Canada's infamous health care system may be free of charge for residents seeking essential services, but its riddled with institutional racism that impairs accessibility for racialized members of our community. Due to the subtle nature of racial implicit bias in the health care environment, challenges faced by minority groups are easily overlooked and thus permeated throughout the system.
Studies show that racial biases affect clinician behavior and decisions which in turn affect patient access to health care services and overall health. As a result, minorities struggle with inequitable health care.
Racialized Minorities in Canada (Immigrants, Black and Indigenous).
Recognized as one of the most ethnically diverse countries in the world, Canada is home to over 450 ethnic groups. Although Black Canadians, Indigenous people, and immigrant groups can be categorized as racial minorities, each group faces distinctive challenges with the healthcare system as a result of their unique cultural and historical values.
Black Canadians.
Anti-Black racism is deeply entrenched in Canadian institutions and can be traced back to the transatlantic slave trade which was legal in Canada until 1834. 1"Almost two centuries later, racist ideologies established during these periods in history continue to drive processes of stigma and discrimination." 2
A study conducted in 2016 revealed that medical students incorrectly believe that Black patients have a higher pain threshold in comparison to white patients as a result of having thicker skin or less sensitive nerve endings. This misconception can be traced back to the slave era when such myths were used by physicians to justify violence against slaves. The effects of slavery and Anti-Black racism continue to impact Black Canadians in all areas of life, including their ability to access trustworthy healthcare.
Indigenous Canadians.
Members of indigenous communities and their family members are more likely to face challenges to health due to the legacy of colonialism and systemic racism. Traditional indigenous healing involves wholistic healing which addresses spiritual, mental, emotional, and physical aspects of care. 3 Anti-Indigenous racism in health care systems result in a lack of cultural safety and acceptance of Indigenous health and healing.
The Canadian Medical Association has recognized the importance of incorporating traditional healing and has convened with Indigenous leaders to establish a new goal to combat barriers to health care and uphold Indigenous peoples' right to self-determination and respect Indigenous worldviews, medicine and healing practices. 4
New Immigrants to Canada.
Nearly one of in four people in Canada are immigrants and the number continues to grow as a result of Canada's approach to immigration. 5 Newcomers play a vital role in shaping our communities, and their contribution to our economy has allowed Canada to experience one of the fastest recoveries from the COVID pandemic. 6 Despite the benefits immigrants provide to our community, they are still subjected to culturally insensitive health care that discourages them from seeking medical services.
Racial Biases in Health Care.
A recent study done defines racism as "a power-based social system: a hierarchical relation between White and Non-white populations that produces ill health among Non-whites through economic, political and cultural (ideological) relations. Participants expressed feelings of disrespect or mistreatment when receiving health care, with complaints centered around racial discrimination, dehumanization, negligent communication, professional misconduct and unequal access to health services. 7
Racialized health care users further reported health care providers not completing proper assessments, ignoring patient symptoms, and belittling or talking down to the patient as concerning conduct that require change. 8
Perceived racism in the health care setting is associated with a reduced trust in the health care system, reduced adherence to medical regiments and a delay in health care or not seeking health care all together. Racial implicit biases have been repeatedly demonstrated in systematic reviews of health care providers. 9
Social and economic influences on health include factors such as income and social status, employment and working conditions, education and literacy, childhood experiences, biology and genetic endowment, culture and race.
How to Provide Culturally Sensitive Care.
Patient-centered culturally sensitive medical care is the ideal solution to combat overt institutional racism in the health care environment. Patient centered care conceptualizes the patient-provider relationship as a partnership that emerges from patient centeredness and is patient empowerment oriented. In practice, it would be displayed as a modifiable provider behaviour and attitude that is identifiable by culturally diverse patients as indicators of respect for their culture. Informed consent is compromised when language or cultural barriers are present. Language barriers present a challenge to accessing health care services as "cross-cultural differences in information-seeking patterns, communication styles, perceptions of health risk, and ideas about prevention of disease [have] an impact on health." 10
An individual's culture defines how they perceive their symptoms or illness and how they behave while suffering. Different cultural groups use different "languages of distress" and are subject to the risk of a wrong diagnosis if they're treated by a provider who is unaware of the differences in communication style.
Gluckstein Lawyers is Here to Help All Canadians.
"Racism is systemic. The individual need not personally or consciously do anything to maintain institutional racism but if nothing is done to actively oppose racism, nothing will change." 11 There is a dire need for cultural awareness and sensitivity in our health care system that is currently riddled with overt institutional racism. To acknowledge the need for change would be to recognize our multicultural community and value each and every member of our society.
Footnotes
3 https://iphcc.ca/indigenous-healthcare-blog/
5 https://www150.statcan.gc.ca/n1/daily-quotidien/221026/dq221026a-eng.htm
7 8 9 https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-021-01410-9
10 I. Hyman, "Immigration and Health" Health Policy Working Paper Series (Ottawa: Minister of Public Works and Government Services Canada, 2001) at 111.
11 K.R. Mock & A.S. Laufer, Race Relations Training in Canada: Toward the Development of Professional Standards (Toronto: Canadian Race Relations Foundation, 2001) online: Canadian Race Relations Foundation at 10.
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