Abstract
BackgroundIn 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.MethodsThis 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.ResultsParticipants 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’.ConclusionsOur 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.
Highlights
Despite publicly funded health insurance, there is growing recent evidence from the Canadian Community Health Survey, the largest nationally representative dataset, of health inequities for racialized groups in Canada [1,2,3,4,5,6] and in Toronto [7]
This study focuses on meso level practice and policy specific to the Canadian health care system: a biomedical model of health care delivery and cultural competence policy
Of the participants that completed the rating activity (n = 72), 41 participants identified as racialized health care users, 23 participants identified as non-racialized health care users, and 11 participants identified as either a racialized or non-racialized health care provider
Summary
Despite publicly funded health insurance, there is growing recent evidence from the Canadian Community Health Survey, the largest nationally representative dataset, of health inequities for racialized groups in Canada [1,2,3,4,5,6] and in Toronto [7]. Of the limited previous research conducted on health inequities in Canada, most studies had relied on proxies for racialized groups (e.g. immigrant status or region of origin) [16]. 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
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