Building Equity from the Ground Up

Despite being a medical doctor with 11 years of experience, when Ruksana Rashid immigrated to Canada, she found her employment options limited to low-paying retail jobs.

Although she had come knowing her academic credentials wouldn’t be recognized here, the transition was extremely difficult. 

“Knowing something and experiencing it are two different things,” says Rashid, who ended up applying at eight universities before being accepted into the Master of Health Sciences program at the University of Lethbridge. 

With a master’s under her belt, Rashid has found success as a research coordinator at the University of Calgary. However, she can’t forget the challenges immigrants face. 

“When you come to Canada, your pre-immigration story doesn’t count,” she says. “You face numerous educational, language and cultural barriers. Immigrants also face racism and discrimination.” 

This first-hand experience has motivated Rashid to work to address the gap in resources immigrants face when it comes to their health, education, employment and well-being. 

“Because of my experience, I co-founded a local advocacy group, the Voice of Immigrants in Canada for Empowerment (VOICE),” says Rashid. “We empower the immigrant community through culturally relevant events that provide knowledge and information.” 

Through VOICE, Rashid has worked alongside UCalgary community health researcher, Dr. Turin Tanvir Chowdhury, MBBS, PhD, conducting community-based research within Calgary’s immigrant community. 

“I have learned that making a difference in the community requires people to feel safe,” she says. “That’s why we make sure our events are in places that are easily accessible by our community and comfortable for them.”

The premise behind this approach is that connection is critical – whether providing information or conducting research. It’s an approach that Chowdhury greatly supports. 

For much of his early career, Chowdhury believed the answer to better cardiovascular health lay in knowledge. Like many researchers studying prevention, his work focused on health literacy—helping people understand how to reduce their risk of cardiovascular disease. But after years of studying, he began to see a disconnect.

“Health literacy has been around for decades,” he says. “But it’s not making the impact we hoped.”

For Chowdhury, a member of the Libin Cardiovascular Institute at the University of Calgary, the realization prompted a fundamental shift in how he approached research and how he thinks about equity.

Instead of asking how to better educate communities, he began asking a more basic question: What do people actually need?

Rethinking health behaviour

Through years of community engagement, Chowdhury and his team began to see patterns in how people approach their health. They realized that within communities, people exist along a spectrum of health knowledge and engagement, which can be grouped into five broad categories.

Some people don’t know about the health issue. They lack basic awareness and need exposure to foundational health information. Others know but don’t care. Some know and care but don’t fully understand what they should do to stay healthy. Another group know, care, and understand but struggle to act due to daily life challenges like work demands, financial constraints, or access issues. Finally, there are those who know, care, understand, can act with support, but struggle to sustain healthy actions because of social determinants in life.

The key to meaningful change, Chowdhury realized, lies in recognizing that people are at different stages of awareness and engagement, and they require different types of tailored activities, interventions and support. And as they move into subsequent level in the spectrum, they also need support tailored to that stage.

It isn’t an easy task, but part of the solution lies in a concept known as candidacy—whether someone believes a health service or message applies to them in the first place. For prevention strategies, such as managing blood pressure, improving diet or reducing cardiovascular risk, that perception can make all the difference.

“If people don’t see themselves as candidates for a service, they won’t seek it out,” Chowdhury explains, adding empowering individuals to see themselves as candidates for better health is a powerful way to reduce cardiovascular risk.

Community as partner

Chowdhury’s work focuses largely on racialized immigrant communities, where rates of cardiovascular disease are often higher and individuals face barriers to their health. 

It’s a natural fit for Chowdhury, himself an immigrant. Born and trained as a physician in Bangladesh, Chowdhury later pursued graduate training in health promotion and epidemiology in Sweden and Japan before coming to Calgary for a postdoctoral fellowship in 2010.

As an immigrant, he saw the challenges newcomers face as they struggle to stay afloat financially and adapt to a new culture. Health, particularly prevention, may fall low on the priority list. 

“A large majority of immigrants struggle,” Chowdhury says. “They don’t always have the time or resources to take care of themselves.”

These realities motivated him to focus on community-driven solutions for this population. 

Instead of designing research in isolation, Chowdhury embeds communities directly into the research process, from helping shape the questions and designing the study, to recruiting participants and disseminating results. When he began working with this approach, the community’s response was cautious.

“When we first reached out, people wondered who we were,” he recalls.

But over time, something remarkable happened. Community organizations began approaching Chowdhury’s team themselves asking to collaborate on events, outreach and research projects, something he calls “a huge positive.”

Chowdhury’s model relies on grassroots influencers already trusted within their communities: faith leaders, youth mentors, ethnic media and informal organizers.

This strategy, known as asset-based community development, holds powerful potential to spread health information organically and sustainably. 

From numbers to narratives

Chowdhury’s path into this unique research was unconventional.

Trained primarily as a quantitative scientist, he initially focused on statistical analysis. But as he worked more closely with communities, he realized numbers alone couldn’t capture people’s lived experiences.

So he taught himself new methods, learning community engaged qualitative research techniques and blending them with quantitative analysis to better understand social and cultural influences on health. Not being formally trained in these approaches, he believes, actually helped.

“It allowed me to think outside the box,” he says. “If there’s something that needs to be done, we just figure out how to do it.”

Playing the long game

Today, Chowdhury’s research program spans more than 40 studies and over 300 peer-reviewed publications. It tackles barriers to equitable access to health care, such as social and structural determinants of health, and community health literacy levels with the goal of improving cardiovascular health outcomes for vulnerable groups. 

His work has been noticed. Chowdhury has received numerous awards, including the Inclusion Champions Awards from Immigrant Champions of Canada and the 2022 North American Primary Care Research Mid-Career Researcher of the Year. In 2024, he was ranked among Canada’s Top 50 Cited Primary Care Researchers, an honour that reflects the growing influence of his work.

Yet for Chowdhury, the goal has never been recognition. Instead, he’s focused on impact. 

“It’s a long game,” he says. “Equity is achievable only through sustained partnerships and shared ownership of solutions.”