Allison Needham (Photo by Katie Cooper)

By Natalie Leung

Racism and discrimination create significant barriers to people accessing health services. Building and establishing a culture of equity and anti-oppression within a health centre’s workforce is critical to championing psychological and physical safety, feelings of belonging and more equitable patient care. Recognizing this, Unity Health Toronto is developing and implementing an anti-racism, equity and social accountability strategy – and a key step is finding the right leader to steer this transformational change across the network.

As the first Director of Anti-Racism, Equity and Social Accountability at Unity Health Toronto, Allison Needham’s work will support the organization’s priority of creating a more equitable and anti-oppressive space for staff, physicians and patients.   

We sat down with Allison to learn about her role, where she draws inspiration and why she needs everyone’s help.

What drew you to this role?

If you ask a younger version of me if I had set out to focus on equity and race, I would probably say no. But if I look at the things that I have done, I can see that a view to champion equity was sprinkled throughout my journey. I grew up in Newmarket at a time where there was almost no one who looked like me. My parent’s best efforts to get me into the most academic public schools and to make sure I always looked well put together did not save me from being called the N word in the school yard or being told a teacher that my career aspirations would most likely not come true. In high school, I used my English projects and portfolios to discuss Black misrepresentation on television. I used my volunteer hours to raise funds and consciousness for anti-viral medication and social support for communities with HIV. I see that this was the seed of my approach to equity and social accountability work in my life: interrogate systems and make change right where you are – do the [equity and social accountability] work while you do the work. I’ve carried this attitude with me throughout my formal education and my career in health care. What an incredible opportunity to now do this work formally and to make transformational change across our sites.

Do you have any specific goals or priorities in your first few months?

This role is about strategically implementing change across our sites. I have worked at Unity Health for four and half years and have had the pleasure of knowing St. Joseph’s intimately. I want to get to know the people and culture at St. Michael’s and Providence too. The ways we interact with and acknowledge others and our norms all feed into systems of power. If we want to deconstruct the systems of power, we need to know how they function first.  This means also getting to know our policies, processes, and structures in key places like patient experience, and human resources.

Last year, the organization established Black and Indigenous patients, staff and physicians as priority groups. One of our first initiatives will be holding closed forum conversations for Black staff. Having forums for Black staff only will allow participants to hear from each other and heal. When it comes to race and discrimination, sometimes it is easier to have difficult conversations with people who look like you first before you talk to other people. These discussions will inform our strategy and help us determine the low hanging fruit that we can address as well as the larger long term work that we can prioritize. It is also Indigenous History Month in June.  I would like to see Unity Health do something meaningful to recognize the achievements and history of Indigenous people and to support Indigenization across our sites.

The health care system and society at large has not always paid attention to how factors like race, gender, orientation or accessibility play a part in how people are able to get well. We do not have a template to take and apply to Unity Health. This means we have a lot of room to learn, grow and build partnerships. We will never get the work done as fast as we want, but we need to be thoughtful if we want lasting impactful change. 

Do you have advice for those who want to learn, but are afraid of offending others?

I encourage people to think about this like anything else on their learning journey. It often starts with discomfort, but with feedback and the humility to receive it, we are able to improve. For those who feel like they do not have enough baseline knowledge, approach it like an academic topic. Go online and research or read a book. Educate yourself on the basics, like terminology and a high-level overview of history and some of the struggles equity-seeking groups are facing. Go deeper and dig into the structural systems that support inequity – this is so much more than overt racism and discrimination- its structural and internalized too. Consider buddying up with a colleague who is more familiar with the space and can offer you feedback as you start to take action. It is unfair to put the burden on people who are already experiencing oppression and say, “You need to teach me too.” Take on the responsibility yourself.

What do you like to do in your free time?

One hobby that has developed during COVID is hiking. I was not an outdoor person but the outdoors was what we had and it has become a place of great joy. I am not a winter person either, but I bought ice spikes to keep hiking this winter. I also love to sing. I like the power singing and music has to move people’s hearts, including my own.

What are some of the biggest challenges to achieving equity in health care?

One of the biggest challenges is resources. Historically, the health care system often did not put focused attention to factors like gender, race, orientation and accessibility. By providing resources to this work, it is a signal that equity is necessary and a priority. The only way we at Unity Health can meet our mission and vision is to focus on places that have inequity and racism so that we are truly providing the best care experiences for everyone. Another challenge is understanding how power systems have created inequity. If we try to dismantle systems without understanding how they are motivated, we will simply shift inequity without getting rid of it.

Where do you draw your inspiration?

I get my inspiration spiritually – I feel moved by forces like Love. I cannot lead anyone or respond to a patient without having love in my heart for them. Love for others, love for myself and love for my community is what pushes me to try to see change. Spiritually, I feel transformed by love, and that transformation is what gives me the energy to do justice work. It is not easy to come against a well-established system of oppression and try to pull it apart. When working with people who do not always know how or want to see change, having love for them allows you to be honest and lead with patience. I am most effective when my anti-oppressive practice is rooted and grounded in love.

Is there anything else you would like to add?

It will not just be up to myself and other leaders to create the change we want to see in the organization. It is going to take all of us. I am not patient facing and I won’t sit on every hiring panel. Even if we put policies, procedures and education and training in place, the experience patients have are with frontline workers and the experience staff have are with their teams and supporting departments. We have to implement these changes across the board so that anyone who comes here has a sense of belonging. It is not enough to be diverse or inclusive. We need to create an environment where as soon as people walk through the door, they feel like they belong, they can be safe here and they want to come back. This involves all of us.