K'JIPUKTUK (Halifax) - The North End Matters project is entering its final stage in developing a from-the-ground-up health assessment tool for African Nova Scotians who live in North End Halifax.

The three-phase project represents the first time such a tool will be developed for an African Canadian community — and the first of its kind in Halifax.

North End Matters began in 2010 with a research project by Ingrid Waldron, an assistant professor at Dalhousie University’s School of Nursing. The project focused on “meaningful occupations” in the North End for its Aboriginal and black residents, as well as social determinants of health in the neighbourhood.

The study was followed up with the popular North End Matters live-streamed talk show in 2012, which saw experts from a variety of backgrounds discuss what makes the North End healthy — or unhealthy.

Now Waldron is recruiting participants for the People Assessing Their Health (PATH) process to engage African Nova Scotian North End residents, agency members and business owners in mapping the social determinants of health in their community. The process will in turn be used to develop a Community Health Impact Assessment Tool (CHIAT), which will be applied to North End policies, programs and services in order to make them work better within the neighbourhood.

On Oct. 17, Waldron hosted a meeting at the Halifax North Memorial Public Library to introduce residents to the PATH process and CHIAT. Along with monthly project meetings to update residents, media coverage and other publicity, Waldron is trying to create visibility for the project and encourage African Nova Scotians in the North End to “buy in.” In order for the CHIAT to be successful, she says, residents need to invest in the process.

Her research assistants are currently recruiting PATH participants — youth, adults and elders — for the six- to eight-hour process. Once that happens, hopefully by mid-November by Waldron’s estimation, a committee will put together the CHIAT, which can take as few as four hours.

Rooted in personal history

Waldron arrived in Halifax in 2008 and was soon acquainted with the North End. She found it to be the most accessible and racially diverse urban community in Halifax and was intrigued by its ongoing transformation, particularly with regards to gentrification.

Waldron grew up in Montreal. As a child, she faced racism and discrimination. As an adult, she butted up against “insurmountable employment discrimination.” The effect, she says, was spiritual, emotional and mental.

These experiences also guided her career, which has seen her delve into occupational therapy and, now, nursing with a tinge of sociology. Her work is led by a passion for the issues of inequality and health combined, with a particular focus on racial or ethnically diverse communities.

A telling report

In December 2010, Waldron published “Challenges & Opportunities: Identifying Meaningful Occupations in Low-Income, Racialized Communities in North End, Halifax” with her primary North End Matters project partner, the North End Community Health Centre.

The report studied the main social determinants of health for the African Nova Scotian and Mi’kmaq communities. Its findings, to a certain extent, were unsurprising: race, sexual orientation, disability, culture and age were all internal characteristics that affected residents’ well-being. Meanwhile, neighbourhood, employment and education were external influences, or un-natural characteristics, that affected it as well.

One health influence stood out in Waldron’s findings: “What I found to be perhaps the most significant determinant of health for both Mi’kmaq communities and African Nova Scotians (was) discrimination — discrimination that permeates every institution of society, including employment, labour, health,” she says.

That discrimination, and what Waldron calls the “legacy of oppression” in racialized North End communities, also plays a part in residents’ “meaningful occupations,” the activities that give people a sense of purpose. Waldron found those meaningful occupations to be drastically lacking in the North End.

“When you are not employed or you feel oppressed there is a kind of paralysis, an emotional paralysis or a spiritual impotence, I like to say, where you feel a sense of helplessness and hopelessness, and that prevents you from wanting to engage in any meaningful way in activities,” says Waldron. “So that … ‘cultural depression’ or ‘spiritual impotence’ is very typical in vulnerable communities, where you don’t feel to engage, where you don’t have the energy to engage, where you are lethargic or show apathy and you don’t get meaning from what you’re doing.”

Compounding problems

Waldron also identified two other contributing factors to health that, although likely not news to North End residents, are often ignored by health service and other program providers outside of the community.

One is “neighbourhoodism,” a form of discrimination based on place of residence:

“(The North End is) seen as a neighbourhood with a lot of crime, it’s seen as a neighbourhood with a lot of poverty and it’s also seen as a neighbourhood that is populated by a certain racial or cultural group, particularly African Nova Scotian,” says Waldron. “So when you add ‘race’ onto ‘neighbourhood,’ that can be particularly debilitating for African Nova Scotians who live in the North End …”

Waldron offered the example of people she interviewed for her report who said having a North End address on their resumé lost them a job or an interview. Neighbourhoodism against the North End has also made news recently: the CBC reported in early October that a youth group was denied pizza delivery because of its location on Gottingen Street.

People’s misconceptions about the North End might be changing. As it gentrifies, Waldron says neighbourhoodism is slowly fading away. But with that transformation come other health-impacting factors. Waldron says that certain people, many of African Nova Scotian descent, are already feeling pushed out as rents rise and the makeup of the area changes. Housing, displacement and the fragmentation of community all influence health, says Waldron, pointing to the continuing effects of Africville as an example.

“I think it’s important to note that all communities come with a sense of history and the North End has a specific history that is both located in class (and) race, and those two variables alone really indicate people’s accessibility to appropriate, culturally competent health care,” says Lana MacLean, a social work clinician and member of Cultural Clinical Consultants, who participated in the North End Matters live-streamed talks.

MacLean says that the North End Community Health Centre has been a model for culturally competent health care on a provincial, even national, level. It is sensitive to, and understands, the neighbourhood’s distinct health-care needs — not to mention it has a diverse staff, whereas the relatively nearby IWK and Capital Health do not.

“People have different ways of communicating, acknowledging and expressing their health and wellness concerns, specifically how they identify mental illness and mental wellness from a culturally specific lens,” she says.

Determining that lens, and applying it to health services and other programs in the community, is where the PATH process and CHIAT come in.

Developing a health — and empowerment — tool

The PATH was developed in the mid-1990s and first applied in eastern Nova Scotia. The CHIAT followed in the early 2000s thanks to the newly created PATH Network, and partners the Antigonish Women's Resource Centre, St. Francis Xavier University and Public Health Services. These tools have seen success in Antigonish County, Pictou County, the Town of Canso and as far away as India. St. Francis Xavier University now has a two-week course at its Coady International Institute to train PATH facilitators — a graduate of which is helping with North End Matters.*

The PATH process picks residents’ brains for determinants of health in a particular community in order to develop a toolkit, the CHIAT. This guidebook of sorts articulates the important elements of what is needed and what works in the community. In principle, the CHIAT, once developed, will be applied to all incoming interventions, programs, services and even businesses.

The CHIAT doesn’t only ensure that more successful interventions occur in a community, it also empowers its residents, says Waldron.

“When you have that kind of history (of oppression), you often feel silenced, you often feel like you don’t have a say, you often feel that you lack privilege, you often feel that you lack power,” says Waldron, pointing to gentrification as example of something that is happening around African Nova Scotians in the North End without their consent.

“(The CHIAT) gives them a say in what’s happening around them; they don’t feel like things are happening to them, they’re part of the process and for a group that’s been silenced or oppressed, who feel vulnerable, that’s powerful because it then becomes an empowerment tool.”

Despite its narrow focus, Waldron says this tool’s effects will ripple out across Halifax. Neighbourhoodism tends to be connected with thinking about communities — and their problems — in isolation. But the North End’s health, in every sense of the word, has serious implications for all of Halifax, says Waldron.

“Most people don’t recognize that inequality or disadvantage affects them … you think that it’s not about you and you think that it has nothing to do with you,” she says. “In reality, however, when members of our community … are struggling with some of these issues, it impacts everyone.”

MacLean agrees: “You can’t have a thriving, integrated community if there’s a branch of that community or a segment of that community whose health and wellness needs are not being addressed or whose social and economic needs are not being addressed.”

Reservations and moving forward

Despite her optimism, Waldron makes it clear that the CHIAT is not some magical tool that will automatically heal the North End.

Two things need to happen in order for the CHIAT to be successful. First, the community needs to accept the tool and apply it. That’s where community partners like the North End Community Health Centre, Halifax Community Health Board and an African Nova Scotian advisory committee come in. This team will carry the CHIAT forward once it has been developed and Waldron takes a step back.

Second, the community must press outsiders looking to implement a program/service/intervention/business in the North End to abide by the toolkit. While Waldron says there is nothing preventing outsiders from ignoring the CHIAT, she says that if the project partners and the community rally behind it, they’ll be a force to reckon with should someone want to ignore the toolkit’s suggestions.

MacLean adds that she hopes the toolkit moves the North End away from “parachuting in” projects and people, and instead toward long-term investments in the community.

While Waldron’s initial report focused on African Nova Scotians and the Mi’kmaq in the North End, the resulting CHIAT will be tailored to African Nova Scotians as it must target a specific community.

That said, North End Matters doesn’t have to end with this one toolkit, says Waldron. She envisions the PATH process being introduced to a variety of marginalized communities across Halifax. A member from a Halifax agency outside the North End has already contacted her about creating a toolkit for her community.  The PATH Network, based in Antigonish, helps to oversee the use of this tool in a variety of circumstances.*

If you’re interested in learning more about the final phase of North End Matters, want to participate in the PATH process or simply keep track of the project, visit its Facebook page. Monthly and special events are regularly posted to the Halifax Media Co-op website.

*CORRECTION: An earlier version of this story omitted the origins of the PATH and CHIAT.