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The health care system in Atlantic Canada cannot adequately help immigrant, refugee and racialized minorities if it cannot hear or see them. So when it comes to access to health care for diverse populations, their current invisibility within the system is a top concern.

Recent studies sponsored by the Maritime Centre of Excellence for Women’s Health (MCEWH) have exposed a critical knowledge gap in the Atlantic Region about accessibility of health care for disadvantaged sub-populations in general and women in particular. This lack of information about the lives of minority women and their families—especially Aboriginal, Black, immigrant and refugee women—forms one of the chief roadblocks to their proper care. The voices of these ‘forgotten’ populations deserve greater attention and inclusion in program and policy planning in the health care system.

Roughly a dozen research projects on immigrant and refugee women in Atlantic Canada sponsored by the MCEWH are beginning to enhance our understanding by initiating a critical body of policy-based research on health needs by ethnic origin and by passing the research through the gender lens. These projects tell us that, although health care is officially as ‘available’ for marginalized groups as it is for those in the mainstream, in Atlantic Canada language and cultural issues can severely limit access to adequate care, especially in the case of new ethnic minorities. Their small numbers mean they can easily be forgotten or excluded if special efforts are not made to inform health care policy about them.

Regional research on the voices of diverse and excluded populations has revealed language, culture and medical research as three major barriers between ethnic subpopulations and adequate health care.

More and better trained health care interpreters are needed to help prevent misunderstandings and to enhance communication processes about diagnoses. Training for interpreters in medical terminology, and cultural and linguistic translation also would improve immigrants’ encounters with doctors and nurses, and enable their voices and needs to be more clearly presented and heard. A parallel need exists for more organizations to provide and deliver vital information and health education in an immigrant’s own language about how to use the system, and about health promotion. Provincial health systems in Atlantic Canada should develop umbrella policies integrating multicultural issues into programs for health providers and students of nursing. Diversity training for medical and support staff must become a matter of policy and practice before the system can become culturally responsive.

Culturally relevant community-based research on social and economic inclusion is required to shape policy, professional education and ultimately, service delivery. Without it, there can be no knowledge base about the diverse health needs of racialized minorities. The research should identify the health needs of women, elders and children using a cultural, age and gender-based analysis. The research also should identify concrete steps to better integrate excluded populations into mainstream health care services and programs.

The Maritime Centre of Excellence for Women’s Health is producing regional research on diversity, inclusion and health on a continuing basis to help bridge the information gap. We also participate in a national working group on immigrant and refugee women’s health in Canada that we hope will contribute to the work and will ultimately inform public policy. But much more needs to be done. Particularly in the absence of a national Metropolis Centre of Excellence for Research on Immigration in the Atlantic region, more resources are absolutely essential to allow us to see and serve the legitimate needs of racial and ethnic minorities inside the Canadian health care mosaic.

For more information on these and other projects in the area of social and economic inclusion, please visit our web site: www.medicine.dal.ca/mcewh

Carol Amaratunga, PhD, is the Executive Director of the Maritime Centre of Excellence for Women’s Health (MCEWH), supported by Dalhousie University, the IWK Grace Health Centre for Children, Women and Families, Health Canada, and by anonymous generous donations.