Discrimination in healthcare as a barrier to care: experiences of socially disadvantaged populations in France from a nationally representative survey

Abstract

Background: People in socially disadvantaged groups face a myriad of challenges to their health. Discrimination, based on group status such as gender, immigration generation, race/ethnicity, or religion, are a well-documented health challenge. However, less is known about experiences of discrimination specifically within healthcare settings, and how it may act as a barrier to healthcare. Methods: Using data from a nationally representative survey of France (N = 21,761) with an oversample of immigrants, we examine rates of reported discrimination in healthcare settings, rates of foregoing healthcare, and whether discrimination could explain disparities in foregoing care across social groups. Results: Rates of both reporting discrimination within healthcare and reporting foregone care in the past 12 months were generally highest among women, immigrants from Africa or Overseas France, and Muslims. For all of these groups, experiences of discrimination potentially explained significant proportions of their disparity in foregone care (Percent disparity in foregone care explained for: women = 17%, second-generation immigrants = 8%, Overseas France = 13%, North Africa = 22%, Sub-Saharan Africa = 32%, Muslims = 26%). Rates of foregone care were also higher for those of mixed origin and people who reported "Other Religion", but foregone healthcare was not associated with discrimination for those groups. Conclusions: Experiences of discrimination within the healthcare setting may present a barrier to healthcare for people that are socially disadvantaged due to gender, immigration, race/ethnicity, or religion. Researchers and policymakers should consider barriers to healthcare that lie within the healthcare experience itself as potential intervention targets.

Utilization of preventive care among migrants and non-migrants in Germany: results from the representative cross-sectional study ‘German health interview and examination survey for adults (DEGS1)’

“…In addition to possible differences in health needs, preferences, and expectations different barriers to the utilization of preventive care have been discussed a potential explanation for differences in utilization [13][14][15]. This includes the absent or limited health insurance coverage, language barriers, discrimination and insufficient information about and access to preventive care among migrant population [16,17]. However, many studies have demonstrated that the use of preventive care is generally associated with a medium and high SES [5,18].…”

Social diversity and access to healthcare in Europe: how does European Union’s legislation prevent from discrimination in healthcare?

“…patients with chronic conditions such as cancer or diabetes or requiring surgical interventions [12,13]. Discrimination in healthcare can be based on several characteristics, such as income, education, occupation, gender, race, ethnicity or religion and is a welldocumented challenge to equal access in healthcare [14][15][16]. For example, patients with lower socioeconomic status consistently report more discrimination compared to patients with high socioeconomic status.…”

Strategies to establish and maintain trust when working in immigrant communities

“…Data from a variety of studies suggest that erosion of trust in the health care system, due to discrimination and fears of detention and deportation, is resulting in adverse health outcomes among immigrants (D’Alonzo et al., 2020; Novak, Geronimus, & Martinez‐Cardoso, 2017; Szaflarski & Bauldry, 2019; Torres et al., 2018). In addition, immigrants are more likely to report instances of health care discrimination (Hacker, Anies, Folb, & Zallman, 2015; Rivenbark & Ichou, 2020). Nurses are often on the front lines in these confrontations.…”