The murder of George Floyd on May 25th has led to worldwide protest against racism and police violence. Arthritis Consumer Experts (ACE) stands with those fighting for justice and believes that it is deeply important to highlight the ways in which racism and inequity also exists within the arthritis community and more generally in Canadian healthcare.
Over the next several weeks, ACE will be regularly sharing information about health inequalities in arthritis to raise awareness about these issues and start conversations about them in our community. While our focus will be on issues linked to race, we will also highlight the overlapping factors of wealth and where people live. ACE is continuing to learn about these issues and our role within them. We hope that you – as a person living with arthritis, or as a caregiver, healthcare provider, researcher, educator, elected official or industry member – will also join us in this work, thinking deeply about how you can support change.
Our first Health Inequities in Arthritis and Beyond post provides a brief summary of how factors such as race impact the health of Canadians. We hope that this information will be helpful background for future posts in this series, which will look more deeply into inequities in arthritis.
Understanding Health Inequities in Canada: What shapes a person’s health?
What makes one person healthier than another? Many people think first about things like smoking and exercise, however, economic and social conditions have a greater influence on the health of individuals and communities. Some examples include race/racism, gender, housing, income, employment, and disability. These are known as the social determinants of health and are typically the root cause of health inequalities because they impact where and how a person lives, their work, their access to resources (e.g. groceries, healthcare, day care) and the level of stress in their daily life. Health inequalities are called health inequities when they are unjust.
Why do social determinants have a more powerful effect on a person’s health than diet or physical activity? Essentially, because lifestyle and personal health behaviours are often determined by social and economic conditions. For example, when a lot of energy is needed to ensure things like food, shelter and income, it makes it nearly impossible to find the extra energy or time for things like exercising, eating healthy foods, learning about one’s disease or seeing a team of healthcare professionals – all of which are considered key aspects of managing chronic diseases like arthritis.
ACE commitment: ACE acknowledges that making lifestyle changes requires time and resources that not all Canadians have easy access to – thus making it difficult to partake in our patient education and resources to build self-management skills. We recognize we must consider the different social and economic positions of people living with arthritis, so that our resources can be meaningful to all those in the arthritis patient community.
How does race impact health in Canada?
Race is an important social determinant of health because it is closely tied to other factors such as income, employment, education, housing, and experiences accessing healthcare resources. In other words, systemic racism can impact many areas of a person’s life and thus their health. In addition, life-long experiences of racism and discrimination can affect a person’s health by causing them high levels of stress in their daily life. Research suggests that daily experiences of racism can explain why Black Canadians have higher rates of diabetes and hypertension than white Canadians, regardless of education, income, physical activity, and body mass index (BMI)1.
What is systemic racism? Systemic racism occurs when policies and practices exclude or discriminate against particular groups. Racial discrimination can be deeply rooted within systems such as education, government, employment, criminal justice and healthcare. Discrimination and exclusion can happen without the intent of people working within these systems. The ‘hidden’ aspect of systemic racism makes it especially harmful.
The largest racial health inequalities in Canada are faced by indigenous peoples who have higher rates of heart disease, hypertension, asthma, arthritis and cancer2. In fact, these inequities are even greater than those of Indigenous populations in the US2, despite Canada’s tendency to view itself as ‘more equal’ than our southern neighbours. There is strong evidence that these health gaps are not the outcome of genetic differences but are instead the result of social and economic conditions shaped by a long history of colonialism, racism, destruction of land and food resources, and the trauma that comes with these experiences2,3.
Moving forward
Our next post will highlight the growing body of research that looks specifically at rates of arthritis, severity of disease and access to care in Indigenous communities. We hope that the information above will allow for a deeper understanding of this research, and the factors responsible for inequities in arthritis.
Share your experience
ACE is committed to learning from and listening to members of its community – If you have witnessed or personally faced discrimination during your experiences as an arthritis patient, researcher or healthcare professional, please consider sharing your experiences by emailing feedback@jointhelth.org. Your input will help inform advocacy work in this area.
Go deeper: ACE’s Arthritis At Home program features an interview with Dr. Cheryl Barnabe, Senior Research Scientist of Arthritis Research Canada. Dr. Barnabe is one of Canada’s leading researchers in the area of identifying and resolving health care gaps for Indigenous patients. Dr. Barnabe shares her insights on healthcare delivery to Indigenous and underserved communities, many of whom are at a higher risk of COVID-19 because of underlying medical conditions. She explains the challenges of physical distancing and mental health as well as how virtual care is being used in these communities.
1. Veenstra, G., & Patterson, A. C. (2016). Black-white health inequalities in canada. Journal of Immigrant and Minority Health, 18(1), 51-57. doi:http://dx.doi.org.ezproxy.library.ubc.ca/10.1007/s10903-014-0140-6
2. Ramraj, C., Shahidi, F. V., Darity, W., Kawachi, I., Zuberi, D., & Siddiqi, A. (2016). Equally inequitable? A cross-national comparative study of racial health inequalities in the United States and Canada. Social Science & Medicine, 161, 19–26. https://doi.org/10.1016/j.socscimed.2016.05.028
3. Adelson, N. The Embodiment of Inequity: Health Disparities in Aboriginal Canada. Can J Public Health 96, S45–S61 (2005). https://doi-org.ezproxy.library.ubc.ca/10.1007/BF03403702