In recent weeks, I have read several reports on the health of immigrants in Canada. All these reports are unanimous in their conclusion that immigrants are healthier than Canadians when they arrive in Canada. However, over a 10 year period, their health deteriorates, with increasing rates of heart disease, hypertension, blood pressure, autism, diabetes and obesity. Immigrant health deteriorate for adults and children alike, and both men and women.
These studies highlight several factors that contribute to this deterioration. Socio economic factors such as lack of education, unemployment or underemployment, lower income and higher poverty levels all contribute. Genetic predispositions and lifestyle factors (not walking as much, driving more; eating fast food) add to the problem. Difficulty accessing health care due to language barriers, lack of access to a GP, knowledge of what service is available and where also contribute. In fact, according to all reports, access is the biggest challenge facing immigrant populations vis–à–vis their health.
I came to Canada in 1983 and am an educated, employed, middle class Canadian citizen. I am not poor by any stretch, am educated by all standards, have worked all my life, and can speak English fluently. I am active, fit, eat well and am in good health. In other words, the educational, social, economic, awareness and/or language barriers identified in health studies (and typically applicable to new immigrants), doesn’t apply to me anymore. Nor does it apply to many immigrant women living in Canada (some stats on this in my next blog).
Yet, access is still an issue for me and many other long-time immigrants. Here is why. After 25+ years of living in Canada, I access medical care like I live in the small town I was born in. Turns out, so do many of my immigrant female friends. Why? Conversations reveal the following:
First, we access medical care as a last resort. We start by managing our symptoms as mind over matter. Some aches and pains are part of life and so we accommodate them. We try a variety of home remedies – warm baths, oil massages, and teas made with roots and herbs that worked for our grand mothers. It’s only when the pain limits daily function and needs expert attention that we call a doctor. By the time we see a doctor, we have already tried most available non-prescription remedies, traditional and western. In other words, we approach our primary care doctor as our emergency physician. There is no time to wait, or try the simple steps. We are hoping for fast action.
We access health care sparingly, cost is a reason; attitude is another. We come from countries and cultures where medical care is generally private and we access it sparingly. We often think long and hard about the downstream costs. We are not always in jobs with generous benefits (10% of immigrant women are self employed; 49% who are work part time – not far from stats for Canadian-born women), so costs of tests, medications and supplemental care is a consideration. So is sick leave and lost wages.
Culture can be a factor too. Since culture can be so varied, I hesitate to make any broad statements here, except one. Physicians want us involved in our care – they want to discuss and collaborate, from the beginning of symptom onset. But I come from a culture where doctors are brought it at the end, not the beginning. Doctors don’t consult or collaborate; they decide and dictate. There is a line separating our respective responsibilities. Health is my responsibility; medicine is the doctors’.
Like other immigrant woman, I prefer female doctors. Any male doctor who has cared for my health was imposed on me at ER (twice, both high risk situations). After 25+ years in Canada, I will still enquire about available female doctors. This preference is not prejudice; its comfort level. I am prepared to wait an extra month or two or even six to access the system. According to the CMA (2012 stats), Canada is graduating more female doctors than male (60% of medical school students are female; in some universities 70% are female) and women have outnumbered men in 14 of the last 15 first-year classes at Canadian medical schools. But, female doctors (family physicians, especially) are not as accessible. 36% of Canada’s 72,000+ doctors are female and not all of them work full-year, full-time. So, after 4 years of managing without a GP, I created my own health care team. It includes my mother, my sister (a doctor in the US), gym instructors, and two physician friends who gave up medical careers to raise a family. I only access my part-time female family physician when absolutely needed, for tests and referrals.
I am fluent in English, so language is not a barrier, but communication certainly is. In a 10 minute appointment, there is not enough time to communicate. So our chat is usually symptom-driven; not health driven. Communication is also challenging because of the knowledge gap. Physicians don’t seem to know much about the quirks of my immigrant body – and neither do I. ‘Has there been any cancer deaths among your blood relatives?’ Don’t know. ‘How about heart conditions?’ Don’t know. ‘Diabetes?’ Don’t know. ‘Depression?’ Don’t know. I, for one, don’t know much about my body’s history except one thing – medications have the same effect on me as alcohol. Pill popping is alien to me. My constitution and petite build can’t handle the adult dosage I am prescribed – I get a bit high and float around in a daze (a good number of us Asian gals are no bigger than Canadian teenagers). So I still take children’s Advil for almost everything or I reduce the adult dosage a doctor prescribes.
Here’s an example. A few years ago, I drove myself to the hospital ER complaining of severe chest pains and a growing numbness in my left arm. Chest pains were not new. I had had them for about a year, but the numbness was new. I was sent to the Heart Institute and spent months undergoing tests but there was no diagnosis. Months later, still in pain, I happened to discuss my ordeal with a female physician from India. “Oh,” she replied, “that chest pain is very common in Indian women of your age.” She recommended two simple dietary changes and asked me to take a multi vitamin for women. Cured in 2 weeks. I have a similar story about a breast lump that was tested 3 times and referred all the way to a breast cancer surgeon. He sent me home with a prescription for primrose oil.
Why is it important to know that immigrant women access health care differently? For three reasons:
1. Our access is not necessarily limited by socio-economic determinants of health or language barriers as is so commonly reported in health studies.
2. Immigrant women distinguish between health care and medical care. We take full responsibility for our health and do all we can to care for it. We create our own family and community-based networks to guide us. We access medical care only when needed, as a privilege, sparingly, with a strong bias towards prevention, use of natural remedies and, as a last resort, expensive medical interventions.
3. How we behave, the values we have and the choices we make, have important implications for health care delivery because our numbers are growing. There are 3.3 million immigrant women in Canada, and the numbers are expected to double to 7.7 million by 2030. Immigrant women are no longer a small special interest group or sub-population. Two 2012 Statistics Canada reports note that half of Toronto’s female population, right now, is immigrant women. 57% of Markham’s female population and 58% in Richmond BC are immigrant women. Burnaby, Vancouver, Surrey, Mississauga, Brampton, Vaughn also post similar numbers, between 47%-52%. We are not all uneducated or poor, suffering from extreme social exclusion and terrible housing conditions. Some perhaps (usually newcomers and refugees), but not most. We play a central role in our families’ social and economic lives. How we access health care guides how our entire family – our children, spouses, aging parents – also access health care.
Understanding how immigrant women access health care is key to ensuring that Canada’s healthcare system continues to meet the needs of its diverse citizens.