Data gaps in Canada’s healthcare are putting minoritized patients at risk
In the last couple of years, the University of Toronto Medical School has made concerted efforts to increase the number of black medical students in their program. David Latter, the university’s director of admissions and student finances, told University Affairs in 2018, “We think the doctors of the University of Toronto should really reflect our community, and I don’t think that was the case in the past.” At the time of the interview, Black students accounted for less than five percent of the University of Toronto’s Medical program, which was out of step with the rest of Toronto’s Black population of 9 percent. With data on the demographics of the city population and student body, the university was able to identify its own racial disparities, but the same can’t be said for Canada as a whole since Canada doesn’t maintain data on the race and ethnicity of healthcare providers. This lack of data not only inhibits patient care, but points to a deeper reluctance to confront the country’s history of institutional racism.
Data gaps in Canada are the norm. In 2019, Eric Andrew-Gee and Tavia Grant detailed in The Globe and Mail how the gaps in data range from marriage and divorce rates to vaccination rates. Robert Andersen, a professor of political science, sociology and statistics, told Andrew-Gee and Grant,“We have high-quality data – when they produce it.''
The Canadian Medical Association collects some data on physicians in areas such as age, sex and province/territory, but they don’t provide information on race or ethnicity. In the U.S., however, The Association of American Medical Colleges collects data on race/ethnicity as well as degree (MD/PhD), sex, department, and tenure status. As of 2013, 4.1 percent of active physicians in the U.S. were Black, 4.4 percent were Latinx, and 11.7 percent were Asian. Just 0.4 percent of working doctors were Indigenous. White physicians accounted for the largest group by far at 48.9 percent. In Canada, these values aren’t available. Without this data on race and ethnicity, we are unaware of inequities in our healthcare system that could put patients at risk.
In 2011, one in five Canadians identified as part of a visible ethnic minority, and we know that structural inequalities in the medical field can have a devastating impact on the health and quality of life of minoritized people. According to the Canadian Public Health Association, “Canada remains a nation where a person’s colour, religion, culture or ethnic origin are determinants of health that result in inequities in social inclusion, economic outcomes, personal health, and access to and quality of health and social services.”
Fo Niemi, co-founder and executive director of the Centre for Research-Action on Race Relations in Montreal tells The Globe and Mail, “We have a Canadian way of avoiding race issues; we don’t talk about it, and how do we not talk about it? We don’t collect data based on race. We collect on everything else − but not on race.” Canada’s denial of racism has impeded the collection of important race-based information for patients and healthcare alike.
While there may be no hard data on the effects of racism in Canadian healthcare, plenty of heartbreaking stories testify to what patients face in a “colorblind” system. In 2019, The Globe and Mail profiled Olga Lambert, a Black woman from Ontario who was first diagnosed with breast cancer in 2008. As a Black woman, Lambert’s was at risk of developing breast cancer earlier in life than white women, which is why in the U.S. Black women are advised “to have their breast-cancer risk assessed by the age of 30.” Guidelines in Canada for breast cancer screening don’t take race into account, and Lambert didn’t have her first mammogram until she was 45.
In the U.S., researchers have found that minoritized groups have “higher hospitalization and mortality rates due to conditions that many providers and health services researchers agree should be preventable with appropriate outpatient management.” Another study found that “Asians, and to a lesser degree Hispanics, also reported lower levels of cultural sensitivity among their physicians.” These two findings are likely connected. In a blog post on the importance of diversity in healthcare from St. George’s University, Dr. Linda Girgis is quoted as saying, “It is difficult enough for many patients to see a doctor. Where there is no diversity, it may make it more intimidating for some patients to seek medical care, thus causing them harm.” Demographic data on healthcare providers is an essential step toward improving patient-physician relations in Canada.
The National Collaborating Centre for Aboriginal Health details a correlation between patient mistrust of physicians and a decreased likelihood of seeking medical care when symptoms appear. The death of an Indigenous man named Brian Sinclair brought these issues to public attention in 2008. Sinclair died while waiting for treatment for a bladder infection in a Winnipeg hospital ER. Other people at the hospital advocated for Sinclair by telling health care providers and security of Sinclair’s long wait for medical attention. Sinclair’s cousin is quoted as saying, “Honestly, they thought he was just a street person sleeping it off, they thought he was just another drunken Indian coming in to pass out.”
Studies have found that patients from minoritized groups "experience lower quality interactions with their physicians," which "appear to be influenced in part by the physician's race/ethnicity." Important information isn’t being collected consistently enough—or at all, which makes it nearly impossible to identify patient needs and take subsequent steps to improve the health of Canadians. Canada should be collecting data on the race or ethnicity of physicians and in other areas as well. It is difficult to fix inequities if we don’t have the data that demonstrates their existence.
Image credit: Laboratory waiting room, Demond Henderson, 2010 (Flickr | CC BY-NC-ND 2.0)
