Health of Racialized Canadians

Health Status of Racialized Canadians

• Chapter examines racism and health status of Canada's racialized groups, ethnicity and immigrant health
• Racialized group members will comprise 29-32% of all Canadians by 2031
• Health inequities among racial minorities are significant
• Individuals reporting racism experience higher rates of illness
• Perceived race-based discrimination is linked to higher blood pressure, hypertension, cardiovascular, respiratory, and pain issues
• Racialized groups have more unmet health needs than non-racialized groups
• Adverse health outcomes are associated with discrimination, including racial discrimination which can result in poor physical/mental health and risky lifestyle behaviours
• Black women in Nova Scotia experience diabetes, cardiovascular disease, HIV/AIDS, and mental health issues
• Nearly 20% of Canadians identify as a "visible minority," with 3 in 10 born in Canada
• A growing body of research connects racism and poor health
• "Race" is a social construct, not based in biology and despite being scientifically discredited, people are grouped by selective characteristics
• Racism, regardless of intent, perpetuates race-based biological differences and supposed superiority of one group over another
• Racism occurs at interpersonal, institutional, and structural levels, racial categories constructed as real, different, and unequal lead to social exclusion

Social Conditions and Health Disparities

• Social and economic conditions have a major effect on health
• There are disparities in health determinants like income, employment, and poverty
• Racialized Canadians have disproportionate levels of poverty, homelessness, inadequate housing, and discrimination
• Racialized Canadians are 3x more likely to be in poverty, at 19.8% compared to 6.4%
• Racialized groups have higher unemployment, lower skill jobs at low pay, and more single-parent families
• Racialized Ontarians aren't Japanese, and tend to have higher joblessness and earn less

Toronto's Ethno-Racial Diversity

• Racialized group members inToronto are likely in neighbourhoods that face higher poverty, limited employment, poor access to transportation, and less access to health and social services
• These neighbourhoods are vulnerable to environmental risks, leading to cardiovascular disease, cancer, diabetes, and respiratory diseases
• Racialized children make up 43% of children in poverty yet only 23% of Ontario's children
• Racialized groups have higher rates of depression, anxiety, and antisocial behaviors
• Childhood racial discrimination has been linked to poor health and development

Social Exclusion and Health

• Inequalities in material conditions result from social exclusion, affecting well-being
• Groups facing social exclusion have higher health risks and lower health status
• Poor jobs and conditions cause injuries, harassment, and toxic exposure
• These groups face discrimination/racism, which underlies social exclusion
• Racism causes high-risk health behaviors like substance abuse, self-harm, negative coping, and delayed care
• Health care providers have potential biases that affect care and health services are Eurocentric
• Racial profiling, racist assumptions, and stereotypes in psychiatry affect intake, assessment, diagnosis, and treatment

Impact of Racism on Health

• Racism has a direct and indirect impact on health
• Racism leads to economic and social deprivation, discrimination, and trauma
• Racism results in depression, psychological distress, hypertension, and high blood pressure
• Inequities in socioeconomic determinants of health lead to structural disadvantages for racialized groups
• Intersectionality is needed to appreciate racism's intersection with dimensions of inequality
• Research on gene mapping and "racially defined" groups raises worries about increasing scientific and societal racism
• Despite "race" being arbitrary, racial taxons have been "medicalized," legitimizing them in medical literature, making way for "racial profiling"
• There is a tendency to racialize and medicalize the risks of infections in socio-economically disadvantaged populations

Canada's Cultural Diversity

• The 2011 NHS data indicates over 200 ethnic origins in Canada but that census counted about 25 different ethnic groups in 1990
• Since 1990, Canada has received around 200,000 immigrants per year
• Focus has increased on the health and illness of Canada's ethnic groups and immigrant population
• Immigrants comprise a large proportion of the population

Understanding Immigrant Health

• Understanding the health patterns and behaviour of the immigrant community is important
• Immigrants, particularly first-generation, are sometimes seen as problematic due to cultural differences in Canada's healthcare system.
• Healthcare service providers face the challenge of addressing needs in relation to the diverse population

Health and Illness as Social Constructs

• Health and illness terms are typically taken for granted but are actually social constructs and they are not objectively defined across cultures.
• Some members of society have more power in defining health and illness, legitimized by so-called medical knowledge
• Dominant cultural model in Canada is biomedicine and physicians/doctors are considered the experts.
• Different cultures have different understandings of health and illness, and experience could affect both their willingness to seek medical attention as well as their ability to access medical services.
• Cultural beliefs and experiences influenced attitudes toward health care, notions of treatment, use of health services, and willingness to report problems

Cultural Influences on Health Beliefs

• Vietnamese believe emotional/physical illness is caused by a duong/am imbalance
• Latinos use the word susto for loss appetite, nervousness or depression caused by shock
• Pain beliefs vary by culture/ethnicity due to significance beliefs
• Former Yugoslavs view medicinal mud baths as having value for treating rheumatism, arthritis, & respiratory problems

Immigrant Health Beliefs and Practices

• Immigrant women only see physicians with serious illness
• They rely on natural and herbal remedies for routine issues
• Anglophone/Francophone Canadian-born immigrants were likely to use primary-care mental-health services/seek specialty mental-health care against Vietnamese, Caribbean, and Filipino who prefer religious leaders or traditional healers
• Cultural factors are involved in mental-health service use among the immigrant groups

Cultural Competence in Healthcare

• Access to healthcare is considered fundamental
• Challenge is ensuring equitable health resources for those with varying cultural characteristics.
• Cultural competency means professional conduct being consistent in diverse cultures
• Delivery of services need to be in the language of those patients
• Linguistic/communication barriers hinder healthcare, especially for persons not fluent in official languages
• Language/ethnic origin are main criteria in choosing healthcare providers
• Limited translation affects the quality of healthcare
• Cultural competence requires culturally appropriate services

Barriers to Healthcare Access

• Cultural/communication barriers are reasons for Pap smear screening underutilization among immigrants and ethnic minorities
• There is a need for hospitals to consider different cultural practices related to childbirth and post-partum confinement
• Eurocentric healthcare orientation in services, insensitive to cultural beliefs and/or cultural discrimination
• Lack of familiarity may impact perceptions of healthcare
• Bias may be present when healthcare services/staff training have ignored differences in culture

Addressing Social Determinants of Health

• Focus on systemic, institutional, and organizational racism in healthcare
• Healthcare equity means more than just removing financial barriers
• Recognize that Western healthcare/medical systems are based on the "universal" human body identity and a lack of social context/identity recognition for those from non-dominant populations
• Need for culturally appropriate care
• A culturally competent health care system needs racially/culturally diverse staff, professional interpreters/translators, acknowledgment of racism, and culturally appropriate educational materials
• All services are needed with consideration against discrimination and disability
• Must go well above and address access barriers for poverty, racism, unemployment, and social exclusion

Conclusion: Integration for Equity

• Canada needs strategies that integrate these two approaches while recognizing equity does not mean treating everyone the same
• Focus is needed on the complex interrelationships between structural factors, ethnicity, racialization, and culture
• Although Canada is multicultural, social exclusion, racism, and disparity is a reality for racialized groups, immigrants, and refugees
• Research also shows racism affects stress, material deprivation, and healthcare access
• Both cultural and structural factors play a large part in healthcare experiences
• Differences in health/illness are important for understanding and treating everyone, whatever social inequalities may exist