybe the pronunciation is not quite correct, consulting. Sharon was appointed and served as a commissioner on the Independent Commission on Effective Electoral Representation of a Canadian and African Nova Scotians. She was also a presenter and writer for the 2018 Women in Leadership Campaign School and is author of the Knowing Your Community pamphlet for the Nova Scotia Advisory Council on the Status of Women. In October 2020, Sharon was selected as one of the Black women leaders for the Black Women in Leadership, sharing and shaping our journey online conference. Sharon is a proud member of the Dartmouth community and an even prouder Nana of the Grand Baby Boys. We are very lucky to have Miss Davies Morduk here with us today. She will be talking about the matters of Black health, resilience and determination. So I'm going to pass it on to Sharon and looking forward to the presentation. Thank you. Thank you, Adelina. And certainly thank you to the Shulik School of Law and for those coordinators of this seminar series. I'm very, I'm delighted to be here and I'm honored to have been asked to be here. So we are going to move into the presentation. And but before that, I guess I would just say this. As you heard from that kind introduction, I am a policy person. All my career I've been involved in policy as policy analyst, senior policy analyst, policy advisor and so on. And so policy tends to be the way that I think and my framework for things. So today for this presentation, I thought I would take a multi-pronged approach, which is kind of policy language. And what I'd like to do, I'd like to accomplish three things in this. I'd like to tell a story and share a story with you. I would like to also leave a history of our health resistance in this province. And I would also understanding that among the broad audience that is here are a number of law types, lawyers and law professors. So thirdly, and perhaps maybe even most importantly, I'd like to build a case, a case for our policy determination. So thank you for allowing me to frame it. And I certainly would appreciate sharing the presentation now. Our Hock Administrative Assistant is going to help me with that, sharing the screen for the presentation. So here we have the beginning of the presentation. And I think we can we can move right to the second slide now. So I think it is, in fact, I know it is important to give you a sense of the Health Association of African Canadians in terms of our founding members. It's really important to do that. And our founding members include former MLA Yvonne Atwell, the one and only black female MLA in Nova Scotia history still. Also, Sue Edmonds, who is in now lives in Quebec, she was a psychiatric nurse at the Nova Scotia Hospital, the late and wonderful Fran Harper, who was a nurse and a trailblazer at the IWK, and certainly Dr. Josephine Atawa, who is an author of numerous books and articles on health and race and those intersections. She was a professor of nursing at Dalhousie and is now a professor of nursing at the University of Ottawa. So those women and myself are the founding members of our Health Association of African Canadians. I'm pleased to ask to add as well that Rhonda Atwell, the daughter of of MLA, former MLA Yvonne Atwell is one of our board directors, but she is also the first Nova Scotia Health African Nova Scotian services consultant. And we also have among our membership the daughter of our founding member Fran Harper, and that is public health nurse Angela Harper. So it's wonderful that we have among our membership and as part of our work, the daughters of two of our founding members. So all of us together have since the establishment of the Health Association of African Canadians, also known as HAWK, our vision has always been thriving healthy African Canadian communities in Nova Scotia. And our mission still is to promote and improve the health of African Canadians in Nova Scotia through community engagement, education, policy recommendations, partnerships, and research participation. So next slide, our history, our struggle, our health, and our destiny. So when we think about the history of our people, we have to recognize that Africa's great civilizations were in existence long before the Transatlantic slave movement across the Middle Passage and to wherever we ended up in the African diaspora. We were interrupted by 400 years of enslavement. Our people were then diminished by segregation, racism of all sorts. We are still punished with racism and discrimination, but indeed we've been resilient throughout. We are not defined by the past, but we have been hurt by it. And I'm going to talk about that today. So we are determined to fight for justice. Dr. Joy DeGru is the author of the post-traumatic slave syndrome. She wrote that book, was published in 2005. And she says, the slave experience was one of continual violent attacks on the slaves body, mind, and spirit. Slave men, women, and children were traumatized throughout their lives and violent attacks during slavery persisted long after emancipation. In the face of these injuries, those traumatized adapted. They adapted their attitudes and behaviors to simply survive. And these adaptations continue and manifest today. So the syndrome examines, or the post-traumatic slave syndrome examines these adaptations with an eye toward identifying those adaptations that limit us and those that make us stronger. But in her powerful words, DeGru asks, or states, let's do the math. 339 years of trauma. No help, then you get freed. Did the trauma continue? I think we all understand that it certainly did. Next slide. So Dr. Joy DeGru explains that the syndrome is a condition that exists when a population has experienced multi-generational trauma resulting from centuries of slavery and continues to experience oppression and institutionalized racism today. Added to this is the belief, real or imagined, that the benefits of the society in which they live are not accessible to them. We bought, that is, Hock brought Dr. DeGru to Nova Scotia for our mental health conference in 2015. And some of you may have attended and may remember that. So Dr. DeGru, next slide, talks about the painful experiments that were that were done to our, to our people. It's really important in these next slides. It's going to be difficult for me to even talk about this. But it is important that we know our history. We must know our history so that we can learn from it so that we can continue our determination for justice. The history informs what we need to do. And so in conveying information about our history, I want to start by talking about Dr. Marion Sims. He is credited for the invention of the vaginal speculum and repair of vaginal fistula. He is referred to as the father of gynecology. However, it is important that we know that Dr. Sims experimented on black women who were enslaved, performing surgical techniques without the use of anesthesia. Women were considered the property of enslavers and they were not even permitted to give consent. I also want to say that every woman who is watching this and listening to this is likely and very importantly a patient of the healthcare system and as is necessary for health promotion and disease prevention on the receiving end as a patient of pap tests. Pap tests are important and they are ways in which certain kinds of cancers can be can be seen early and early enough that it is a life-saving process. But gynecology actually was the practice was actually built on the bodies of black of our black female ancestors because the speculum was used in crude crude pre-speculum tools if you want for the lack of a better word were used on our women. And it was also the sense that we were so dehumanized through the enslavement process that there was this myth that black people and black women in this case didn't actually feel pain in the same way that other people did. And that myth continues, believe it or not. So when we look back at the history of enslavement we know that women and we even have some of the names of some of these enslaved women Lucy, Anarka and Betsy were taken to sims by enslavers who were focused on increasing the production yields of our people. So chattel slavery dehumanized us and we were treated like animals and Dr. DeGru covers this history extensively in her book. I want to add that this information is available publicly from the history channel and the health line websites and this is where we have been able to glean this information today. Next slide please. So the pain of these enslaved women, the stories that of those terrible experiences that they had were not told in the ways that they would be today. They weren't even considered. But giving a voice to that kind of pain that came, maybe there were oral histories shared between the women. But Dominique Cristina who is an award-winning educator, poet and author. She is a cultural historian. She wanted to give voice to these women and so she has written this poem No Magic, No How and it goes like this. Right there, right there when Massa Doctor looked right past the way I heard to say she a tough old gal, she could take a mighty lickin. That puts it in context. The deepening roots of mistrust indeed apart from our women, our men were experimented on and treated as disposable. Well known to many of you is the Tuskegee study, 40 years of human experimentation in America. This experiment was conducted by the U.S. Public Health Service over a 40 year period starting in 1932. It involved about 600 black men from Alabama who were between the ages of 25 and 60 and experiencing poverty. The study included 400 black men with untreated syphilis and around 200 who didn't have the disease to act as a control group. They were all told they were being treated for bad blood for six months. And again, the study involved painful spinal taps, x-rays and blood tests. Next slide. So the Tuskegee study continued. When participation waned, the researchers started providing transportation and hot meals, exploiting the poverty of these men. In 1947, penicillin was shown to be effective in the treatment of syphilis but wasn't administered to the men in the study. Instead, researchers studied the progression of the disease, allowing the men to become ill and die. In addition, the researchers ensured that the participants weren't treated by other parties. Now, this study only ended in 1972. I was in junior high school when it ended. And it ended because the Associated Press tipped off by Peter Buxton reported on it. Tragedy continued. Many men in the study died from syphilis and related illness. But they also affected women and children as the disease spread. An out-of-court settlement was given to men who survived. And the families of those who died received a mere 10 million dollars. Next slide. And I do want to say that the following slides were produced by my colleague and former Hock co-president, Dr. David Haas. Many of you will have heard Dr. Haas' presentation about mistrust at our Hock COVID-19 town hall that we held earlier this month on vaccine. That is COVID-19 vaccines, fact versus fiction. So I do want to acknowledge that these slides were produced by Dr. Haas. Next slide. This is a New York Times article from 2016, which talks about this mistrust. 2016, this was. The mistrust from these experiments, these atrocities that continue to impact our thinking and our trust of the health system. Now there are a number of these, and there are more that I'm going to tell you about, but certainly these are within U.S. history. And there are not, or at least I don't have access to this kind of information from Canada. But understanding that the transatlantic slave trade impacted all of us across the African diaspora, and certainly those of us in North America came from this kind of background and were impacted and still are impacted by these atrocities in the United States that inform us and unfortunately create mistrust in us about the health system. Another case, next slide, is about Henrietta Lacks, a woman who was reduced to cells. At the age of 31, this black woman was diagnosed with and died. Doctors preserved sample tissue from the tumor without her consent or the consent of her family. In fact, informed consent didn't even exist at that time. The cells considered immortal were used in over 70,000 medical studies and played a significant role in medical advances, including the treatment of cancer, in vitro fertilization, and vaccines for polio and HPV. In 2013, Lacks genome was sequenced and that was made available or made public to some people. This was done without her family's consent and constituted a privacy violation. The information about that violation was hidden from public view. The National Institutes of Health later came to an agreement with the Lacks family on the use of data. Next slide. And there she is, Henrietta Lacks, a picture of this woman. And indeed, forced sterilization is another issue of atrocity that has faced or that our people have endured. Fanny Lou Hamer was one of the people affected by this 1961 when she went to a hospital in Mississippi presumably to have a uterine tumor removed. At that time, the surgeon removed her uterus without her knowledge and Hamer only found out when the rumor spread across the plantation where she was a sharecropper. This kind of medical violation was intended to control the African American population. It was such a common occurrence that it was dubbed the Mississippi appendectomy. Now, it might surprise you to know that there have been concerns raised by Black women in this province about unnecessary hysterectomies, but thus become or begins the case that I would like to make about the fact that we do not have Canadian evidence of this. We don't have data about this. And so all I can tell you is that I have been in conversations with women who have talked about unnecessary hysterectomies right here in this province. Next slide, please. In 1966, in Chicago, at a press conference before his speech at the second convention of the Medical Committee for Human Rights, our icon, Dr. Martin Luther King Jr., said in part, of all the forms of inequality, injustice and health is the most shocking and the most inhuman because it often results in physical death. This, of course, would have been at a time when the Tuskegee experiment was going on, but hadn't even been made public. Things from the time of enslavement through the kinds of atrocities that he was aware of led him to make this statement. And it's a powerful one about health and the health system. And black people's interaction with it. And indeed, this informed his civil rights struggle and the movement. And he said, I see no alternative to direct action and creative nonviolence to raise the conscience of the nation. Next slide, please. Now, in this picture, it's not terribly clear, but you will see that that is former President Ronald Reagan, and next to him is a woman by the name of Margaret Heckler. And this is important because I would, I was surprised that it was under the Reagan administration that Secretary Heckler wrote the report on black and minority health. So commonly known as the Heckler report, this was the first time in the history of the U.S. government where there was a comprehensive study of the health status of racial and ethnic minorities and this elevated minority health onto a national stage. The Heckler report concluded that health disparities accounted for 60,000 excess deaths each year and that six causes of death accounted for more than 80% of mortality among blacks and other minority populations. Next slide. The Heckler report was actually the impetus for the establishment of the U.S. Office of Minority Health, which is a an aspect or an office of the U.S. Department of Health and Human Services. And this Office of Minority Health was created in 1986. The mission of the office is to improve the health of racial and ethnic minority populations through the development of health policies and programs that will help eliminate health disparities. Now, I would really like to see the equivalent of the Office of Minority Health in Canada. We don't have an equivalent. We have offices, we have structures, but this office is essential to a movement toward health equity for people of African descent living in the United States. And it has tentacles across the African diaspora. Here on this slide is a picture of the current director of the U.S. Office of Minority Health, LaShawn McIver. Next slide. Indeed, the priorities of the Office of Minority Health for this year for 2020 and 2021 are as follows. Supporting states, territories, and tribes in identifying and sustaining health equity, that is the promotion of policies, programs, and practices. Expanding the utilization of community health workers to address health and social services needs within communities of color. And finally, strengthening cultural competence among health providers throughout the country. And I want to talk a bit about that. Cultural competence began with the work of Joseph Bettencourt and Terry Cross in 1989. The definition of cultural competence is a set of congruent behaviors, attitudes, and, to my policy, preference, policies that come together in a system, agency, or amongst professionals that enable them to work effectively in cross-cultural situations. The Nova Scotia user-friendly version is that cultural competence means having the attitudes, awareness, knowledge, skills, and policies to better meet the needs of the people that we serve. It is the context for Hock work from the very beginning when Dr. Josephina Tawa, when Sue Edmonds, and Fran Harper, and I, and MLA, Yvonne Atwell, worked together. It was within this context. And I think that it is important to make this point today. Cultural competence is not about an end. It's not about getting, going to a cultural competence training session for an hour or two, getting the t-shirt and coming out saying you're culturally competent. That is not the appropriate or accurate understanding of cultural competence. It never was. Cultural competence within healthcare comes out of the understanding of healthcare practice that competence is an ongoing lifelong learning process. And so I often say that cultural competence is a journey, not a destination, but standing still is not an option. Today I'm adding that cultural competence is lifelong learning, always striving, but never arriving. Next slide. So you can see that indeed it is a process that begins with cultural sensitivity. That's the very bottom of it and moves from an individual, an organizational, and a system level through awareness, knowledge, skills, and ongoing competence, ongoing competence. Nobody gets there. It is a continuous movement toward learning and applying. And indeed, next slide. It is important to understand within this context that it is necessary for individuals, individual clinicians, for organizations such as, for example, the Nova Scotia Health Organization, the governors of the Nova Scotia Health System, that and indeed for the system, the Nova Scotia Health System writ large that in all of those areas there is an understanding of our history that evolves. There is an understanding of our lived reality that evolves. There is an understanding of our clinical needs, the need for clinical cultural competence that will equip providers with an understanding that diseases and conditions look different, can look different, can behave differently in black bodies than in white bodies, than in indigenous bodies, than in Asian bodies. That there are diseases and conditions that need attention that will support our health, so that that understanding, those clinical needs, be developed on an ongoing basis so that we are served. We inform the system and we are served by the system. And very importantly, cultural competence gets to the point that one size will never fit all. So indeed, it is about having an understanding of our history lived reality and our needs between black people and other populations, but also between populations of black people because what diseases and conditions may look like in African Nova Scotians might be quite different than what they look like in people of African ancestry from other parts of the world. Sickle cell anemia, for example, is one which may show up differently from people who have immigrated to Nova Scotia from sub-Saharan Africa than other kinds of blood disorders that are more commonly seen in Nova Scotia. And of course, I say all of that because of the anecdote that has been passed on, not because we have the data and the evidence that I can prove. So having said that, before I move on from cultural competence, I just want to say that indeed, cultural competence has a clear and comprehensive practice framework. It is still relevant and it is as relevant for professionals, organizations, and systems as the change we seek in each of those. Next slide, please. So we have been resistant to the kinds of atrocities, the kind of mistrust that we've dealt with with the health system over many years. And here are quotes from two black authors from two books. Blacks in particular are stigmatized and discriminated against in a fashion that drastically undermines their social and economic status in Canada. That was from Christensen and Winefield in 1993. And indeed, from Fraser in 2005, perceived as a threat to the white community, Nova Scotia Blacks suffered more severe discrimination than other ethnic minority communities in Canada. And so, next slide, please. The Health Association of African Canadians was born in 2000. It is the only solely health-focused African Canadian organization in the province. It was initiated, or it was established in 2000. And indeed, we have initiated all existing black health programs in Nova Scotia and over 15 black health projects. Without operational funding, we have remained relevant and resilient. Our advocacy is for Nova Scotia and Canadian governments to take health policy action to address anti-black racism and health inequities. So I want to tell you just a few of the programs of which I'm speaking. We were absolutely pivotal in the establishment of the Nova Scotia Brotherhood Initiative. And we advocate and we've been advocating since 2018 for the establishment of the primary health equivalent, a Nova Scotia Sisterhood Initiative. And this was most recently evidenced by the Safe Spaces in Race and Health Talks project, which you might have heard about and seen on CBC television and heard about on the radio, in which we had hairstylists and barbers create the environment for talking about the intersection between race and health and understanding of racism as a social determinant of health. Hock initiated that project, which was funded by the Department of Communities, Culture and Heritage, and we involved black health care providers and black educators as facilitators, because in this process we wanted to build capacity for the expansion of the Nova Scotia Brotherhood Initiative and for the establishment of the Nova Scotia Sisterhood Initiative. Indeed, other aspects or other programs that we have initiated include the matter of black health, many of you would have been familiar where we had black coaches in place who were supporting the management of chronic disease. We were instrumental in the plans group at DAO, which is promoting leadership in African Nova Scotian health and building capacity among students, black students at Dalhousie in the health professions. We wanted to get more of them in and we wanted to support them to success and we still do. We have been the initiators in partnership with the Dartmouth General Hospital Foundation of the TD Bank Heart Health Project, which is taking place as we speak. It is a project that is focused in the Preston Township. We are also Veronica Marsman and I as co-presidents, also the co-managers as you heard in my introduction of the ABSW Hawk COVID-19 response and impact team initiative. These are the programs and the initiatives that are still going and, of course, 15 other projects where we focused work on the social determinants of health, where we wanted to improve the lives of previously incarcerated people in Nova Scotia, many, many projects over the 20 years or almost, well, going on for 21 years since we've been established. Next slide. So indeed, this is an example of our connection to the plans program and indeed this picture was taken on May the 28th, 2017 and you will recognize some of the young gifted and black beautiful health professionals, among them physicians, nurses, social workers, other kinds of health professionals all in this group and we continue to build capacity, support our health professionals, our students as they build careers in health and we look forward to a different day when many of these will be in these people will be in positions of leadership in health administration as well. Next slide. It is important also to let you know that Hawk bought Dr. David Williams to Nova Scotia in 2015. Dr. David Williams is a sociologist and chair of the Department of Social and Behavioral Sciences at Harvard. He developed the early discrimination scale, the most widely used measure of experiences of racism in daily life. He talked about that when he was here and he certainly also talked about unconscious bias. He is the father of unconscious bias in health care. Next slide. Dr. Williams when he was here he asked and answered many questions and what he asked and answered particularly and what he has done in the United States and throughout his career is to talk about what kinds of care and what kinds of inequities exist and still exist for our people and he says or asks what happens when blacks and other minorities get into health care contexts in the United States. Does their race or ethnicity make a difference in terms of the medical care they receive? The report of the IOM released in 2003 was called unequal treatment and what it documented was that across virtually every class of medical procedure from the most simple to the most complex, minorities receive poor quality care and less intensive care. When he was here he was able to share knowledge with across the system and with communities as well. He talked to communities, he talked to clinicians, he talked to government. When I worked at the Department of Health and Wellness we welcomed him to speak to a group of people there, policy people there and he did and indeed he was so impressive and had such knowledge and unfortunately again in my effort to build this case we have no Canadian data to substantiate the findings that he has for the United States. Something that we continue to work on. Deprioritizing sickle cell, the reality of research inequities. Indeed, sickle cell disease and cystic fibrosis are very similar diseases. Both are inherited, painful and short in lifespan but cystic fibrosis receives more research funding per patient. Sickle cell disease is more commonly diagnosed in black people and cystic fibrosis in white people. Sickle cell disease is a group of inherited blood disorders that causes the red blood cells to sickle and people with sickle cell are often stigmatized as drug seeking because the recommended treatment for their pain is associated with addiction. Now, as I have said, Hock was established in 2000. Dr. Itawa had a constant made constant effort to raise the importance of sickle cell screening in Nova Scotia and that didn't take place at the IWK until 2014. To date, we have no numbers on the impact of sickle cell in Canada to prove what is well known to us anecdotally. Next slide. So inequities in pain management, they've talked about these myths about black people feeling pain less intensely, ridiculous as that may sound. It is a widely held myth and studies have suggested that sickle cell patients wait 25 to 50% longer to be seen in the emergency department that there is a dismissal of black pain and indeed that under treatment of black patients pain has been connected to false beliefs. As I've said, in a 2016 study, half of a sample of 222 white medical students said they believe that black people have thicker skin than white people. We do not have Canadian data and research to prove this or to even demonstrate this that these beliefs are held here in Nova Scotia or held here in Canada. But that is a reality from 2016 in the United States. Next slide. So we have ongoing inequity abroad and at home. As late as last year, a nurse reported that immigration customs enforcement ICE, I know you're familiar with that terminology from the United States that ICE was ordering unnecessary hysterectomies on women in a Georgia detention center as late as last year. At home, we know that our sister Lynn Jones has endured racist responses in a Halifax ER. This story has has been documented in the Nova Scotia advocate and I invite you to go and read the full account of her dreadful experience. Her honor man, Francis, had racist responses while she was recovering from surgery at the Dartmouth General. Again, this story and this experience is available. You can read it in its entirety in the Nova Scotia advocate online. But we also have anecdotal evidence of other inequities such as young black men being disproportionately affected by mental health responses that criminalize them for being sick, that they end up being arrested when they are experiencing traumatic health crisis to do with mental health, that black seniors were disproportionately affected by COVID-19, by the infection and indeed by deaths. We don't have data to support what we suspect here in Nova Scotia and it's time we did. Next slide. So when I've talked to you about the matters of black health, resilience and determination, you can see through this presentation the fact that throughout all of this trauma we have been resilient. But we aren't, the struggle continues and we must fight for justice. Equity in medicine requires specific attention to marginalized groups, certainly including our people. Strict adherence to the informed consent requirement, implementing protocols which is another language or another word for policy, implementing policy to counteract racism and unconscious bias and developing more appropriate standards for funding research on the diseases that disproportionately affect our people. Everyone deserves care and no one should be sacrificed for it. So yes, we want medical advances, we need them but we don't want to be harmed by them and these are the words of Alicia Wallace and Alicia Wallace is a woman's rights activist and author and educator from the Bahamas those are her words and certainly we concur. Next slide. So we've mentioned to you about the fact that or I've mentioned to you the fact that my co-manager and my co-president and Veronica Marsman and I are also the co-managing the initiative around COVID-19, the impact initiative and our work continues to support our people who have been hit so hard by COVID. This is from a newsletter that hasn't yet been made public so you kind of have a preview here but our message includes the fact that COVID has impacted our families, our jobs, our incomes, our way of life, our bodies and our minds and our history and lived experience of anti-black racism in all its forms have made it even harder for us to withstand the damage but we have proven that by working together we can get through these difficult times it's that resilience that we have. We have demonstrated it from the grassroots up by making a way out of no way and that is common to black people to find physical, mental and spiritual strength. Next slide. So our determination is actioned as well. We have in-hoc continued from the time of our establishment in 2000 to call on the Nova Scotia government and the Canadian government to collect data with diversity identifiers. Hock is a member of the African Nova Scotian decade of people of African descent coalition often called D-pad and in solidarity we have advocated for the collection of this data as is evident from the U.S. and the Office of Minority Health Experience addressing health inequities and disparities must begin with identifying the nature of these and the groups at risk by collecting information stratified by factors including race, ethnicity and language and access and analysis of this data is essential for evidence-based decisions, health promotion, research, prevention activities and management of chronic disease ultimately equitable health care. Very importantly it must be done with us and not on us with communities of African descent leading collection and governance of information by our people. Next slide. We absolutely need to facilitate, create or sustain culturally competent, culturally specific community driven educational programs, resources and approaches intended to target populations and ensure and to address the social and structural determinants of health and that includes anti-black racism and we require accountability, accountability from the health system in response to decades of recommendations most recently synthesized in the yet to be public Nova Scotia Health African Nova Scotian health strategy. Our sister Rhonda Atwell will be presenting on this on February the 1st that is that strategy but it is yet to be public and we call on Nova Scotia Health to respond to be accountable for the many many well thought out well laid out recommendations we have made to provide care and service with a culturally specific orientation because we know that culturally relevant strategies are essential to meeting our needs to fixing the health system so that becomes more equitable for us. Next slide please. So to leave you I certainly want to show and demonstrate that we're with resilience and determination we did, we did it. We have women in positions of power and influence who have provided policy direction, policy information to Canada and certainly to the United States. Miquel Jean the former, I've just lost my language there but the Governor General of Canada to her honor, May Ann Francis, the former Lieutenant Governor of Nova Scotia to Senator Wanda Thomas Bernard from us and by us these women have come and ultimately for the first time in the history of the United States the Vice President of the United States a Black woman of South Asian descent and she says she shares that her mother had a saying Kamala you may be the first to do many things but make sure you're not the last and indeed that is our task at Hawke your task as Nova Scotians to make sure that these women are not the last women to work toward health equity to work toward all equity for our people and with that I thank you for your kind attention. Thank you. Thank you so very much for that extremely powerful and insightful presentation. We have about well almost 10 minutes for questions so we and we already have a few. I'm going to start with a comment we have a comment from Dr. Romy Schwer she's thanking you for the brilliant and insightful and inciting lecture and then we have also thank you Robert he posted the links to the two stories that were referred to by Sharon in her lecture in the Nova Scotia Advocate and then we have a number of questions just a quick one here somebody's asking where will Ronda be presenting on February 1st. So that is online and and I think if you go to our Hawke website you will be able to find that and and my our Hawke administrative assistant can certainly send the link to to you as well it is a Zoom presentation. It's not posted on our website okay however it is posted on the ANSA calendar online the office of Nova Africa Nova Scotia affairs event calendar online. All right thank you so much. Okay now I'm gonna I'm gonna go through the questions um so one of them um starts by saying those of us taking the seminar series course which is attached to to this talk series read an interesting article about white fragility and the limited tools whites often have to recognize and talk about racism and the limited opportunities there can be to gain those tools through improved interaction bearing that in mind what opportunities exist through uh HAAC or other local groups to jointly engage in policy development around health and its social determinants and importantly to mingle informally. That's that's a lot to unpack so I think that um initially they're absolutely I am a um a supporter and a reader of that white fragility book I think it it provides tremendous insight and and I've spoken about it before in presentations I urge people to read that book because I think it you know it points out um how the lived experience of of uh of black people or people of color um create in them uh a conceptual framework about about our lives and about about equity that isn't easily shared by the white majority but uh so first of all read the book I would recommend that. Second of all what are opportunities for learning um um I think that's kind of what the second part of that question was um opportunities include uh you know the the hawk town halls that that are open to everyone that we've talked about since COVID-19 we've talked about the the importance of of culturally specific approaches to care understanding the disease understanding uh vaccines and so on those are those are ways in which um people can be invited to learn and to share um and uh and indeed we are always having um events obviously during the time of COVID there they tend to be online um but in fact they're all online I shouldn't say tend to be but there there have been opportunities leading up to uh COVID and there will be opportunities please god post COVID um where we will have those events where all people are welcome and uh and that sharing and learning can take place I hope that helps to answer um most of the question. I think so and I think that goes also into um a bit related to um another question that asks if you are offering cultural competency training for healthcare professionals so I think yes well um and indeed I hope that Nova Scotia Health will move forward with that um you can you can be sure that we have suggested that and uh and indeed yes it it would it would make sense always though with the proviso that no training makes somebody culturally confident right so I just I need to keep saying that it's about lifelong learning but the training will give you an understanding and perhaps will will provide you with with a framework to aim for um and uh and really it's it's so important that uh that people begin to see the the importance of change at a system level and at an organizational level as well as an individual clinician level right so so that's that is the the attractiveness uh for me and has been since I started working on cultural competence and and my bio talks about that since you know since the early 2000s is because of that policy component and that system reach so anyway in short yes Nova Scotia Health please let's move forward and do it yeah um thank you we have time for one more question somebody's asking um why is there no acknowledgement of the need for monitoring in the system so professionals can be graded accordingly and therefore individuals who do not meet the required standards uh be deemed unfit to work with minority communities well that is absolutely it's a fabulous question because there is a need for that kind of monitoring and evaluation what get doesn't get measured doesn't count right so we need to see improved practices improved individual and system change um over time and it needs to be monitored it needs to be evaluated and you learn from that it doesn't it doesn't mean that you know for a provider who doesn't sort of get you know get an A plus on all levels that they should they should stop trying it's about when we know we have a benchmark of what we're achieving then we need to we need to then create opportunities provide education and support to to improve to improve practice thank you um so we're going to end here with uh with a comment that I think a lot of us can echo the the sentiment behind it so let's go out to the saying that she had the privilege to work with Sharon Rondine Senator Wanda Thomas Bernard and they are very fortunate to have their knowledge and expertise leaving us in this important work um I think that's a it's a great uh a note to end on and to thank you so much for sharing your knowledge and your expertise with us today um thank you for the over a hundred people who tuned in and um and were interested in in uh this phenomenal work and there is so much more to do but uh we really thank you for uh for leading the way in this uh thank you Sharon thank you Carla for your assistance and thank you Amber for uh providing the live close captioning I thank you so much from the bottom of my heart thank you everyone