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Health and Black Canadians

Overview

Blacks make up the third largest visible minorities in Canada, behind the Chinese and South Asians. The 2001 Census reported a total of 662,200 blacks in Canada, representing approximately 2 percent of the overall Canadian population. The black population has grown dramatically over the past few decades. For example, between 1991 and 2001, black population grew by 31%, during the same period; the overall Canadian population grew by 10%. In 2001, almost half of the black populations in Canada were born here (Statistics Canada, 2004). For more information on the history of Blacks in Canada, refer to the document titled “Blacks in Canada: A Long History” available at the following web link. http://www.statcan.ca/english/studies/11-008/feature/11-008-XIE20030046802.pdf

Unlike the United States, the Government of Canada does not collect health data by race or ethnicity. Therefore, Canadian national health surveys do not provide specific information on the health of Black Canadians. Further, limited studies have been conducted in Canada in the area of the health of Black communities. However, Health Canada released a document in April 2000 outlining the health issues among Black and Caribbean Canadian Communities. A Racism, Violence and Health Project is currently in the data collection and analysis stage, however it is looking at the impact of violence and racism on the health of African Canadian community members in Halifax, Toronto and Calgary. In addition, various studies have been conducted in the African-Canadian population in Nova Scotia. These studies mentioned above will be outlined in this document. A number of health conditions have been identified as having a significant impact on the health of Black-Canadians; these include diabetes, HIV/AIDS, high blood pressure, sickle-cell anemia, and uterine fibroids. However, prevalence data regarding health conditions specific to the Black-Canadian population is scarce. Racism is ongoing in Canada and has been reported to be a significant contributor to increased stress and mental health conditions among the Black-Canadian population. Canada is in desperate need of more comprehensive health studies on the health status of Black-Canadians.

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Black Canadian Research

Racism, Violence and Health Project

The racism, violence and health project involves working with Black Canadians from Halifax, Toronto, and Calgary to study the impact of racism on the health of African-Canadians. For a more complete project description, refer to the following site http://rvh.socialwork.dal.ca/01%20Project%20Description/descripion.html

A community forum for this project was held in Calgary on January 25th, 2003. The purpose of the forum was to provide an overview of the Racism, Violence and Health Project as well as get feedback on how racism affects the health and well-being of African Canadians in Calgary. A total of 62 African Canadians completed the evaluation in Calgary. When asked about the issues impacting the health and well-being of African Canadians in Calgary, 23/62 of the respondents indicated racism as a general problem. A common theme from a number of respondents included emotional and mental stress caused by racism, unemployment and underemployment. When asked about the actions they feel are required to improve the situation, respondents reported needing support mechanisms for anger management, self-esteem and conflict resolution and the need for a strong community support organization for Black Calgarians. Results of this forum are presented at the following web link. http://rvh.socialwork.dal.ca/05%20Community%20Forums/Calgary/forum0203cgy.html#data

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Health Promotion and Population Outreach in the Black and Caribbean Canadian Community

In 2000, the Canadian Centre on Minority Affairs and Health Canada conducted a study to determine the primary health care issues and health care needs of Black and Caribbean communities in Canada. A total of 32 key people from Black and Caribbean communities in Ontario and Nova Scotia were consulted and completed a standard questionnaire. Findings from the study revealed that stress as a result of racism and adjusting to a new society are societal risk factors impacting the Black-Canadian community. Further, findings indicate that numerous Black and Caribbean Canadians are unfamiliar with the Canadian health care system and therefore are not using it in the most effective way. The economic disadvantage of the Black Canadians play a role in the health of the community. Consultation with key informants indicated that specific health conditions are having a significant impact on the Black Canadian population. These include diabetes, heart disease and stroke, hypertension, arthritis, asthma, hepatitis, sexually transmitted diseases, HIV/AIDS, sickle-cell anemia, lupus, breast and prostate cancer, drug addiction, and mental health. Although specific prevalence information was not collected in this study, key informants recognized the above issues as having an impact on the Black communities in Canada. Recommendations for action from the study participants included 1) qualitative and quantitative research on the health conditions among the black population and their health program and service needs, 2) creation of a database of research information, 3) education on the black culture, beliefs and values to health care professionals, 4) increase the black representation in the health sector, 5) conduct culturally appropriate education and health prevention to the black communities in Canada. For more information on this study, refer to the following web link

http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-certain-equit-acces/2001-certain-equit-acces_e.pdf

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Strong Black Women

The strong black women project conducted by Etowa & Keddy (2005) is a community-based research project that investigated the health and well-being of middle aged African-Canadian women in Nova Scotia. Specific attention was given to how women are affected by menopause. A series of interviews, focus groups, workshops and questionnaires were conducted on 50 women between the ages of 40-65 years of age. In addition, a population of 60 individuals participated in a study from 8 communities in the Halifax region.

Findings from the interviews with the 50 black women resulted in the emergence of four common themes; depression, menopause, racism, and “the strong black women”. Findings indicated that depression is often not discussed among Black women; it is commonly interpreted as sadness, unhappiness, self-doubt, and feels of being overwhelmed. Major causes of depression among black women included: concerns for their family and friends, business and work related stress, grief, loss and stress from death, racism, unresolved trauma from the past, menopause, tiredness, and anxiety and pain related to illness. Depression was identified among 24% of the sample. Racism was reported as being a destructive and negative impact on their health. Feelings of stress, rage, anger, and being overwhelmed were identified to be of greater prevalence because of racism. Difficulties in finding a doctor that supports them was a concern expressed. Further, participants reported that racism is an ongoing problem in Nova Scotia and is difficult to escape.  The women reported being prepared for the physical changes associated with menopause, but not the emotional changes. Finally, black women reported feeling pressure to play the “strong black women” role and put other people’s needs in front of their own.

For more detailed information on this study, refer to the following web links http://www.haac.ca

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On the Margins:
Understanding and Improving Black women’s health in rural and Remote Nova Scotia Communities

Dalhousie University in Nova Scotia, is conducting a community research project titled “On the Margins: Understanding and improving Black women’s health in rural and remote Nova Scotia Communities”. The purpose of the study is to investigate the health status, health care delivery and utilization of health care services among African Canadian women living in rural and remote regions in southern Nova Scotia. This is an important study as African Canadians face barriers to health on a daily basis. They are a marginalized and a relatively disadvantaged population in Nova Scotia today. It is hoped that this study will provide a better understanding of the health disparities among African-Canadians living in Nova Scotia. Further, awareness of the barriers and health disparities will help health professionals, researchers and policy developers attempt to eliminate such barriers. At present, the research is ongoing and analysis has not been completed as of yet. However, stay tuned for the results of the research at the following web link http://www.haac.ca

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Black Women’s Health Project

A study by Edmonds, Amaratunga, Enang, & Atwell (2001) called “the Black Women’s Health Project” investigated the health issues among Blacks in Nova Scotia. A two-day workshop in Nova Scotia brought key players working in the field of health of black Canadians together, to share research findings and make recommendations for policy makers, researchers and community leaders. The goal of this project was to put together a comprehensive report on the current level of knowledge regarding the health of Black Nova Scotians. The report is located at the following link http://www.acewh.dal.ca/eng/reports/BWHNFinal.pdf

Findings from this project were separated five categories, 1) accessing health services, 2) health status of blacks, 3) general status, 4) personal health practices and 5) behaviour and lifestyle.

A number of barriers limiting access to health services were identified. Transportation was reported to be a barrier to service access, racism between health care provider and patient and language barriers were the main difficulties in accessing heath services.

Numerous health conditions were identified as being disproportionately represented among African-Canadians. It must be noted, that much of the research has come from United States literature. Diabetes was estimated at 2.5 times more prevalent among Black people, compared to white people. Death from cardiovascular disease was higher among black people. Hypertension rates were double among Blacks compared to Whites. Black women have been found to experience early onset and late diagnosis of breast cancer. Rates of obesity were higher among Black women compared to white women. Mental health issues such as schizophrenia, suicide and depression related to racism were found to be highly prevalent among Blacks. The prevalence of HIV/AIDS is increasing among the Black population in Canada, especially among the women. Approximately one in twelve African Canadians had sickle cell anemia. The rate for lupus among Black Canadian women is approximately one in 250; significantly higher than the general population rate of one in 2000. Sarcoidosis was found to be 10-15 times higher among African Americans compared to the general US population. Stress was reported to be the most common health problem among African Nova Scotians.

The general socioeconomic indicators were also investigated among African Canadians. Findings indicate that approximately 15% of the African Canadian population in Nova Scotia had less than a high school education. The unemployment rate among Black Nova Scotians is significantly higher (20%) compared to the Nova Scotia rate (7.7%).

Investigation into personal health practices among African Canadians indicated that Black women are less likely to utilize preventative health programs, such as pap tests, mammograms, compared to the general population.

Considering the findings from the reviews and information sharing opportunities, recommendations were made on the future directions for health promotion, health prevention and health services activities for Black Canadians in Nova Scotia. For a more comprehensive overview of the study, please refer to the following web link http://www.acewh.dal.ca/eng/reports/BWHNFinal.pdf

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Diseases found among Black-Canadians

HIV/AIDS

Although the overall prevalence of HIV/AIDS has decreased, the proportion of HIV and AIDS cases among the Canadians of a black ethnic origin has increased over the past five years. In 1998, 8.2% of all AIDS cases in Canada were among individuals of a black ethnic origin. By 2003, blacks represented 20% of all AIDS cases (Health Canada, 2003). The black population accounts for approximately 2% of the overall Canadian population. Therefore, Black Canadians are significantly over represented among AIDS cases in Canada.

For more information about HIV and AIDS in Canada, refer to the following links
http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/04vol30/dr3013ea.html

or

http://www.phac-aspc.gc.ca/publicat/aids-sida/haic-vsac0603/pdf/haic-vsac0603.pdf

Springboarding a National HIV/AIDS strategy for Black Canadian, African and Caribbean Communities Project. (2005). Available at http://www.icad-cisd.com/pdf/publications/SNS_EnviroScan_Final_Report_9_Dec_05.pdf

Sickle-Cell Anemia

Sickle-Cell Anemia is an inherited blood condition. It is characterized by pain and swelling in the joints, fever and respiratory infections. According to the Sickle-Cell Anemia association of Ontario, it affects more Black people, compared to any other racial group (Sickle-Cell Association of Ontario, 2006). An exact prevalence of Sickle-Cell Anemia among the Black community in Canada is unknown. It is estimated that approximately 1 in 400 black babies are born with sickle-cell anemia (Health Canada, 2000).

Diabetes

Research has indicated that individuals of African Decent are at increased risk of developing type 2 diabetes (Public Health Agency of Canada, 2005; Canadian Diabetes Association, 2006).

A study by Zdravkocic, Daneman, and Hamilton (2003) investigated the clinical experience of the multiethnic population of children and teens diagnosed with type 2 diabetes at the Hospital for Sick Kids in Toronto, Canada. A chart review was conducted on patients diagnosed with type 2 diabetes between January 1994 and November 2002. Findings indicated a steady increase of type 2 diabetes among children 18 years and younger at Toronto Sick Kids hospital between 1994 and 2002. African- Canadians and South East Asian children were over represented among the child population with type 2 diabetes. African-Canadians represent approximately 6% of the Toronto and area population. However, 27% of all diabetes cases during this study period were among African-Canadians. This suggests that African Canadian and South East Asian children are more likely to develop type 2 diabetes compared to their Caucasian counterparts. For more information about this study, refer to the following reference, Zdravkovic, V., Daneman, D., & Hamilton, J. (2003). Presentation and Course of Type 2 Diabetes in Youth in a large multi-ethnic city. Diabetes Medicine, 21, 1144-1148.

High Blood Pressure

The incidence of high blood pressure is higher among Black Canadians (Heart and Stroke Foundation, 2002).

Mental Health Problems

Various Canadian studies have outlined the increasing prevalence of mental health problems among Black-Canadians (Health Canada, 2000; Enang, 2001). Although prevalence data is not available, qualitative data indicates that black-Canadians are impacted by mental health problems, such as depression, anxiety and schizophrenia. Racism has been identified as a major cause. More research on the mental health status of black-Canadians is required.

Uterine Fibroids

Uterine Fibroids are tumerous growths that develop in a female’s reproductive tract. Uterine fibroids are rarely cancerous and they do not increase the risk of developing uterine cancer. They are a common condition affecting women in their reproductive years.

The prevalence of uterine fibroids in the population is difficult to determine, because many may have them and show no signs or symptoms. The Mayo Clinic estimates that they are present in as many as every three of every four women; however they only cause problems such as pain and extreme menstrual bleeding in about one in every four women.

Research shows that Black women are more likely to have symptomatic uterine fibroids compared to women of other racial groups (Pron, Cohen, Soucie, Garvin, Vanderburgh, & Bell, 2003; Mayo Clinic, 2005). This was confirmed by the National Uterine Fibroids Foundation (2004) that stated that African-Americans are 2-3 times more likely to have uterine fibroids compared to women of other racial groups. In addition, African American women are more likely to present symptoms of uterine fibroids at a younger age.

For more information about Uterine Fibroids refer to the Centre for Uterine Fibroids at the following link http://www.fibroids.net/aboutfibroids.html

and

http://www.ahcpr.gov/research/fibroid/fibreg.htm

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References, Reports and Websites:

1. Public Health Agency of Canada. (2005). Type 2 Diabetes Info Sheet. Available at http://www.phac-aspc.gc.ca/seniors-aines/pubs/info_sheets/type2_diabetes/pdf/type2_diabetes_e.pdf

2. African Americans and Alzheimer’s disease: A silent Epidemic http://www.alz.org

3. African-Canadian and Other Minority Children and Youth at Risk: Systems and
Strategies to Stimulate Survival and Viability. (link no longer available)

4. Pron, G., Cohen, M., Soucie, J., Garvin, G., Vanderburgh, L., Bell, S. (2003). The Ontario Uterine Fibroid Embolization Trial. Part 1. Baseline Patient Characteristics, fibroid burden, and impact on life. Fertility and Sterility, 79(1), 112-119.

5. Mayo Clinic. (2005). Uterine Fibroids. Available at http://www.mayoclinic.com/health/uterine-fibroids/DS00078/DSECTION=1

6. National Uterine Fibroid Foundation. (2004). Risk factors for Uterine Fibroids. Available at http://www.nuff.org/health_riskfactors.htm

7. Health Canada. (2003). HIV and AIDS in Canada. Available at http://www.phac-aspc.gc.ca/publicat/aids-sida/haic-vsac0603/pdf/haic-vsac0603.pdf

8. Sickle-Cell Association of Ontario. (2006). Available at http://www.sicklecellontario.com/frameset.html

9. Canadian Diabetes Association (2006). Are you are risk for Type 2 Diabetes? Available at (link no longer available)

10. Heart and Stroke Foundation of Canada. (2002). High Blood Pressure. Available at http://ww2.heartandstroke.ca/Page.asp?PageID=1562&ArticleID=1362&Src=&From=SubCategory

11. Zdravkovic, V., Daneman, D., & Hamilton, J. (2003). Presentation and Course of Type 2 Diabetes in Youth in a large multi-ethnic city. Diabetes Medicine, 21, 1144-1148.

12. Enang, J. (2001). Black Women’s Health: A synthesis of Health Research Relevant to Black Nova Scotians. Available at http://www.acewh.dal.ca/eng/reports/BWHNFinal.pdf

13. Public Health Agency of Canada. (2003). The Tides of Change: Addressing Inequality and Chronic Disease in Atlantic Canada: A Discussion Paper. Available at http://www.phac-aspc.gc.ca/canada/regions/atlantic/Publications
/Tides_of_change/tides_change_e.html#table

14. Mothering at the Margins: An African-Canadian Immigrant Woman’s Experience. (2001). Available at http://www.cwhn.ca/network-reseau/4-2/4-2pg3.html

15. Racial Discrimination as a Health risk for female youth. (2003). Available at http://www.whiwh.com/Research/ePub_RacialDiscrimination.pdf

16. Health Canada. (2000). Certain Circumstances: Issues in Equity and responsiveness in access to health care in Canada. Available at http://www.hc-sc.gc.ca/hcs-sss/alt_formats/hpb-dgps/pdf/pubs/2001-certain-equit-acces/2001-certain-equit-acces_e.pdf

17. Etowa, J. & Keddy, B. (2005). Menopause and Midlife Health of the “Strong Black Woman”: African Canadian Women’s Perspectives.

Websites:

Black Women’s Health
http://www.cewh-cesf.ca/PDF/acewh/black-womens-health.pdf

African-American Health
http://www.nlm.nih.gov/medlineplus/africanamericanhealth.html

Black Women’s Health
http://www.blackwomenshealth.com/

Black Studies Centre
http://www.blackstudies.ca/

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