The ethos of Canada’s healthcare system relies on principles of equality and diversity. Healthcare providers have a duty to provide unbiased treatment and care to all patients regardless of their race, gender, class, or socioeconomic status.

However, Canada — the land of free healthcare and multiculturalism — finds itself confronting a stark reality. Multiple studies have illuminated longtime, deeply-rooted systemic biases within its public health system that particularly impact Black Canadian communities. The findings of these studies are crucial to our understanding of the intersection of healthcare access, racial equity, and social justice, and are essential to the path of healthcare reform. 

Black Canadians face a range of obstacles in seeking care

A 2021 study published in the International Journal for Equity in Health worked with members of racialized communities in Toronto and grouped their negative experiences in the health care system into five clusters: dehumanization, negligent communication, professional misconduct, racial and class discrimination, and unequal access to healthcare resources and treatment. 

Dehumanization as a patient was a common experience among participants, as well as having unequal access to care. Such disparities not only compromise the health outcomes of Black patients but also erode trust in the healthcare system, discouraging racialized groups from seeking care and perpetuating cycles of poor health.

Despite being the third-largest racialized group in Canada, Black Canadians face a myriad of obstacles with respect to accessing social support systems and health services, such as social and economic barriers. A 2023 literature review published in The National Library of Medicine noted that many Black Canadians indicated that they would prefer to seek out mental health resources provided by Black healthcare workers. The data emphasized the need for a stronger focus on the integration and support of Black healthcare providers to promote access and inclusivity for patients seeking treatment.

The review also found that the everyday racism experienced by racialized groups had a strong correlation to the exacerbation of negative health outcomes and higher levels of mental illness, such as depression. Black Canadians also face higher rates of risk for diseases such as heart disease and stroke. Finally, the 2021 study found that racialized groups were six to seven times more susceptible to COVID-19, further cementing the need for improved access to healthcare in marginalized communities. 

Social determinants of health and implicit bias

Historically, Black Canadians have been exposed to prolonged trauma as a result of colonialism, racism, and segregation, which has led to them being underprivileged and having reduced access to healthcare services. Other social determinants that further exacerbate healthcare disparities include hindered access to education, affordable housing, mental health supports, and equitable employment opportunities. Improving access to healthcare begins with acknowledging these determinants and developing more inclusive strategies to target them. 

Implicit biases, unconscious attitudes, and stereotypes harboured by healthcare providers and researchers also play a detrimental role in perpetuating disparities in care delivery. For example, if a physician has an unconscious belief that a patient is inferior to them, they may minimize the patient’s symptoms or concerns. This can lead to a less thorough screening, which results in a poorer quality of care for the patient, as well as negative feelings toward the physician.

Moving forward, more studies need to be conducted on Black Canadians and their experiences with healthcare. Canada has historically left Black Canadians out of the narrative by not collecting data from this population for databases, health registries, and other healthcare settings, which has led to a reliance on proxies for information on marginalized groups. These proxies include immigrant status and region of origin, both poor classifiers for any studies that intend to use racial data. This has further contributed to the rapidly widening gap in accessible healthcare. 

Policy and reform for health equity

The findings from these studies have profound implications for healthcare reform and policy. The first step toward change begins with healthcare professionals’ awareness of systemic barriers within our healthcare system, which can then be used to develop equity-driven strategies to encourage inclusivity and accessibility for marginalized communities in healthcare practices. Anti-racism strategies are also essential to respond effectively to the oppression and inequitable treatment of Black Canadians by the healthcare system. 

Recruiting and retaining a diverse workforce that reflects the racial, ethnic, and cultural diversity of Canada can enhance cultural competence, foster trust and rapport with patients, and improve the quality of care delivered to Black communities. Moreover, creating pathways for career advancement and leadership opportunities for underrepresented minority healthcare professionals can help address disparities in healthcare leadership, ensuring that the perspectives and experiences of Black Canadians are adequately reflected in healthcare policy and practice. 

Both the 2021 study and the 2023 literature review also discussed how collaboration between healthcare providers, agencies, community organizations, and the government are crucial to implementing trauma-informed practices that are accessible to Black patients and patients from other racialized groups. Trauma-informed care involves acknowledging an individual’s full history and trauma-based responses when providing care. Encouraging culturally-sensitive training and enhancing diversity in our healthcare spaces are imperative when it comes to healthcare reform. 

In our journey toward health equity, addressing the systemic bias within Canada’s public health system is a fundamental obligation rooted in social principles and human rights. By reflecting on the insights extracted from these studies and embracing a commitment to transformative action, Canada can strive toward a future where healthcare is truly accessible, inclusive, and equitable for all.