Like it or not, our cultural backgrounds play a not insignificant role in our access to health care.
The Action for Health project focused on technology, but also examined other issues impacting health care delivery. One of the most important of these is the relationship of ethnic groups and health status. Research assistant and doctoral candidate Kjetil Rodje spent time unraveling the complexities of defining ethnicity and why it is such a challenge to undertake research involving diverse ethnic groups and their access to and utilization of health services. Why are they so often disadvantaged and what can be done about it?
You might be surprised to learn that when immigrants arrive in Canada (and many of these factors are true in any country) they are generally healthy, even more so than the general population, but this advantage is lost over time. Perhaps it is because of unhealthy lifestyle choices, but it may also be that they are disadvantaged in society because of their lower income and worse living conditions. This then compounds the stress they face in struggling to integrate and adapt.
But the situation may become worse. Immigrants from different cultures may interpret their health concerns differently causing communication problems even beyond the obvious language issues. They may be intimidated by services designed for the mainstream, and they may have little concept of preventative programs or even know about them.
Researchers addressing these problems begin with a huge stumbling block—what exactly constitutes race and ethnicity? They are not the same thing. Ethnicity is a category used to explain a sense of cultural belonging and identity, but race is a category used to explain genetic characteristics and other biological factors. Nevertheless, even researchers confuse the two.
One of the things we do instinctively is to begin with a standard (white—us) and define everyone else in relation to that (nonwhite-them). The problem is that even this Caucasian white standard group doesn’t really exist. So we have the added dilemma of defining something in relation to something else that is all pretty subjective. What exactly is a “white” skin tone? Just where would you place Barack Obama on a colour scale? To a white person he’s dark. To an African he might be white. Even the terms are loaded. Some have criticized the terms Caucasian and white as racist.
Different categories exist to try to standardize ethnic groups. But even that becomes messy. For example, in the United States one might think of people who come from a European ancestry as constituting a distinct grouping. But there is also a clearly defined Hispanic American group that we hear so much about as they eclipse African Americans in size and clout. But wait a minute—isn’t Spain in Europe? Why is it the only one singled out of the European Diaspora then?
In addition to accurately defining someone’s ethnicity there may also be confounding effects of confusing this with socio-economic status (SES). We know that low SES is a strong correlate of poor health so perhaps it’s just that ethnic minorities are generally not as well off. But even that doesn’t match the evidence. There do appear to be two separate issues. When health outcomes are examined and SES is taken into account, ethnicity still plays a role. Ethnicity must be addressed one way or another if we are to give everyone the same services.
There are four approaches that have been suggested to consider ethnicity in relation to health services. The first is to encourage people in these groups to adapt and assimilate into the established system. Then it’s just a matter of getting the right information to the right people, perhaps in their own language and through their local cultural channels. But this really downloads everything onto the people themselves and some might call it grossly unfair.
The second thing we could do is to assume that everyone has needs and problems that must be addressed, regardless of their race or ethnicity. We do our best to simply make sure everyone is included. But this returns us to the “Caucasian white” as the gold standard approach. Everyone else runs the risk of getting care and health care services that relate to that. Again, it might not be just.
The third suggestion is to target every specific group. We do this already in providing services for those with HIV or groups that are more likely to engage in risky behaviour such as smoking. It sounds like it could work but it’s a very top-down approach. And of course it might exacerbate discrimination as everyone is forced to define that elusive categorization problem. If you can’t define the group, you can’t target the services
The final approach is diversity. The system is open, flexible, and allows for multiple ways to meet health care needs and services. Individual groups have input and policymakers determine what everyone needs. The problem? It’s very, very expensive to offer this much training of personnel, response to feedback from consumers, provision of technical resources that are flexible, and on and on.
Whatever we decide however, needs some thought. Increasing multiculturalism is a global trend as people move, merge, and incorporate into existing societies. Whether it’s Asians in Canada, Hispanics in the United States, or Turks in Germany, the health care system must evolve to includes these people not because it’s the right thing to do but because it’s the only practical solution for everyone.
If you have a comment or question or Guenther, contact him directly at: firstname.lastname@example.org
Why is ethnicity so difficult to determine?
Some people have suggested that the whole idea of classifying people according to their ethnicity be thrown out, it’s an unanswerable question. That’s unlikely to happen, but just think about the constellation of factors that go into the definition: place of birth, nationality, physical features, language, ancestral origin, name, religion, identity, sense of belonging, culture, tradition, lifestyle…and more. Small wonder then that in many parts of the world there is far more disagreement (and often conflict) among various groups than there is agreement.