1. Introduction

I chose Access Alliance Multicultural Health and Community Services (Access Alliance) to research an assignment for this course as I am interested in social integration of immigrants and refugees. This is what I did in my country and I would like to do in the future as well.

 

Access Alliance explains itself that;

Access Alliance Multicultural Health and Community Services provides accessible, community-governed, inter-professional, primary health care services, including health promotion, illness prevention and treatment, chronic disease management, and individual and community capacity building.

 

“AccessPoint on Danforth Program Calendar – October 2017,” Access Alliance, accessed October 20, 2017, http://accessalliance.ca/wp-content/uploads/2017/10/Danforth-October-2017.pdf

Although it has several centres in the city of Toronto, I would like to focus on one of them called AccessPoint on Danforth. It is the largest centre among them, at the same time I currently live within walking distance from there and feel familiar with the neighbourhood.

2. History and Background of Access Alliance

Since opening its doors in 1989,

Access Alliance has been working to promote the health and well-being of immigrants and refugees in Toronto through a social determinants of health approach that addresses medical, social, economic and environmental issues. Originally focussed on four ethno-cultural communities in response to their identification of significant barriers to services for immigrants and refugees, Access Alliance has since expanded its mandate by undertaking ongoing needs assessments and looking at its role within the sector of immigrant and refugee serving agencies and other community health centres in Toronto.

 

“Access Alliance Multicultural Health and Community Services,” Community Knowledge Centre, accessed October 20, 2017, http://ckc.torontofoundation.ca/org/access-alliance-multicultural-health-and-community-services

 

Access Alliance holds up its vision and mission below.

Our Vision:

Toronto’s diverse communities achieve health with dignity.

 

Our Mission:

Access Alliance provides services and addresses system inequities to improve health outcomes for the most vulnerable immigrants, refugees, and their communities.

 

“About us,” Access Alliance, accessed October 20, 2017, http://accessalliance.ca/about-us/

 

Its current strategic directions are:

• Promote the successful long-term integration of Immigrants and Refugees through targeted advocacy regarding key systemic issues and collaboration.

 

• Engage local communities to address issues that impact their lives by mobilizing community assets, building capacity and creating connections.

 

• Ensure service excellence by pursuing funding strategically and by applying evidence, inter-professional practice and effective partnerships in service and program delivery.

 

Community Knowledge Centre, “Access Alliance Multicultural Health and Community Services.”, http://ckc.torontofoundation.ca/org/access-alliance-multicultural-health-and-community-services

 

Access Alliance made impacts below in 2016-2017:

Number of clients by site: Total 15,443

• 21.4%(3,302): College
• 34.8%(5,376): AccessPoint on Jane (APOJ)
• 43.8%(6,765): AccessPoint on Danforth (APOD)

Research and Advocacy

• Helped advocate for $ 15 minimum wage and decent work legislation (Bill 148)
• Identified best practices in refugee health and settlement services based on Syrian refugee response

Client Experience Survey

• 94% clients strongly agreed or agreed that they would refer Access Alliance to their friends or family members.
• 91% clients thought that Access Alliance had a positive impact on their community.
• 89% clients thought that the programs and services at Access Alliance helped improve their overall health and wellbeing.

 

“2016-2017 Annual Report,” Access Alliance, accessed October 20, 2017, http://accessalliance.ca/annualreport/

3. Type of Non-profit

Considering the above, Access Alliance is supposed to be categorized a public benefit organization, and also a health-related organization in a fine classification.

 

It is managed by a voluntary Board of Directors who is responsible for creating the organizational vision, and setting policies that will support achieving our mission.

 

Its board is comprised of individuals who:

 

• Understand social determinants of health and their impact on newcomers;

 

• Understand the role of community health centres;

 

• Have experience with or an understanding of the role of a community-based Board of Directors;

 

• Commit a minimum of 6 hours per month to the organization;

 

• Live or work in the City of Toronto.

 

“Board of Directors,” Access Alliance, accessed October 20, 2017, http://accessalliance.ca/about-us/board-of-directors/

 

According to the BY-LAW (Version 11), the affairs of the Access Alliance are

managed by the Board of Directors, and the Board of Directors are composed of twelve directors.

The Executive Director attends meetings of the Board in an ex-officio capacity.

The Board annually, or more often as may be required, elects from among its number an executive committee consisting of no fewer than four members, consisting of the chairperson, vice-chairperson, secretary and treasurer.

 

“BY-LAW (Version 11),” Access Alliance, accessed October 20, 2017, http://accessalliance.ca/wp-content/uploads/2015/03/2014-By-Law-Version-11-Approved.pdf

 

4. Environmental Scan

4.1 Socio-Demographic Shifts

The information for the Table-1 below <Socio-Demographic Shifts> comes from a review of the 2011 census data for the Taylor-Massey (former Crescent Town) neighbourhood and Oakridge neighbourhood.

These two are the closest neighbourhoods from APOD. Both Taylor-Massey and Oakridge have a high percentage of racialized groups compared to the City of Toronto.

Above all, immigrants who were born in Bangladesh are the most in both neighbourhoods.

Table-1 <Socio-Demographic Shifts>

2011	Taylor-Massey[1]	Oakridge[2]
The population	15,594	13,497
Population Change 2006-2011	+ 2.5%	+ 1.0%
Percentage of immigrants who arrived in Canada between 2001 and 2011 (While overall city of Toronto rate is 16%)	35%	30%
Visible Minority as Percentage of Population (While overall city of Toronto rate is 49%)	65%	69%
Top-3 Birth Country for All Immigrants	Bangladesh (2,500) India (820) Pakistan (555)	Bangladesh (2,380) Philippines (840) Other places of birth in Africa (485)
Top-3 Non-Official Home Languages	Bengali (2,345) Urdu (520) Tamil (230)	Bengali (2,060) Urdu (360) Persian/Farsi (270)

^[1] “2011 Neighbourhood Census / NHS Profile, Taylor-Massey, Social Profile #4 – NHS Languages, Immigration, Income,” City of Toronto, accessed October 20, 2017,　https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=cd3bb3d0122c1410VgnVCM10000071d60f89RCRD

^[2] “2011 Neighbourhood Census / NHS Profile, Oakridge, Social Profile #4 – NHS Languages, Immigration, Income,” City of Toronto, accessed October 20, 2017, https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=2bd9addfbd6e1410VgnVCM10000071d60f89RCRD

4.2 Health Status Findings

See the Table-2 <Prevalence of chronic health conditions> below. Taylor-Massey and Oakridge neighbourhoods experience the highest prevalence of all chronic conditions, including diabetes, high blood pressure, chronic obstructive pulmonary disease (COPD), and mental health visits. Especially the ratio of mental health visits among youth and children aged 16-25 in Taylor-Massey is extremely high.

Table-2 <Prevalence of chronic health conditions>

The following information was retrieved from the Ontario Community Health Profiles Partnership website. Health status compared to the city of Toronto, in Taylor-Massey and Oakridge neighbourhood there are (rate ratios were created by dividing the local area rate by the City of Toronto aggregate rate);

Health Topic Category	Taylor-Massey	Oakridge
Diabetes Age-Standardized, All Ages 20+ (2014/15)	1.26	1.47
High blood pressure Age-Standardized, All Ages 20+ (2014/15)	1.09	1.24
COPD Age-Standardized, All Ages 20+ (2014/15)	1.14	1.12
Mental Health and Addiction-related Visits Age-Standardized, All Ages 20+ (2014/15)	1.33 (1st highest ratio among all 140 neighbourhoods in Toronto)	1.24 (4th highest)
Average annual rate of Emergency Department visits that are Mental Health and Addiction-related visits, Youth and Children aged 16-25 (April 1st, 2012-March 31, 2015)	4.21 (1st highest, twice higher than the second highest neighbourhood)	1.31

“Data – LHIN 7 (Toronto Central and City of Toronto),” Ontario Community Health Profiles Partnership, accessed October 20, 2017, http://www.torontohealthprofiles.ca/ont/dataTablesON.php?select1=7#

4.3 Economic Findings

See the Table-3 <Low household income> below.

And it is said that:

Low income groups in Toronto often have worse health. For the most recent years of data available, low income groups had significantly worse health than higher income groups for 20 of 34 indicators of overall health and wellbeing, chronic disease, communicable disease, reproductive health and health behaviours.

 

“The Unequal City 2015,” City of Toronto, accessed October 20, 2017, https://www1.toronto.ca/City%20Of%20Toronto/Toronto%20Public%20Health/Performance%20&%20Standards/Health%20Surveillance%20and%20Epidemiology/Files/pdf/The%20Unequal%20City%202015_AODA.pdf

Table-3 <Low household income>

In 2011	Taylor-Massey[1]	Oakridge[2]	City of Toronto[3]
Median After-Tax Household Income	$37,875	$32,079	$52,149
Average After-Tax Household Income	$45,283	$41,303	$70,945
Percent of Population in Low Income (LIM-AT)[4]	35%	40%	19%

[1] City of Toronto, “2011 Neighbourhood Census / NHS Profile, Taylor-Massey, Social Profile #4 – NHS Languages, Immigration, Income.” https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=cd3bb3d0122c1410VgnVCM10000071d60f89RCRD

[2] City of Toronto, “2011 Neighbourhood Census / NHS Profile, Oakridge, Social Profile #4 – NHS Languages, Immigration, Income.” https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=cd3bb3d0122c1410VgnVCM10000071d60f89RCRD

[3] City of Toronto, “2011 Neighbourhood Census / NHS Profile, Taylor-Massey, Social Profile #4 – NHS Languages, Immigration, Income.” https://www1.toronto.ca/wps/portal/contentonly?vgnextoid=cd3bb3d0122c1410VgnVCM10000071d60f89RCRD

[4] Low-Income Measure (After-Tax) / LIM-AT The Low-income measure after tax (LIM-AT) is a fixed percentage (50%) of median adjusted after-tax income of households observed at the person level, where ‘adjusted’ indicates that a household’s needs are taken into account.

4.4 Federal/Provincial Policy & Legal Trends

According to the official website of the Ontario Government,

In April 2017, the federal government introduced legislation to legalize and regulate recreational cannabisin Canada starting July 1, 2018. If passed, the proposed Cannabis Act would create rules for producing, using and selling cannabis across Canada. We will propose to make it illegal for people under the age of 19 to buy, sell, have, share and grow cannabis. 

“Cannabis legalization”, Government of Ontario, accessed October 20, 2017, https://www.ontario.ca/page/cannabis-legalization

The Government of Canada welcomed 40,081 Syrian refugees between November 4, 2015 and January 29, 2017. And the government said that its commitment to resettling Syrian refugees to Canada continues in 2017.

“Welcome Refugees: Key figures,” Government of Canada, accessed October 20, 2017, http://www.cic.gc.ca/english/refugees/welcome/milestones.asp

4.5 Technological Shifts

The most popular messaging app in Canada 2016 was Facebook’s Messenger, and in Bangladesh as well.[1]

And also Canadians love using social media in 2016 and Facebook continues to be the social network they use most.[2]

[1] “The Most Popular Messaging App in Every Country,” THE MARKET INTELIGENCE BLOG, accessed October 20, 2017, https://www.similarweb.com/blog/worldwide-messaging-apps.

[2] “Canadian Social Media Use and Online Brand Interaction (Statistics),” Canadian Internet.com Business, accessed October 20, 2017, http://canadiansinternet.com/2016-canadian-social-media-use-online-brand-interaction-statistics/.

 

5. Strategic Issues

From the general view, Syrian refugees come first as an emergency community. At the same time, in view of the world-wide conditions, any other countries’ refugees possibly come suddenly following Syrians. Therefore, commitment to the refugees’ communities is the most significant issue.

 

On the other hand, focusing on APOD, immigrants who were born in Bangladesh are supposed to be the majority part of the clients there. Although the latest socio-demographic data has not been issued yet, it is necessary to scan it when it would be issued.

 

Moreover, it is worthy of notice that the ratio of Mental Health and Addiction-related visits, especially the ratio of children and youth aged 16-25 in Taylor-Massey neighbourhood is extremely high, rather than others (see Table-2 above). It is necessary to take measures to meet the situation as needed to assess the cause background. The needs related to the mental health and addiction in this area including Oakridge neighbourhood are definitely high, so the measures are supposed to be implemented as priority.

 

Furthermore, to watch the condition to be legalized using marijuana in Ontario is also required. As described above, Taylor-Massey and Oakridge are vulnerable neighbourhoods in the mental health and addiction context, so providing the correct information and education is required to save the children and youth from the abuse of drugs.

 

Using the ICT would be effective for these digital native generations. According to the data above, Facebook is the most popular as a messaging and social media app among the people in Canada and also Bangladesh. Therefore, finding the possibility of providing information and education is required. In addition, making the cost-effectiveness better is also significant. For example, it is supposed to be possible to ask Facebook to corroborate to start a campaign that is low cost or free.

 

It is important to assess APOD’s impacts on the health condition of the residents concretely so far since opening its door in 2010. An assessment team should be built when the new data being issued by Ontario Community Health Profiles Partnership. Implementation of effective and reasonable measures on APOD which are used among most people among its centres is a significant issue for Access Alliance.

6. Conclusion

The number of immigrants and refugees are increasing, and their needs are getting bigger and more complicated. I am extremely happy to have an interview with the executive director who shows leadership for such a difficult mission. I would like to absorb her insights as much as possible.

 

Toronto as an international society formed by immigrants would be a picture of the future of Japan which is declining the birthrate and aging population. I hope to learn the know-how and insights from Access Alliance and utilize them to take leadership and promote the health and the better life of immigrants who would come to Japan in the future.