Mary’s mother is Polish and her father is from Nigeria; she was born in France and has lived in Canada since she was six. What does she call herself? Is she Polish-Nigerian? Or maybe just Canadian? What does she look like, and how does she sound on the phone? How many languages does she speak? More importantly, how will all of this impact the care she receives if she is diagnosed with cancer this year?
Canadians tend to be averse to labelling people based on ethnic or cultural characteristics, and while this is generally commendable, there are certain social contexts where there may be advantages to categorizing people on some measure of ethnicity. In health care, for example, categorizing patients by ethnic background allows health-care providers to answer critical questions, such as whether individuals from certain ethnic groups are at higher risk of developing diseases, or whether others are marginalized by the health system. In other words, ethnicity data can help us examine disparities in the delivery of health care.
While Statistics Canada doesn’t collect such data, the United States does classify all individuals into one of five broad groups: White American, Black American, Hispanic/Latino, Asian/ Pacific Islander and Native. This allows researchers to access health statistics that aren’t available in Canada. For example, the American Cancer Society 2012 annual Facts and Figures report notes that the death rate for cancer among African-American males is 33 per cent higher than among white males and for African-American females, it is 16 per cent higher than among white females. Such information permits targeted interventions.
Currently, foreign-born Canadians represent almost one in five of the total population. We were interested in potential disparities in health care at the Tom Baker Cancer Centre in Calgary, and since ethnicity data wasn’t available, we conducted a series of studies led by Dr. Bejoy Thomas to investigate this. We developed a framework that classifies people into quadrants based on whether they look and sound like the majority population (European-Canadian native English speakers). We found that although access to health care among visible minority populations was comparable to those who look and sound like the majority, utilization of health-care services seemed to be lower. That is, they may not take advantage of the services that are available to them, which can lead to more adverse health outcomes.
And foreign-born people who do not speak English as a first-language (whose English skills may be limited or even proficient) are more likely to report emotional distress related to a cancer diagnosis than other groups. Symptoms such as pain, fatigue, anxiety, depression and sleep deprivation are more common for visible minorities than for Canadians of European descent. This is even the case for those who are Canadian-born visible minorities and speak perfect English. Literature has, for the most part, considered this group as the cultural bridge between their immigrant parents and the host society, but they seem to be suffering just as much when diagnosed with cancer as their immigrant family members.
Unfortunately, foreign-born visible minorities are less likely to be satisfied with their cancer care as well. This may mean they will wait longer before seeking care, and may also have poorer outcomes from their treatment. A sad and startling statistic we noted recently is that visible minorities, with English as a second language, are more likely to have suicidal thoughts after a cancer diagnosis than the majority population.
So what does all this mean for Mary? She looks different than most Canadians, although she sounds pretty much the same. Just by virtue of that, she may be vulnerable for worse outcomes, more distress and more symptoms, such as pain and fatigue. Now that we have uncovered some of these disparities, the challenge is how to address them so that all Canadians, regardless of how they look or sound, not only have access to, but actually receive optimal cancer care. Dr. Thomas and his team continue to investigate ethnic disparities in cancer care across Alberta to overcome this challenge.