Access to health care among racialised immigrants to Canada in later life: a theoretical and empirical synthesis

Abstract

Evidence that immigrants tend to be underserved by the health-care system in the hosting country is well documented. While the impacts of im/migration on health-care utilisation patterns have been addressed to some extent in the existing literature, the conventional approach tends to homogenise the experience of racialised and White immigrants, and the intersecting power axes of racialisation, immigration and old age have been largely overlooked. This paper aims to consolidate three macro theories of health/behaviours, including Bronfenbrenner's ecological theory, the World Health Organization's paradigm of social determinants of health and Andersen's Behavioral Model of Health Service Use, to develop and validate an integrated multilevel framework of health-care access tailored for racialised older immigrants. Guided by this framework, a narrative review of 35 Canadian studies was conducted. Findings reveal that racial minority immigrants’ vulnerability in accessing health services are intrinsically linked to a complex interplay between racial-nativity status with numerous markers of power differences. These multilevel parameters range from socio-economic challenges, cross-cultural differences, labour and capital adequacy in the health sector, organisational accessibility and sensitivity, inter-sectoral policies, to societal values and ideology as forms of oppression. This review suggests that, counteracting a prevailing discourse of personal and cultural barriers to care, the multilevel framework is useful to inform upstream structural solutions to address power imbalances and to empower racialised immigrants in later life.

COVID-19 Pandemic and Im/migrants’ Elevated Health Concerns in Canada: Vaccine Hesitancy, Anticipated Stigma, and Risk Perception of Accessing Care

“…These findings also echoed a recent provincial study in British Colombia, which found that females, those with less than high school education, racialized and indigenous groups had lower intentions to receive a COVID-19 vaccine [29]. Barriers to accessing health care, including lower vaccine uptake for infectious disease prevention, have been frequently documented among migrants [15,25] racialized populations [61,62] and socioeconomically disadvantaged groups [63], who are fundamentally deprived of health-promoting resources and at more risk of COVID-19 infection and adverse clinical outcomes [64]. In addition, this research demonstrates that health risk perceptions about seeing a doctor were more prominent in the im/migrant community, regardless of a publicly funded health care system in Canada.…”

“…In addition, this research demonstrates that health risk perceptions about seeing a doctor were more prominent in the im/migrant community, regardless of a publicly funded health care system in Canada. This is another worrying situation for im/migrants that could lead to underutilization of needed health services (e.g., delay of diagnostic tests and specialized care) in the host country during turbulence times [15,65]. Thus, building COVID-19 vaccine confidence among these underserved populations primarily relies on the public health systems to become more accessible and sensitive on a structural basis, rather than placing the personal responsibility on these equity-seeking groups to become less hesitant [8].…”

“…However, the challenge of low vaccine access is persistent for im/migrant and refugee populations, who often experience discrimination and suboptimal treatments when accessing local health services even under normal circumstances before the pandemic [14]. While "universality" is a cornerstone of the Canada Health Act, health care inequity still disproportionately affects im/migrant populations [15][16][17]. Compared to Canadian-born residents, im/migrants are more likely to lack a regular doctor [18], experience difficulties in accessing immediate care [19] and encounter barriers in obtaining selected diagnostic tests [20], all of which lead to greater unmet healthcare needs [21].…”

“…Compared to Canadian-born residents, im/migrants are more likely to lack a regular doctor [18], experience difficulties in accessing immediate care [19] and encounter barriers in obtaining selected diagnostic tests [20], all of which lead to greater unmet healthcare needs [21]. In addition, the inadequacy of culturally sensitive health care [22], the lack of interpretation services [15], limited health insurance eligibility [17] and the arbitrary 3-month wait period for insurance coverage [23] further exacerbate im/migrants' mistrust in the Canadian health care system. These pre-existing access problems, together with recently widespread misinformation around the pandemic [24] (i.e., the COVID-19 "infodemic"), could give rise to the vaccine hesitancy-one of the top 10 global health threats in 2019 as declared by the World Health Organization (WHO) [25]as well as stigma and fear accompanying COVID-19-"the greatest enemy" named by the United Nations [26].…”

Generalized anxiety disorder during COVID-19 in Canada: Gender-specific association of COVID-19 misinformation exposure, precarious employment, and health behavior change

“…Grounded in the socioecological paradigm ( Davison et al., 2021 ; Kawachi et al., 2002 ; Lin, 2021 ) and the social determinants of health framework ( Marmot, 2005 ) and fundamental social cause theory ( Phelan and Link, 2005 ; Phelan et al., 2010 ), the present study hypothesizes that individuals who are affected by the disruptions from the COVID-19 pandemic at macro-, meso‑ and micro-levels of their ecosystems may be more susceptible to adverse mental health consequences (see Fig. 1 for the conceptual framework).…”