Moving toward equal access in health care

Issue: BCMJ, vol. 47 , No. 6 , July August 2005 , Pages 283 Letters

There is increasing evidence that the health care system is less responsive to the needs of immigrants and ethno-cultural communities than to other Canadians. Systemic barriers to access can be seen at every level of the health care structure: lack of linguistically appropriate services; predominantly homogenous staff and management; lack of proactive policy and programs and services based upon demographics that are no longer accurate.

Across the province there is a patchwork of responses, with serious gaps in service provision for non-English speaking people and those with limited ability in the language. Depending upon where an individual has chosen to live in BC, and when he or she needs health care services, it may or may not be possible for him or her to communicate with health care professionals. Language is not the only barrier. Cultural barriers also impede access to health care.

In today’s British Columbia, where over one million people are immigrants and where over 100 000 do not speak English, these issues are not a matter of responding to the needs of a small or marginal population. This is a significant portion of BC society and ad hoc programs aimed at specific segments of this group are temporary solutions at best. Systemic change at the root of the health care system in policy, at training institutions, and in financial structures will be needed to address true accessibility.

The growing diversity of the patient population increases the likelihood that cultural differences between patient and provider will lead to diagnostic errors, inadequate patient adherence to clinical recommendations concerning medications, treatment plans, and self-care, potential harm from simultaneous use of conventional and alternative (or traditional) medicines and treatments and, inevitably, a lack of trust in the health services available.

Moving toward cultural responsiveness in the health care system is not going to be an easy task but is essential if the system is to deliver relevant, high quality, and safe health services to the ever-widening diversity of BC’s population.

AMSSA, the Affiliation of Multicultural Societies and Service Agencies of BC (www.amssa.org) is a non-profit umbrella organization with over 85 member organizations providing immigrant settlement services and multicultural programs throughout BC. With the support of the Population Health Fund of the Public Health Agency of Canada, AMSSA’s Multicultural Health Committee has initiated a project called Promoting Healthy Living in BC’s Multicultural Communities. This three-phase project aims to support effective intercultural communication in public health through the mounting of a Multicultural Health Fair (held in February 2005) to encourage partnerships in the drive toward equitable, accessible, and responsive health care services; a mapping project to identify best practices, gaps in current resources, and new resources needed for provision of health services to multi-ethnic communities; and a directory of cross-cultural public health expertise and skills in BC.

To increase the ability of public health providers to respond to health care issues and health emergency situations in BC, the mapping phase of the project is identifying current public health trends, issues, challenges, tools, and resources that are available in multi-ethnic communities in the province. One stage of the work involves an Internet-based survey of health professionals.

AMSSA encourages all health care professionals to respond to the survey. To do so, send your e-mail address to amssahealth@amssa.org. You will receive an introductory letter with the web link and instructions on how to access and respond to the questionnaire. It should take only 15 minutes to complete.

For more information, contact Ms Dora Replanski at 604 718-2784 or at amssahealth@amssa.org.

Lynn Moran
Executive Director, AMSSA

Lynn Moran. Moving toward equal access in health care. BCMJ, Vol. 47, No. 6, July, August, 2005, Page(s) 283 - Letters.



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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

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