|Micro Level Application|
Actions are carried out at community or local level
Equity Issues in Healthcare Accessibility
|Examples of Possible Actions|
|Point of Application||Discredit||Distract||Disregard||Acknowledge||Illuminate||Disrupt|
In an encounter between a public health nurse (PHN) and an Indigenous woman seeking care for an injection-related abscess, the client expresses anger about her treatment at an emergency room, saying she will never return.
|The PHN tells the woman that her recall of the experience was likely inaccurate because of her drug use.||The PHN ignores the woman’s comment and suggests that the she consider treatment for substance use.||The PHN continues to assess the abscess, pretending not to hear the comment.||The PHN continues to assess the abscess, saying, “I know. Many of our clients encounter discrimination in hospitals.”||The PHN provides a safe place for the woman to describe what happened and how it affected her, then invites reflection about the issue of system-wide discrimination in hospitals with colleagues in public health.||Recognizing the damaging impacts of structural violence, the PHN provides a safe place for the woman to describe what happened, how it affected her, and supports the woman to document the encounter in a patient quality care report.|
An emergency room manager develops a unit-level policy for triage encounters.
|The policy requires triage staff to approach people appearing to be street-involved with extreme caution because of their violent, unpredictable nature, describing “street-involved” people as “often Aboriginal”.||Arguing street-involved people often leave prior to receiving care, the policy requires staff to offer street-involved persons treatment for substance use during triage.||The policy is silent on discrimination, focusing on procedural rules for what food or clothing staff are permitted to give to street-involved patients.||The policy begins with a purpose statement acknowledging evidence of the impact of racial discrimination on the willingness of street-involved people to seek emergency care, even during critical illness.||The policy expands upon the purpose statement described in ‘acknowledge’, requiring staff to ask and respond to patient safety concerns and access to food and shelter prior to discharge.||The policy focuses on integrating cultural safety in the emergency room through required training, staff.|
A team of researchers prepare a proposal to identify patterns of healthcare services use among street-involved persons in a community.
|The proposed study identifies genetic patterns among a group of ‘frequent visitors’ to a local emergency room.||The proposed study identifies street-involved people’s healthcare literacy, particularly in understanding when to access alternate services.||The proposed study identifies healthcare service use patterns using postal code data to estimate income by neighborhood, where an absent postal code is categorized as ‘street involved’.||The proposed study identifies healthcare services use among street-involved persons, including asking questions about experiences of racial and poverty discrimination.||The proposed study identifies experiences of structural violence and includes a direct commitment to knowledge translation planning in its design.||The proposed study identifies experiences of the impact of a cultural safety training intervention offered to employees and leadership in hospital settings.|