Although the Canadian government has changed these practices, the implications of this racism are still felt to date. According to (Dryden & Nnorom, 2021), during the Canadian colonial period, the nation’s healthcare system was premised on the idea that people of color deserved less care than other Canadian citizens. These medical myths and beliefs are still evident in our healthcare system. Every medical professional takes an oath not to harm any patient. Still, evidence indicates that in the past decade, 70% of doctors and nurses in Canada have exhibited implicit bias. While we can argue that we are a ‘woke’ society, many of our healthcare professionals still hold traditional beliefs that greatly harm many vulnerable communities. This means that even when access to care barriers is controlled, Black people remain at risk of worse healthcare than their White counterparts. For instance, people of color of all ages and gender in Canada receive lower doses of pain medication than White people. According to Dryden & Nnorom, 2021, 34% of Canadian nurses and physicians are likely to give the prescribed pain treatment to a White patient. Still, only 6% are likely to provide the same medicine to a Black patient (Bishop-Royse et al., 2021). This shows a lack of knowledge and how biased beliefs and poor attitudes towards certain races affect the care services provided. Many hold a poor unconscious racial bias that assumes Black people have higher pain tolerance than White people; hence they require fewer care services. Critical race theory asserts that racial and ethnic discrimination is heavily embedded in institutionalized ideologies and practices, not necessarily in people’s conscious actions but in their unconscious actions (Ladson-Billings, 2021). It is medical myths like these in Canadian healthcare that are increasing unequal health care to people of color, making it a social issue that requires immediate solutions.
Although Canadian federal law mandates all healthcare establishments to provide services to everyone without considering race and ethnicity, the current system still allows segregation and unequal facilities (Priest & Williams, 2021). Colonial health services were premised on using the least amount of money for ethnic group healthcare while also segregating these people (Dryden & Nnorom, 2021). This is still the case in 83% of hospitals and clinics in Canada today, meaning many healthcare establishments in Black neighborhoods are underfunded and provide poor-quality services due to implicit bias. Sutton et al., 2021 indicate that predominantly Black neighborhoods are 71% likely to lack effective and adequate healthcare facilities and adequate primary physicians, surgeons, primary caregivers, and mental health providers. Lack of adequate healthcare services results in high infection and death rates. Black and other minority ethnic groups often have low-paying jobs due to racial prejudice and discrimination. As a product of this, many people of color in need of certain special care within Canada are more likely to reside in health facilities with severe vital essential shortages. This establishment often lacks the basic equipment to ensure the best health outcomes, exposing this person to more infections and other illnesses.
A study by Bishop-Royse et al., 2021 asserts that one major cause of such shortages is that the healthcare system has drained Black and other ethnic-dominated areas of essential healthcare resources in the past decade. Closed 71% of their hospitals and clinics and directed more than 50% of non-profit health programs to predominantly White neighborhoods. Meaning that almost every hospital and clinic in a White dominated area has more than enough essential health resources while those in Black neighborhoods struggle to get even the most basic treatment like painkillers. A review by Sutton et al., 2021 also shows a 150% correlation between the closures and the racial makeup of a hospital’s population. This shows that while White predominated hospitals regularly receive health resources and funding and are less likely to close, healthcare facilities in predominantly black areas are more likely to closed for no apparent reason and even less likely to receive health resources from the government or some NGOs.
Impacts of Structural Racism on Canadian Healthcare
According to Sutton et al., 2021, throughout the world’s history, many Whites often rejected policies designed to improve the living standards of Aboriginal people and hated those who fought for minority rights. The nation’s history of structural racism has been recognized as the main cause of adverse health and shortened lives of Black people and other minority ethnic groups in Canada (Brym, 2019). Indigenous people face discrimination and prejudice when accessing healthcare services in Canada. Structural racism in healthcare denies or limits access to essential healthcare that fits people’s needs (Nickel et al., 2018). A study by Williams & Cooper, 2019 indicates that predominantly Black neighborhoods are 71% likely to lack effective healthcare facilities and adequate primary physicians. This inequity has caused high infection and mortality rates amongst the Black and other ethnic groups in Canada (Williams & Cooper, 2019). Racial and discriminatory practices in the Canadian healthcare system have limited the ability of Black people to access treatment. Therefore, minority ethnic groups in Canada have to wait thrice as long as their White counterparts in hospitals or, worse, be ignored and mistreated by healthcare workers. A tragic example is the death of Joyce Echaquan, an Aboriginal mother of seven who unfortunately died in Quebec Hospital. Before her death, a video shows the staff throwing racial insults at her while she was on her deathbed (Press, 2022). Not only do indigenous people receive limited care, they also suffer mistreatments when they are being treated. Reports by Sutton et al., 2021 indicate that 62% of diabetes, childhood obesity, hypertension, and cancer diseases among people of color are due to limited access to healthcare. Ultimately, Black patients have to wait twice as long as White patients for life-saving treatment procedures such as EKGs.
A study by Dryden & Nnorom, 2021 posits that due to healthcare inequalities in Canadian healthcare, many people of color die sooner and suffer from various preventable diseases than their White counterparts. The report shows that while only 23% of White Canadians die prematurely during COVID-19, more Black Canadians die annually due to racism and discrimination in the States healthcare system. One vivid example is that shows how COVID-19 pandemic further marginalized minority groups in Canada, risking greater exposure to the virus. Blacks were twice more exposed to the risk of contracting the virus and when in critical conditions they had to wait long periods before being given the right treatment or had to pay triple the required price for equipment. The country announced over 3,000 affected persons and twenty daily deaths among Black communities related to poor healthcare provision. Additionally, Priest & Williams, 2021 further indicate that the massive gap in infant mortality and maternal mortality highlights explicit current practices of racial and ethnic exclusion in the Canadian health system. According to Williams & Cooper, 2019, newborn children of color die 230% more frequently in Canada than white children. Further, expecting mothers of color are at least two times more likely to die during childbirth due to ignored birth complications. Regrettably, due to health inequalities in the Canadian healthcare system, Black Canadians between 18 and 50 are at least three times more likely to die due to heart disease (Priest & Williams, 2021). Lastly, the federal policies that segregated housing also resulted in high rates of uninsured populations among Black and other minority groups in Canada. People of color remain the most uninsured, limiting their access to health care. The government has decreased funding programs for health outreach, immigration policies, and enrolment. These losses have further limited the health coverage gains among Black communities, who are already at higher risks of being uninsured.
Social Change Recommendations
Notably, health disparities in the Canadian healthcare system won’t disappear overnight. To eliminate racism and discrimination in our healthcare system, we must all consistently work together to implement long-lasting, effective changes that will ensure that we mitigate the negative consequences of this social issue (Press, 2022). One lasting change strategy that can be employed is building more health into medical care delivery to ensure access to care for all. This can be achieved by emphasizing primary care to eliminate health inequalities in the existing healthcare system (Williams & Cooper, 2019). Primary health care is a crucial strategy ensuring that healthcare systems are reoriented to ensure that society becomes healthier, sustainable, and equitable. Regardless of the efforts since the 70s to increase equality among medically underserved areas, ethnic communities are still disproportionally represented (Press, 2022). One significant factor limiting primary care is high rates of uninsured population among these communities limiting their access to primary care. Uninsured people are less likely to have regular doctor visits or timely care routines. They are also most likely to be hospitalized for preventable diseases. Therefore, extensive health coverage is of particular essence to ethnic-racial groups. Health insurance determines whether and when a person receives required medical care and how and where they receive it (Dryden & Nnorom, 2021). Efforts to provide more health coverage among racial groups give better chances of decreasing the mortality and infection rates in each community (Bishop-Royse et al., 2021). To maximize primary care and eliminate health disparities, the government can restore funding for navigators to enable eligible persons to enroll in health coverage and through outreach activities. It can also increase eligibility for subsidies to purchase health insurance that provides incentives to encourage regions that do not have extended health coverage to do so.
Additionally, this change can be achieved by diversifying the workforce. Studies indicate that racial diversity in healthcare serves the best interest of the performance of every healthcare system. A diverse workforce in healthcare improves access to healthcare for minority groups and improves patient experience and satisfaction. According to Williams & Cooper, 2019, disproportionately represented groups often work with the underserved and underrepresented population, with the number of minorities working in underserved areas higher than the whites. The lack of diversity in healthcare establishments adversely impacts access to quality healthcare, health outcomes, and equity for people from ethnic groups. Racial concordance and diversity ensure better patient-caregiver communication, patient satisfaction, and better health results (Dryden & Nnorom, 2021). The federal government can increase funding to support the recruitment and retention programs of people from underserved backgrounds. The government should ensure that outreach, mentoring, and training programs are available at all educational levels to encourage students from minority groups to pursue medicine. Employing a more diverse workforce will ensure that the quality of care given across the country is of high standards. It will also minimize the mortality rates caused by racial disparities in healthcare.
In conclusion, while some may argue that structural racism is not a social issue in the current society, with factors like colonialism, medical bias, and limited care access still present in the society, structural racism remains to reign in the Canadian healthcare system bringing health disparities. If not properly addressed, these health inequalities cause numerous deaths and infections among vulnerable communities. However, with strategies like building more health into medical care delivery and healthcare workforce diversification, we can ensure equal access to care for all and eliminate racism and prejudice in our healthcare.
References
Brym, R. J. (2019). New Society.
Sutton, M. Y., Anachebe, N. F., Lee, R., & Skanes, H. (2021). Racial and ethnic disparities in reproductive health services and outcomes, 2020. Obstetrics & Gynecology, 137(2), 225–233. https://doi.org/10.1097/aog.0000000000004224
Williams, D., & Cooper, L. (2019). Reducing racial inequities in health: Using what we already know to take action. International Journal of Environmental Research and Public Health, 16(4), 606. https://doi.org/10.3390/ijerph16040606
Bishop-Royse, J., Lange-Maia, B., Murray, L., Shah, R. C., & DeMaio, F. (2021). Structural racism, socio-economic marginalization, and infant mortality. Public Health, pp. 190, 55–61. https://doi.org/10.1016/j.puhe.2020.10.027
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Nickel, N. C., Lee, J. B., Chateau, J., & Paillé, M. (2018). Income inequality, structural racism, and Canada’s low performance in health equity. Healthcare Management Forum, 31(6), 245–251. https://doi.org/10.1177/0840470418791868
Ladson-Billings, G. (2021). Critical race theory—what it is not! Handbook of Critical Race Theory in Education, 32–43. https://doi.org/10.4324/9781351032223-5
Dryden, O. S., & Nnorom, O. (2021). Time to dismantle systemic anti-black racism in medicine in Canada. Canadian Medical Association Journal, 193(2). https://doi.org/10.1503/cmaj.201579
Press, T. C. (2022, September 30). No single fix for anti-indigenous racism in Canada’s health-care system: Doctor. ctvnews. Retrieved December 5, 2022, from https://beta.ctvnews.ca/national/health/2022/9/30/1_6090855.amp.html
Chotiner, I. (2020). The interwoven threads of inequality and health, The New Yorker. Available at: https://www.newyorker.com/news/q-and-a/the-coronavirus-and-the-interwoven-threads-of-inequality-and-health (Accessed: November 24, 2022).
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