Abstract
In Toronto, Canada, 51.5 % of the population are members of racialized groups. Systemic labor market racism has resulted in an overrepresentation of racialized groups in low-income and precarious jobs, a racialization of poverty, and poor health. Yet, the health care system is structured around a model of service delivery and policies that fail to consider unequal power social relations or racism. This study examines how racialized health care users experience classism and everyday racism in the health care setting and whether these experiences differ within stratifications such as social class, gender, and immigration status. A concept mapping design was used to identify mechanisms of classism and everyday racism. For the rating activity, 41 participants identified as racialized health care users. The data analysis was completed using concept systems software. Racialized health care users reported “race”/ethnic-based discrimination as moderate to high and socioeconomic position-/social class-based discrimination as moderate in importance for the challenges experienced when receiving health care; differences within stratifications were also identified. To improve access to services and quality of care, antiracist policies that focus on unequal power social relations and a broader systems thinking are needed to address institutional racism within the health care system.
Highlights
This study examines how racialized health care users (HCUs) feel or experience exclusion in the health care setting of Toronto and the Greater Toronto Area (GTA); and whether these experiences of exclusion differ within stratifications such as social class, gender, and immigration status
Findings from our study indicate that socioeconomic position (SEP)/social class intersects with “race”/ethnic-based discrimination in the health care setting, which may further impact the health of racialized working-class HCUs
This study contributes to the literature by identifying how classism and everyday racism occur in the health care system for some racialized HCUs; these discriminations occur through mechanisms of unequal power social relations in a context of institutional health care policies and practices such as cultural competence and a biomedical model of service delivery
Summary
Research has consistently demonstrated the harmful impact of racism on physical and mental health.[1,2,3,4,5] In Canada, racism remains entrenched within society,[6] with evidence of health inequities among indigenous, racialized, and immigrant groups.[7,8] According to the 2016 census data, 51.5 % of Toronto’s population (Canada’s most populous city, located in the province of Ontario) are members of racialized groups;[9] projected estimates suggest a continued increase to 63 % by the year 2031.10Structural racism, an integrated system of policies and laws at the structural or macro level, resulting in racial/ ethnic stratification,[11] is interconnected to the institutional level (eg, hospitals) and to the interpersonal level, resulting in everyday racism.12 “Race”/ethnicity, a social construct, is defined in this study as a power-based social relation: a set of social relations that are a subset of the structure of a social system.[13]. Structural racism, an integrated system of policies and laws at the structural or macro level, resulting in racial/ ethnic stratification,[11] is interconnected to the institutional level (eg, hospitals) and to the interpersonal level, resulting in everyday racism.. “Race”/ethnicity, a social construct, is defined in this study as a power-based social relation: a set of social relations that are a subset of the structure of a social system.[13] Power differences in social relations result in a racial hierarchy and are, in part, the result of oppressive policies and laws.[11,12,13] Racialization is understood as the social construction of racial categories that are different and unequal (on the superficial basis of attributes such as skin color) such that they have social, economic, and political consequences.[14]
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