Primary health care access among new immigrants at-risk of chronic disease in Canada
pdf
keyboard_arrow_up
School
University of British Columbia *
*We aren’t endorsed by this school
Course
123
Subject
Medicine
Date
Apr 3, 2024
Type
Pages
10
Uploaded by GrandMantis3856
Gybrielle Castillo
Zerufael Derza
Jan Filart
Primary healthcare access among new immigrants at-risk of chronic disease in Canada
Barriers exist in health care access among the immigrant population, such as cultural, communication,
and socio-economic. Canada’s immigrant population is non-homogenous, so different groups have
unique needs and cultural values that may not be met by the Canadian healthcare system. Different
racial and ethnic groups have different chronic disease risk profiles, and immigrants in Canada are
underrepresented in research studies regarding chronic disease.
Primary Healthcare Access Among New Immigrants
at Risk of Chronic Disease in Canada: A Resource
Document
Introduction
The Canadian government aims to welcome hundreds of thousands of new immigrants per
year, but this sector that drives the country’s yearly population growth is vulnerable to inequities
within the healthcare system. Immigrants typically wait three months to receive health insurance
coverage, and face numerous barriers even in the application process (Lake, 2016).
Inequities between immigrants and non-immigrants arise from cultural, communication, and
socio-economic barriers that hinder the immigrant population’s access to health care (Ahmed et
al., 2015). Canada’s immigrant population is non-homogenous, so different groups have unique
needs and cultural values that may not be met by the Canadian healthcare system (Devlin,
2023). Different racial and ethnic groups have different chronic disease risk profiles, and
immigrants in Canada are underrepresented in research studies regarding chronic disease
(Sebastian et al., 2024). Exacerbating these barriers is the presence of a nationwide immigrant
wage gap, where Canadian-born citizens are found to earn higher wages (Dawson, 2022).
Immigrants are more likely to take on multiple jobs and work longer hours, unable to allocate
time or pay out of pocket for health check-ups they may unknowingly need.
For those with higher risk of chronic disease, their long-term health could be compromised.
Individuals susceptible to chronic diseases such as cancer, metabolic, and cardiovascular
disease, need access to screening services to properly monitor their health status. Due to a lack
of resources to undergo screening and check-ups, new immigrants might be less willing to seek
these services, in turn increasing their risk of chronic disease.
The healthy immigrant effect is a known phenomenon in Canada, but in an ideal world,
immigrants would remain healthy as time progresses. To make this a reality, health inequities
that disadvantage new immigrants must be addressed.
Learning Resources
Understanding the barriers immigrants face in accessing healthcare in Canada
(News article)
(Addresses solutions per the perspective of the equity deserving group)
Professor
Saleema
Allana
observes
that
the
Canadian
healthcare
system
can
still
feel
exclusionary towards immigrants, who come to the country with their own sets of cultures,
beliefs, and values when it comes to health. Disadvantages and inequities in health can be seen
through the lens of intersectionality. Professor Allana identifies immigrants susceptible to heart
disease as a particularly vulnerable population, one reason being that immigrants are typically
not part of health research. She suggests that healthcare practitioners in Canada must be more
aware of immigrant patients’ unique health needs, especially since the Canadian immigrant
population is not homogenous.
Immigrant status and having a regular medical doctor among Canadian adults
(Scholarly article)
This paper investigates the link between immigrant status and having a regular medical doctor.
While controlling for some social determinants of health, including the presence of chronic
disease, the participants are grouped based on their years of Canadian residency. Those who
have lived in Canada for 9 years or less are less likely to have a doctor. A higher percentage of
established immigrants, those residing in Canada for 10 years or more, reported having a
doctor. The authors acknowledge some past studies that can support their findings, and some
that are still debated due to exclusion of relevant health factors.
Access to and utilization of health care services among Canada’s immigrants
(Scholarly article)
Raaj Tiagi investigates patterns in healthcare utilization (whether visiting a general practitioner
or emergency room visits) between recent immigrants, established immigrants, and native
Canadians. Related literature suggests immigrants are less likely to seek preventive care such
as mammograms, Pap smears, and blood pressure testing. Tiagi’s results show that recent
immigrants were more likely to visit emergency rooms to seek healthcare. Immigrants might
prefer
less
GP
visits
due
to
cultural
or
linguistic
barriers.
He
suggests
that
provincial
governments should educate and encourage immigrants to visit family practitioners, as this
establishes continuity-of-care and reduces inefficiencies in the healthcare system.
Patient-reported Experiences in Accessing Primary Healthcare among Immigrant
Population in Canada: A Rapid Literature Review
(Scholarly article)
Bajgain et al summarize the barriers of care from 19 studies, targeting different ethnic groups of
immigrants in Canada. Each immigrant’s report about primary health services access varies
depending on their personal preferences, knowledge of the health care system in Canada,
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
health status upon arrival, and expectations in receiving health care. These individual, cultural,
and
socio-economic
factors,
influence
each
other.
While some immigrants have positive
experience with access to primary healthcare, others encounter difficulty due to certain barriers.
This resource broadly identifies common themes of immigrant healthcare access in Canada.
A qualitative study on African immigrant and refugee families’ experiences
(Scholarly article)
(Highlights the voices and experiences of the members of the equity deserving group)
The study involved 83 families from 15 African countries and conducted through interviews in
six different languages between 2013 - 2015, providing a comprehensive report of experiences.
The study reveals three main themes: "Expectations not quite met," where families encounter a
healthcare system filled with barriers such as long wait times, shortage of physicians and high
costs for uninsured services. Second, "Facing a new life," highlighting the struggles of adapting
to
new
environments
including
transportation,
weather,
employment,
language,
cultural
differences. Lastly, the "Let’s buddy up to improve access," where the importance of networking
and collaborative approaches to establish healthcare access is emphasized.
I Am Not the Woman I Used to Be
(Poetry collection, 51 pages)
(Highlights the voices and experiences of the members of the equity deserving group)
This is a compilation of poems written by immigrant women about her stories, challenges, and
resilience.
In
poetry,
these
women
express
the
emotional and psychological process of
adaptation in a new country and giving readers a lens into her personal experience. The poems
display the kind of resiliency and strength that immigrant women endured during times of
adversity. This literature is indispensable for health advocates to give them insight into, and
explore the personal impacts of immigration and the process of identity transformation that
comes along with it.
Immigrants, low-income earners less likely to receive optimal health care
(News article)
Chris Traber reports some findings about the primary care experience of low-income immigrants
and those who live in non-urban settings. These immigrants tend to miss colorectal screening or
a follow-up visit, if they have lung or heart diagnosis. Compared to Canadian-born Ontarians,
immigrants have less effective communication with their physicians and visit them less often. Dr.
Cantarutti explains that with community collaboration with physicians, there has been an
improvement in accessing primary care by immigrants. Dr. Monavvari suggests that a culturally
sensitive approach and timely provision of care will allow ease of access.
Iron-deficiency anemia
(Podcast episode, 6 minutes)
Dr. Kevin Pottie thinks that immigrant children and women of reproductive age should be
screened for iron-deficiency anemia, as they are a subgroup with particularly higher demand for
iron. The typical symptoms of iron-deficiency anemia, such as fatigue or shortness of breath, are
often hardly noticeable, so patients would not normally see the need for screening. There is
currently no recommendation for iron-deficiency anemia screening from the Canadian Task
Force on Preventive Health Care because they couldn’t focus their research on particular
high-risk populations. This reveals the need to include immigrant populations in health research.
Ethnic Disparities in the Burden of Cardiovascular Disease Among Immigrants in Canada
(Scholarly article)
The authors refer to the immigration pattern in Canada, ethnic diversity among immigrants, and
risk factors to explain cardiovascular (CVD) risks. They find that South Asians are at a greatest
risk of
CVD diseases, and it is increasing among East Asians post-migration. In terms of
residency,
living in Canada for 10 years or more increases the likelihood of CVD risks
regardless of one’s ethnic origin. Some modifiable CVD risk factors, such as sedentary lifestyle,
vary both from individuals and ethnic groups- and this suggests policy intervention. This
resource highlights how disease risk profiles within a heterogeneous population vary.
Immigrant income gap is widening, states a new report
(News article)
(Anchors the topic in a particular time and place)
Century Initiative’s 2022 report National Scorecard on Canada’s Growth and Prosperity revealed
that in 2018, the median income of immigrants five years after arrival was $7,300 less than that
of all Canadians. The gaps were wider for refugees and women. Lisa Lalande, CEO of Century
Initiative, thinks that this is because the Canadian government fails to recognize foreign
credentials. Canada has a high rate of low-wage work among OECD countries, “and low-wage
workers
tend
to
be
racialized”
the
report
states.
This resource reveals one of the key
determinants that disadvantage the immigrant population.
Patient-Identified Solutions to Primary Care Access Barriers in Canada: The Viewpoints
of Nepalese Immigrant Community Members
(Scholarly article)
(Highlights the voices and experiences of the members of the equity deserving group)
(Addresses solutions per the perspective of the equity deserving group)
The study utilized 12 focus group discussions with first-generation Nepalese immigrants to
reveal experiences with access to primary care in Canada. The findings present a range of
solutions to healthcare access barriers, categorized within a socio-ecological framework at
individual, community, and government/policy levels. At the individual level, to improve health
literacy, awareness and language skills. Community-level solutions included adoption of cultural
competence training, organizing health information events and facilitating transportation. The
participants also stressed on the significance of government and policy changes that support
expanding dental and vision care as well as increasing employment of internationally trained
health professionals.
Roche Canada Launches Clinical Trial Diversity Alliance
(News article)
(Addresses solutions per the perspective of the equity deserving group)
Clinical trials are fundamental to setting the standards of care for cancer treatments. However,
the failure in including diverse populations in such trials will narrow the generalization of
outcomes of research. Roche Canada has initiated the Clinical Trial Diversity Alliance to
enhance inclusivity in clinical research. This initiative is aimed at making clinical trials more
representative to a large demographic group that are currently underrepresented. The objective
is to ensure that clinical research reflects the diversity of the population. The launch is not only
critical for equitable healthcare but also improves the accuracy and applicability of clinical
research outcomes.
A better health system for immigrants and refugees
(Video, 7 minutes)
(Anchors the topic in a particular time and place)
The video discusses the unique healthcare challenges, emphasizing non-medical barriers
including language differences and the transition between healthcare systems. The surge of
refugees, especially from the Syrian conflict, the speaker talks through the urgency to adapt
healthcare services to accommodate the needs of immigrants and refugees. Some solutions to
these issues include providing translated medical information and medical interpreter services.
The speaker also stressed the importance of recognizing the need for action and valuing
patients' experiences. This is essential for evolving Canada's healthcare system into a more
inclusive and effective approach that ensures equitable service for refugees and immigrants.
Advancing Health Equity Through Language and Communication
(Video, 14 minutes)
(Addresses solutions per the perspective of the equity deserving group)
Lynda Li, a clinician-researcher, highlights the essence of cultural language as the roadblock for
many immigrants to utilize health care services in Canada. Like her family and some neighbors,
limited English language proficiency lowered their chances of advancing to health care services.
She added that language and other socio-economic barriers collectively lead to health inequity.
The Volentia Healthcare Translation in BC, co-founded by Lynda, addresses inequity by helping
non-native
English
speakers
understand
and
communicate their health needs. Her work
includes colorectal cancer screening disparity between immigrants and non-immigrants, which
would follow a high rate of cancer among immigrants.
Barriers and Facilitators to Healthcare for Newcomers
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
(Webpage)
(Addresses structural issues)
This webpage discusses the numerous barriers that new immigrants to Canada face, especially
for children. Some of these barriers are systemic in nature, including insurance ineligibility,
limited access to physicians, patient unfamiliarity with Canada’s healthcare system, pre-arrival
health concerns, financial and cultural barriers, among others. Physicians and healthcare
workers
are
encouraged
to
be
more
culturally
sensitive,
be
more knowledgeable about
immigrant health concerns, and be better advocates at a systems and policy level so that more
immigrant and refugee patients become eligible for Canadian healthcare benefits.
Actions you can take
Newly-arrived immigrants in Canada may not be the best represented population sector of the
country. Immigrants could not vote in elections until they have received Canadian citizenship. In
a way, an immigrant is on their back foot, with little say in the “upstream” determinants of health.
It is important to give immigrants a voice that calls for more equitable access to healthcare.
Caulford and Mayhew encourage physicians and healthcare workers to be advocates for
immigrant and refugee patients by empowering them (2014). Calls for changes at the policy
level
to address the wage gap and to include immigrants in health research should also be
included, as well as community involvement and support.
These are good steps towards giving immigrants more agency when it comes to taking care of
their health, especially for those being at-risk of chronic disease, and addressing their specific
needs. When immigrants are confident in seeking healthcare, and when healthcare providers
are knowledgeable and culturally competent with immigrant patients, we would be truly on our
way towards equitable health for all populations across Canada.
Some actions that can be taken include:
-
Bridge the culture gap between immigrants and the Canadian healthcare system by
providing
for
augmented
translation
services
and
cultural
competency training for
physicians and healthcare workers. Cultural health literacy goes both ways.
-
Involve more immigrants in epidemiological and clinical studies. Immigrants are currently
an underrepresented group in health research, so it is important to collect data from this
population to better inform health professionals about immigrant-specific needs.
-
Have health professionals and Canadian citizens be advocates for new immigrants in
addressing issues that perpetuate health inequities, such as diminishing the immigrant
wage gap, having better health insurance coverage, and overall abolishing systemic and
structural racism within and around the Canadian healthcare system.
References
A Better Health System for Immigrants and Refugees - Jessica Kim at Health Talks
. (2016).
Retrieved from
https://www.youtube.com/watch?v=e7XSZ4wokgg
Advancing Health Equity Through Language and Communication | Lynda Li | TEDxUBC
. (2023).
Retrieved from
https://www.youtube.com/watch?v=ZkVDJ6i2Jb4
Ahmed, S., Shommu, N., Rumana, N., Barron, G., Wicklum, S., & Turin, T. (2016). Barriers to
Access of Primary Healthcare by Immigrant Populations in Canada: A Literature Review.
Journal of Immigrant and Minority Health
. Retrieved from
https://doi-org.proxy.lib.sfu.ca/10.1007/s10903-015-0276-z
Bajgain, B. B., Bajgain, K. T., Badal, S., Aghajafari, F., Jackson, J., & Santana, M.-J. (2020).
Patient-Reported Experiences in Accessing Primary Healthcare among Immigrant
Population in Canada: A Rapid Literature Review.
International Journal of Environmental
Research and Public Health
, 17(23), 8724.
https://doi.org/10.3390/ijerph17238724
Caulford, P., & Mayhew, M. (2014, March).
Barriers and Facilitators to Health Care for
Newcomers
. Retrieved from Caring for Kids New to Canada:
https://kidsnewtocanada.ca/care/barriers
Dahal R, Naidu J, Bajgain BB, et al. Patient-Identified Solutions to Primary Care Access Barriers
in Canada: The Viewpoints of Nepalese Immigrant Community Members.
Journal of
Primary Care & Community Health
. 2022;13.
https://doi.org/10.1177/21501319221141797
Dawson, F. (2022, April 6).
Immigrant income gap is widening, states a new report
. Retrieved
from New Canadian Media:
https://www.newcanadianmedia.ca/immigrant-income-gap-is-widening-states-a-new-repo
rt/
Degelman, M. L., & Herman, K. M. (2016). Immigrant status and having a regular medical doctor
among Canadian adults.
Canadian Journal of Public Health / Revue Canadienne de
Santé Publique
, 107(1), e75–e80.
https://doi.org/10.17269/cjph.107.5205
Devlin, T. (2023).
Understanding the barriers immigrants face in accessing healthcare in
Canada
. Retrieved from University of Western Ontario Health Sciences:
https://uwo.ca/fhs/news/2023/04_24_allana_s_immigrant_barriers.html
Gastaldo, D. (Ed.) 2004.
I’m Not the Woman I Used to Be: 30 Poems by Recent Immigrant
Women
. Toronto: Women’s Health in Women’s Hands Community Health Centre.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
Iron-deficiency anemia
. (n.d.). Cochrane. Retrieved from
https://www.cochrane.org/podcasts/10.1002/14651858.CD004222.pub2
Lake, S. (2016).
Not so universal health care: The neglect of immigrant and refugee health in
Canada
. UBCMJ. Retrieved from
https://ubcmj.med.ubc.ca/not-so-universal-health-care-neglect-of-immigrant-and-refugee
-health-in-canada/
Roche Canada Launches Clinical Trial Diversity Alliance
. (2023, June 12). Retrieved from
Roche Canada:
https://www.rochecanada.com/media/roche-canada-launches-clinical-trial
Sebastian, S., Sethi, Y., Padda, I., & Johal, G. (2024). Ethnic Disparities in the Burden of
Cardiovascular Disease Among Immigrants in Canada.
Current Problems in Cardiology
.
Retrieved from
https://doi.org/10.1016/j.cpcardiol.2023.102059
Tiagi, R. (2016). Access to and utilization of health care services among Canada’s immigrants
.
International Journal of Migration, Health and Social Care
. Retrieved from
https://doi.org/10.1108/IJMHSC-06-2014-0027
Traber, C. (2015).
Immigrants, low-income earners less likely to receive optimal health care
.
YorkRegion.com. Retrieved from
https://www.yorkregion.com/life/health-wellness/immigrants-low-income-earners-less-like
ly-to-receive-optimal-health-care/article_784c82fb-d5c1-5c52-87f3-8f41c7c2f934.html
Woodgate, R.L., Busolo, D.S., Crockett, M. et al. A qualitative study on African immigrant and
refugee families’ experiences of accessing primary health care services in Manitoba,
Canada: it’s not easy!.
Int J Equity Health
16, 5 (2017).
https://doi.org/10.1186/s12939-016-0510-x