Moderator
Mathew Zachariah, Emeritus Professor of Education, University of Calgary
Panelists:
Danika Billie Littlechild, Lawyer, Ermineskin Cree Nation in Hobbema, Alberta
David Este, Professor & Assoc. Dean (Research and Partnerships) Faculty of Social Work, University of Calgary
Grace-Edward Galabuzi, Asst. Professor,Politics and Public Administration Dept. Ryerson University, Toronto & Research Associate, Centre for Social Justice, Toronto
Josephine Bassey Etowa, Assoc. Professor, School of Nursing, Dalhousie University, Nova Scotia
Context for the Dialogue
Healthcare is a fundamental right in Canada. Our healthcare system is based on the core values of equity, fairness and solidarity. These values are tied to an understanding of access to healthcare as a right and not a privilege. However, this fundamental right is not impervious to the implications of race and racism as counter reality in Canadian society.
The panel engaged discussions and critical analyses on the role of race and racism on healthcare access and outcomes for segments of the Canadian population; address the intersectionality between race and healthcare including policy framework for the provision and delivery of healthcare; incorporation of racism as a social determinant of health and the need to integrate an anti-racism lens in the development and implementation of policies and research in healthcare.
Each speaker discussed how racism acts as a social determinant of health and explains how disparities in healthcare utilization and health outcomes can be explained by processes of racialization in the healthcare system.
Structural Racism
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Universal access to healthcare as a Canadian value. Universality is constructed around notions of whiteness and has to be considered in the context of how this leads to health disparities and the denial of equal access and maybe even equal citizenship.
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The unequal access outcomes and health disparities are a social-economic and social-psychological manifestation of racism as a social determinant of health.
Traditional vs. Modern Medicine, Race & Culture
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The creation of a system that does not include traditional medicine methods and dismissed basic cultural understanding and sensitivity has even further isolated the Aboriginal population. The current system does not acknowledge or accommodate indigenous views of health. This disregard may result in hesitancy on the part of patients towards making use of modern facilities.
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Etowa addressed the implication of medical education in white society gaps in education and terminology do not accommodate differences based on race, ethnicity, culture that may be necessary to deliver proper treatment. An example given was the point system to determine the health of a newborn baby. Point were allocated to how 'pink' the child was (to demonstrate the healthiness of the child), but this pinkness is very difficult to gauge when trying to evaluate the health of a black or brown new born.
Access to Healthcare services
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Aboriginal Peoples - limited access to healthcare based on factors such as access to transportation to get to medical facilities; transient medical systems on many of Canada's reserves.
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Limited funding on reserves means that many services are not deemed as essential, which creates a menu-style medical system. Those items that are not within the budget are either sacrificed or the patient has to prioritize their medical care choices.
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The Aboriginal population, due to the reserve structure and the treaty agreements, are currently the only population in Canada where policy, law and politics (which are often contradictory) play a role in their daily lives. They are a group where race - and race alone - plays a major role in determining their access to health care.
Collection of Data/Statistics
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Without proper research and documentation of the health system, it is very difficult to gauge where the improvements can be made. The emphasis here is less on the quality of care (which is an important issue), but more about the system's ability to identify and incorporate all races.
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Are all the races equally represented in the population of doctors? Why is the system so unaccommodating for foreign credentials? If language is a barrier, can I or will I have access to a doctor of my own ethnic or racial background?
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The need for cultural competency, a diversity of medical models and disaggregation in data collection and research to more adequately address health conditions that affect different population groups differently (e.g. sickle cell anemia, diabetes, etc)
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David Este shared the findings of a groundbreaking research by a team of African Canadian researchers examining the intersection of race, violence and health impact for African Canadians in 3 large urban centres - Halifax, Toronto and Calgary. The study is drawing into focus the implications of stress produced by systemic racism. How racism and racism-based violence impact the health and well-being of African Canadian men their families and the communities they live in.
Recommendations:
- The need for a Civil Rights Health Report Card for Canada was argued by Panelist Etowa
- The need to subject health policies to equity reviews
- There is a need for training, education, skill building, and awareness that are backed by comprehensive legislation
- Engagement of all levels of government to establish best practices that incorporates race as a key element
- Encourage the creation and promotion of Canadian narratives which bring to light the Canadian story of race and health
- Increase dialogues on the theme of race and health
- Garner the interest and support of the general public on this issue