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Inequality in healthcare access for immigrants
Inadequate access to primary care and treatment interventions has been and continues to be a prevalent issue amongst minority populations in Canada. As a result, many immigrants are faced with constant barriers with regard to receiving high-quality care. The patient experience is revered as one of the most significant aspects of healthcare, however its relation to immigrant status is not well defined.

The “healthy immigrant effect” is a term that recognizes how immigrants on average enter Canada with better health than those born in the country. However, over time, this health advantage experienced by immigrants may begin to decline. Multiple factors contribute to this health decline, including: racialization and discrimination, stress of immigration, barriers accessing healthcare practitioners and others.

Immigrants in Canada face multiple barriers to accessing mental health services. As with primary care access, the language barrier between healthcare providers and immigrants remains one of the greatest challenges in delivering mental health care and often leads to underuse. Many subpopulations of immigrants, including but not limited to: African women, Latin American men, Iranian immigrants and South Asian immigrants have been shown in studies to underuse mental health services due to the limited amount of services offered outside of the English language, which hinders their access to mental health care. One study discussed how immigrants avoided, or did not benefit from, mental health counselling services as there lacks an adequate amount of professional interpretation services.

Another study conducted in Montreal examined the reasons behind why immigrants were reluctant to access mental health services. They found a multitude of reasons as to why immigrants were hesitant to seek help, including the fact that their perception of Western doctors’ over willingness to utilize pharmaceutical medications, while they believed in the curative powers of non-pharmaceutical interventions, such as God and traditional folk medicine.

Many immigrants report experiencing social isolation in Canada while also lacking social support from friends or family, which significantly impacts their mental health and also impacts their access to mental health services. Other racialized immigrants, specifically seniors, may be reluctant to access mental health services due to the stigmatization that surrounds these issues. Another significant barrier reported was the difficulty immigrants faced in finding mental health providers that were appropriately trained in cultural sensitivity.

Inequality in care for Indigenous peoples
It is well documented in the literature that Indigenous peoples in Canada lack equitable access to healthcare services for a variety of reasons. One major reason for this inequitable access is due to Indigenous locations of residence. Statistics Canada reported that the majority of Métis live in urban centres, while almost half of First Nations people live on reserves. In rural northern communities, they struggle to attract and retain healthcare professionals, leaving a great shortage in services that results in far lesser access to care. In the Inuit Nunangat, it was found that just 23% of Inuit people had a medical doctor they regularly visited. Additionally, due to the lack of healthcare access in northern communities, many are forced into lengthy transportation to southern Ontario to receive necessary care. One study examined an Inuit community in Rigolet, Canada, and looked at the direct and indirect costs of these long-distance healthcare visits, including missed paid employment, mental well-being costs, transportation costs and others. Altogether, this community experiences healthcare costs greater than other Canadian non-Indigenous and urban areas.

Another prominent reason for inequitable access to care is the persistence of racism that remains in Canada. In 2012, The Health Council of Canada conducted a series of meetings across the country with a variety of healthcare workers, researchers and Aboriginal people. Through their conversations, they discovered that a large part of the problem comes from the healthcare system. They found that many Indigenous people simply do not trust mainstream health service due to stereotyping, racism and that they feel intimidated. One participant described their experiences as “being treated with contempt, judged, ignored, stereotyped, racialized, and minimized.” Finally the Health Council of Canada went on to describe that this lack of equitable access comes as an extension of systemic racism in Canada.

A 2015 study examined 80 Indigenous women who experienced neurological conditions. Participants described their lack of access to health services to stem from the racism and sexism experienced in the system. In the same study, the researchers interviewed multiple key informants, including various types of health practitioners. They described how important it is for the health system to implement culturally safe care. They also discussed how many stereotyping problems occur in medical school and that Canada requires further Indigenous-centred training. They recommend higher education and awareness training amongst medical schools and healthcare institutions to address the growing healthcare disparities between Indigenous and non-Indigenous peoples in Canada.

Inequality in care for people living with intellectual disabilities
Healthcare needs and comorbidities are often underdiagnosed in those living with intellectual disabilities. A study conducted in Quebec, Canada investigated healthcare utilization and access amongst people with intellectual disabilities in comparison to the general population. Of the study sample, approximately 30 percent reported not having had a comprehensive medical examination in the past year, which is what is currently advised in the 2018 Canadian consensus guidelines for practitioners providing primary care for those with intellectual disabilities. Compared to the general population, women with intellectual disabilities aged 18-69 years were found to undergo cervical cancer screening less often. Results demonstrated them to be 1.5 times less likely to undergo a Pap test in the past 3 years compared to similar aged women without disabilities. For breast cancer screening, women living with severe or profound intellectual disabilities or Down Syndrome were found to be screened significantly less than those in the general population. People with Down Syndrome also reported the lowest usage of physiotherapy services compared to other measured population groups, which is a concern given that Down Syndrome is associated with a variety of musculoskeletal problems that may be improved with physiotherapy.

Socioeconomic gap in healthcare
It has been previously documented that one’s socioeconomic status significantly impacts their health. Another recent study re-assessed this relationship and found similar results that demonstrated that people with higher levels of education or income experience longer life expectancies and health-adjusted life expectancies. The study discovered a distinct stepwise gradient in Canada, with life expectancy and health-adjusted life expectancy incrementally increasing as social position improves. They also found that this socioeconomic gap in healthcare had gotten wider in the previous 15 years. The reasoning behind the socioeconomic gap is complex and multifaceted. Certain relationships between socioeconomic status and health outcomes can be relatively easily explained through direct exposures. For example, lead or pollutant exposure tends to be more common in rural neighbourhoods, which can result in lower cognitive functions, stunted growth and exacerbated asthma. Higher income levels allow for the purchase of higher-quality resources, including food products, produce and shelter, as well as faster access to services. Higher education is often thought to lead to greater health literacy, resulting in the adoption of healthier lifestyles. Longer, more complex pathways can also be used to explain potential relationships between socioeconomic status and health outcomes. Duration of poverty has been related to increased chronic stress levels. Recent studies have described how these stress levels can result in the biological “wear-and-tear” for these individuals constantly exposed to social and environmental stressors. Increased stress and lower SES has been correlated with increased blood pressure, worser cholesterol profiles and increased risk for other cardiovascular diseases.