Cross-Roundtable Summary in English

OurCare Community Roundtables A summary of 10 conversations with equity-deserving communities across Canada about improving primary care

About OurCare Community Roundtables

Between June and December 2023, OurCare hosted conversations with people from some of the most equity-deserving communities in Canada–people who have historically had poor access to primary care, whose voices are too often left out of public consultations but who also have strength, wisdom and innovative ideas about how to improve their collective well-being.

We held 10 Community Roundtables, two each in British Columbia, Manitoba, Ontario, Quebec and Nova Scotia.

Collectively, we met with 192 people from across the country including First Nations, Inuit and Métis (FNIM) peoples; members of the African, Caribbean and Black communities; immigrants, refugee claimants, migrant workers and other newcomers; people with disabilities; and members of the LGBTQIA+ community.

This executive summary highlights common themes from the OurCare Community Roundtables. Full reports from each of the roundtables are available at OurCare.ca.

The Community Roundtables are the third phase of OurCare, a national conversation with everyday people about the future of primary care in Canada. OurCare is led by Dr. Tara Kiran, a family doctor and renowned primary care researcher based at MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto and the University of Toronto.

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About OurCare Community Roundtables The OurCare Community Roundtables were organized with the help of community organizations that had deep roots, strong relationships and trust with the people they served. These project partners collaborated with the OurCare team to recruit participants and organize and host each of the Roundtables. Each collaboration was unique, with project partners helping shape the Roundtable design and logistics.

Each conversation was roughly six hours, sometimes broken up into two days, usually in person though sometimes virtual. The conversation was often facilitated in multiple languages. For example, the newcomer roundtable in British Columbia was simultaneously translated in five languages: English, Tigrinya, Spanish, Dari, and Arabic. During their time together, participants learned about primary care, discussed barriers and facilitators to care and proposed ideas for change. The following sections outline the recurring and distinct perspectives across the Roundtables.

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OurCare Roundtables: Communities and Partners Province British Columbia

Community People Living with Disabilities

Languages Spoken

Partner

English

Refugee, Migrant English, Tigrinya*, Workers, and Newcomers Farsi-Darsi*, Arabic*, & Spanish*

Manitoba

Indigenous Youth

English

Refugee, Migrant English, Arabic*, & Workers, and Newcomers Ukrainian*

Ontario

Quebec

First Nations, Inuit and Métis Relatives living on Urban and Related Homelands

English

African, Caribbean, and Black Communities

English & French

Lesbian, Gay, Bi, Trans, Queer, Intersex, Asexual + (LGBTQIA+) Migrants

English, French, Arabic, & Spanish

Low-Income Residents, Newcomers, and Asylum Seekers

English & French

Nova Scotia Refugee Claimants

African Nova Scotians

English, Spanish*, & Haitian-Creole*

English

*Summary reports are available in this language. Full reports are all available in French and English.

Community Roundtable

Common Themes

Racism and other forms of discrimination are common experiences: Discrimination, both structural and individual, was a consistent theme across all 10 roundtables. This includes racism - anti-Black, anti-Indigenous, and other forms of racial prejudice – as well as transphobia, xenophobia, and discrimination related to disabilities.

Discrimination erodes patients' well being and confidence and fosters distrust in health care settings. Many participants described how racism and discrimination led to reluctance to seek care when needed.

Indigenous Models of Care are culturally determined and have always worked: Indigenous Models of Care have been effective in improving the health and well-being of diverse Indigenous communities. By prioritizing the delivery of wholistic health support, addressing all facets of well-being encompassing mental, emotional, spiritual, and physical care these models foster deeper connections with clients and communities. The emphasis on bridging cultural gaps ensures that health care is tailored to acknowledge and respect the unique needs of FNIM clients and communities. Moreover, the inclusion of Elders, Knowledge Keepers, community advisory boards, and the provision of culturally relevant care create a space that is both inclusive and responsive to the diverse traditions and cultures of Indigenous nations.

Expand the health workforce to reflect the diversity of the community: There is a need to expand Human Health Resources to reflect the diversity of the populations served and respect Indigenous self-determination. In addition to redressing instances of discrimination and historical injustice, representation in the health workforce was cited as a way to build trust with equity-deserving communities and ensure culturally safe, high quality care.

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Community Roundtable

Common Themes

Language barriers are a significant challenge in receiving high-quality care: Miscommunication and misunderstanding between patients and primary care clinicians contributes to negative experiences with the health care system. An inability to access information and care in residents’ primary language was cited frequently as a challenge that urgently needs to be addressed.

Leveraging international experience and learning from best practices: Participants spoke at length of the barriers newcomers face when trying to use their skills and training in the Canadian health care system. The current system takes too long and makes it too difficult for internationally trained health professionals to practice here. Barriers to pursuing medical education in Canada include high costs of training and restrictions on attending post-secondary due to residency status. Participants felt these barriers resulted in a waste of talent and resources that could address gaps in health human resources and contribute to diversifying the field. The roundtables also discussed the benefits of learning from best practices from other countries, with many believing that adapting successful strategies to the Canadian context would help improve access to care.

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Social determinants of health and well-being need to be considered in care: Cost of living, housing, and mental health were raised consistently as key contributors to people’s health and well being. Many participants also described having difficulty affording necessary prescription medications, emergency care, and medical equipment. The intersection of gender, race, spoken language, and residency status added compounding layers, each impacting a person’s ability to access care and their well-being. For many there is a “disconnect between the perception of Canada as a country with universal health care and the reality.”

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Community Roundtable

Common Themes

Empowering individuals and communities is a part of the solution: Participants expressed a strong desire to play an active role in their wellness and care. Solutions such as having access to one’s own medical records and health wellness promotion for youth were discussed. Many participants also called for more engagement and an ongoing role in the governance of the health care system for their communities.

Integrated and culturally safe models of care work best: Many participants spoke of the positive experiences with community health centre-type models. Greater access to integrated teams, culturally and linguistically concordant care, and relationship centered care are just some of the practices participants felt should be prioritized.

The demand and need for Indigenous models of care, and integrated team based models that actively support and meet the specific needs of historically excluded populations far outstrips the availability.

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Other Themes Per Community

First Nations, Inuit and Métis Relatives Living on Urban and Related Homelands: ● The importance of FNIM client and community-led care that is responsive to and meets the unique needs and assets of FNIM living in urban and related homelands through the application of Indigenous knowledge, practices, and models. ● Current health service funding mechanisms are poorly matched to the health service needs of FNIM populations across urban, rural and remote geographies and draw on Western definitions of health care and suitability often excluding or devaluing Traditional Healers and Cultural Practitioners Indigenous Youth: ● Indigenous youth need information and support to navigate the health care system in order to access care for their children, their families and themselves. Indigenous youth in the foster care system spoke of having little support when transitioning to independent living and few adults they could turn to for advice and support. ● The barriers for youth to get health cards, especially those struggling with homelessness or child welfare. Youth need easier access to health cards and also feel the health cards themselves should be upgraded to be plastic/ID-style cards that are more durable and easy to carry.

African, Caribbean and Black Communities, including African Nova Scotians: ● Impacted by systemic racism in the health care system and individual negative experiences, some members from ACB communities are hesitant to seek out care. This can have an intergenerational impact, with children sometimes repeating their parents' actions. ● African Nova Scotians have had to rely on each other due to generations of government neglect, and participants were emphatic in their belief that many of the solutions to better health lie within their community spaces.

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Other Themes Per Community

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Newcomers, Migrant Workers and Refugee Claimants: ● The lack of knowledge of the Interim Federal Health Program by both recipients of the benefit and care providers ● The positive impact of newcomer services in addressing barriers of language, lack of service awareness, and health-system knowledge through system navigators and advocates ● The health care system does not emphasize prevention. Participants shared stories of clinicians telling patients that their symptoms were not yet serious enough to warrant treatment, or of not taking the time to properly assess or diagnose a complaint.

People Living with Disabilities: ● Living with disability means having to navigate non-accessible care settings and becoming an expert in one’s own care—and a teacher ● People with disabilities face discrimination and stereotyping in health care like many other Canadians. Uniquely, they experience “gaslighting” or “infantilization” in health care settings due to their disability of not being believed, listened to or acknowledged when disabilities are “invisible” (e.g., chronic pain, mental health).

LGBTQIA+ Communities: ● Experiences of being misgendered or denied services due to their gender identity ● Experiences of transphobia and fatphobia from providers, and a lack of diversity in care providers are barriers that prevent LGBTQIA+ community 8 members from seeking care

Community Roundtable

Common Ideas for Change Across the Roundtables, participants overwhelmingly supported the recommendations of the previous Provincial Priorities Panels. In addition to those recommendations, the Roundtables specifically highlighted the following Ideas for Change: ●

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Address racism and discrimination in the health care system by mandating cultural safety training in all care settings and ensuring the availability public recourse mechanisms for patients who experience racism and maltreatment when accessing health services Recognize the training, certification, and experience of internationally trained health care workers by reducing the barriers to accreditation to practice in Canada Ensure all care institutions, including hospitals and clinics, in the country are accessible to those with physical disabilities and can provide care in a range of languages Embrace wholistic approaches to health that consider spirituality, mental health, sexuality, the social determinants of health, as well as physical health Expand and build upon the best practices of Community Health Centres and other integrated care models Increase the diversity of the health care workforce with dedicated educational and financial assistance programs for members of historically-excluded communities Empower individuals and communities to play a role in solutions to care Ensure programs include training on patient rights and advocacy resources Adopt an intersectional, gender-affirming lens in the design of health care spaces to ensure that they are safe and accessible for all individuals Create and promote additional financial aid programs for those who are unable to afford their prescription medication Increase the accountability of health care professionals and physicians by standardizing oversight procedures and recourse mechanisms for malpractice

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Other Ideas for Change Per Community

First Nations, Inuit and Métis Relatives Living on Urban and Related Homelands: ● Implementing a model of client-led, community-based care that is responsive to and meets the unique needs and assets of FNIM peoples across urban, rural and remove geographies and advances Indigenous models of health and wellbeing that apply Indigenous approaches and practices such as relationship centered care that empowers clients to take leadership in their own health and wellbeing ● Advancing ongoing, dedicated funding for IPHCOs and other Indigenous-led spaces and services that support mental, emotional, and spiritual health, in addition to physical health Indigenous Youth: ● Work with local Indigenous communities to identify and appropriately engage Indigenous Elders and knowledge keepers to contribute traditional teachings to medical school curriculum ● Work with Indigenous health services and Indigenous health providers across urban, rural and remote geographies to develop and implement practicums in Indigenous health service contexts – this will enhance awareness of Indigenous worldviews, practices, and lived realities ● Revising policies that prevent youth and people who are unhoused from getting health cards and other forms of identification required to access services and supports African, Caribbean and Black Communities, including African Nova Scotians: ● Collaborate with spaces already trusted by the community, such as churches, to expand and promote existing resources for transportation and childcare for individuals when they seek care ● Increase the amount of Black care professionals through post-secondary programs that expand inclusive access to racialized, francophone, and newcomer students in health studies Newcomers, Migrant Workers and Refugee Claimants: ● Offer information about the health care system and how to navigate it to newcomers. This information could be available pre-arrival or immediately upon arrival, and should be available in newcomers’ spoken languages. ● Address lack of awareness and clarity among clinicians and residents regarding the Interim Federal Health Program People Living with Disabilities: ● Create a federal disability benefit specifically to support the health care needs of people with disabilities and the people who care for them ● Expand access to home support for people with cognitive disabilities or neurodivergence LGBTQIA+ Communities: ● Adhere to existing human rights legislation that protects gender identity and gender identity ● Mandate the inclusion of gender-affirming, anti-oppressive, trauma-informed practices in the training of all staff in medical settings, clinicians, and all support staff

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OurCare is a national initiative to engage the public on the future of primary care in Canada. Over 15 months, thousands of people living in Canada told us about their hopes and priorities for creating an equitable and sustainable system that delivers better care for all. Learn more about the OurCare initiative at OurCare.ca.

The OurCare initiative has been made possible through a financial contribution from Health Canada, the Max Bell Foundation and Even the Odds (a partnership between MAP and Staples Canada). The views expressed herein do not necessarily represent the views of the funders.