Confronting Racism within the Canadian Healthcare System: Systemic Exclusion of First Nations from Quality and Consistent Care

Phillips-Beck, Wanda; Eni, Rachel; Lavoie, Josée G.; Kinew, Kathi Avery; Achan, Grace Kyoon; Katz, Alan

doi:10.3390/ijerph17228343

Cited by 75 publications

(92 citation statements)

References 46 publications

(43 reference statements)

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“…These results match the findings of other studies that have documented that experiences of racial discrimination among adolescents are associated with depressive and internalizing symptoms, externalizing behaviours, condom less sex, and having had multiple sexual partners [ 5 , 12 , 35 , 36 , 45 , 51 ]. Hence, there is a need to address not only interpersonal racism, but also all forms of systemic racism and barriers that continue to jeopardize the health and well-being of Black Canadian adolescents, and other racialized groups in Canada [ 18 , 38 ]. Governmental and non-governmental actions are needed to promote antiracist laws, regulations, and policies as well as attitudinal change at multiple levels of the society that will reduce the social and health inequities experienced by Black Canadian adolescents.…”

Section: Discussionmentioning

confidence: 99%

Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis

Okoye

Saewyc

2021

Int J Equity Health

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Background We assessed the prevalence and trends in racial discrimination among African Canadian adolescents in British Columbia. The association between racial discrimination and self-rated health, access to mental health services, substance use, suicidal thoughts and attempts, experience of extreme stress, among others were examined within the 2018 dataset. Methods Secondary analysis used the data collected from African Canadian adolescents (n = 2448) as part of the British Columbia Adolescent Health Surveys (2003–2018). We examined whether racial discrimination increased, decreased, or remained stable over time. We evaluated experiences of racial discrimination for all adolescents, and then disaggregated analyses for boys, girls, immigrant, and Canadian-born African adolescents. We used Rao-Scott’s adjusted chi-square to test differences in racial discrimination and adjusted logistic regressions to test trends across survey years, widening or narrowing gaps in racial discrimination, as well as the link to health outcomes. Results Racial discrimination was significantly different across the survey years (Adjusted F = 4.60, p < .01), with the highest percentage of adolescents reporting past year racial discrimination in 2018 (29.9%) and the lowest percentage in 2013 (21.3%). Girls and immigrant African Canadian adolescents were more likely to have experienced racial discrimination. However, girls and Canadian-born adolescents had the highest odds of reporting racial discrimination in 2018 compared to 2003, AOR = 1.85, and 1.58, respectively. The findings reveal significant differences in the experiences of racial discrimination for boys and girls, as well as for immigrant and Canadian-born African adolescents. Significant differences were noted in the link between racial discrimination and self-rated health and engaging in behaviours that might expose them to health risks. The worst negative health outcomes were found for boys and immigrant African Canadian adolescents. Conclusion The study suggests that more than 1 in 4 African Canadian adolescents in British Columbia report racial discrimination, which is an increasing trend in recent years. Those who reported racial discrimination also had the worst adverse health outcomes. There is a need for more public health action to reduce racism, create awareness about the negative health impacts, and provide better support for African Canadian adolescents.

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Section: Discussionmentioning

confidence: 99%

Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis

Okoye

Saewyc

2021

Int J Equity Health

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“…In another recent study which examined the Canadian health care system, several mechanisms of racism which contributed to the unequal access and quality of care of Indigenous health care users were identified. These mechanisms included navigating a system that devalues Indigenous health and wellness, a preference for English and biomedicine, and a lack of consideration for social and economic obstacles to health care accessibility [69]. Behaviours in which racialized patients are viewed as inferior by health care providers are in keeping with the ideology of a racial hierarchy or ideological racism.…”

Section: Discussionmentioning

confidence: 99%

Experiences of everyday racism in Toronto’s health care system: a concept mapping study

Mahabir

O’Campo²,

Lofters

et al. 2021

Int J Equity Health

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Background In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto’s health care system. Methods This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. Results Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: ‘Racial/ethnic and class discrimination’, ‘Dehumanizing the patient’, ‘Negligent communication’, ‘Professional misconduct’, and ‘Unequal access to health and health services’. Two distinct conceptual regions were identified: ‘Viewed as inferior’ and ‘Unequal medical access’. From the rating activity, racialized health care users reported ‘race’/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include ‘when the health care provider does not complete a proper assessment’, ‘when the patient’s symptoms are ignored or not taken seriously’, ‘and ‘when the health care provider belittles or talks down to the patient’. Conclusions Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.

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“…Around the world, different and shared experiences of racism, including systemic racism, continue to adversely impact the health of Indigenous peoples [ 38 , 39 , 40 ]. Long-term structural inequities continue to play out at the point of care, where negative experiences inform Aboriginal people’s level of trust of the health systems [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“You Can’t Work with My People If You Don’t Know How to”: Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease

Blignault

Norsa

Blackburn

et al. 2021

IJERPH

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Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital–community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.

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Confronting Racism within the Canadian Healthcare System: Systemic Exclusion of First Nations from Quality and Consistent Care

Cited by 75 publications

References 46 publications

Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis

Fifteen-year trends in self-reported racism and link with health and well-being of African Canadian adolescents: a secondary data analysis

Experiences of everyday racism in Toronto’s health care system: a concept mapping study

“You Can’t Work with My People If You Don’t Know How to”: Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease

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