When we talk about access to health care, we’re referring to the ability of people, or communities, to get the services they need and are looking for. It is an important determinant of health.
Fair access does not mean that everyone gets the same thing. But rather that services are provided on a needs basis. There are many factors that can make it harder for people to get to these services in the first place or that affect the quality of the care they get, whether we mean it or not.
Although Canada’s health care system is ‘universal’ not everyone has equal access to health services. There are many people and groups that are under-served, and it shows up as health disparities.
For example, a recent study by Dr Janet Smiley speaks to the very real impact of ‘unintentional racism’ by well-meaning health care providers.
The following section offers food for thought for health professionals as they review and assess the important relationships they form with the people they care for. It is important to provide positive and patient-centered care to ALL patients.
Knowing full well that health care providers often work with diverse populations, what are some ways to ensure we don’t fall into the trap of a ‘One Size Fits All’ approach or have our care impacted by misconceptions?
How to Avoid Stigma
When stigma manifests within the client-provider or patient-doctor relationship, it negatively affects the accessibility, quality and acceptability of sexual health services. Here are some ways to be mindful of that in our everyday practice.
Becoming educated about different people’s realities and needs is the first step to being part of the solution.
Reflect on stereotypes and do not reproduce them
We have invited several partners to tell us about what that can look like in their interactions with the health care system. Click here to read up on these experiences and seek out more information from reliable sources (For example, best or promising practices guidelines, resources or trainings developed by organizations well recognized for their work with specific communities, Public health agencies, etc.)!
Be mindful of your own assumptions, prejudices and beliefs and understand the motivation behind them
Do not project your values onto someone else. If your values interfere with meeting an individual’s needs, refer them to someone else.
Be mindful of your own assumptions and educate yourself on what impacts the health of diverse communities as well as their access to quality and responsive health care.
Consider taking and/or making cultural safety trainings available to colleagues and staff. While cultural sensitivity and cultural competence focus on learning about the culture of the service user, cultural safety pays explicit attention to power relations between service user and service provider.
Assess the specific risks or facts and respond accordingly
Make sure you are not drawing conclusions from what you believe to be true about certain people instead of weighing in the information you have available to you.
Be aware of diversity
We might make assumptions about who we see in our practices or services. That is also true when we speak about key populations. For example, the LGBTQ community is diverse. While L, G, B, T and Q is often tied together, each letter in the acronym represents a wide variety of people of different races, ethnicities, ages, socioeconomic statuses and identities. What binds them together are shared experiences of stigma and discrimination, and, specifically in the context of health care, a long history of mistreatment and lack of awareness of health needs by health professionals. As a result, LGBTQ people face a common set of challenges in accessing culturally-competent health services and achieving the highest possible level of health but they are not one and the same.
Consider a patient’s life as a whole
Respond to the needs identified by patients/clients and seek out ways to get a more complete picture of who they are, what their circumstances are, what kinds of support they have, etc. Bonus: having the necessary conversations to get to that information can help people feel more engaged in their care.
Respect people’s choices
While we may not understand them all, it is important to consider how incredibly complex and personal decisions about one’s life or health can be. Even just on the individual level, people may be juggling things like childcare needs, debt, complicated relationships, abuse, lack of income, loss of job, a break-up, a recent move, mental health conditions or, phobias, to name only a few.
Acknowledge the knowledge and expertise people have about their own bodies, circumstances, experiences and communities
You have medical knowledge and skills to contribute to this partnership; they have other important elements to bring to the table, such as knowledge of their bodies, their health history, relevant information on the communities they are from or identify with, etc.
Respect their rhythm of progression
Especially for people and communities who have been hurt by the health care system or health care providers, it can take time to build and nurture trust. Appreciate that it must be earned!
Create a welcoming environment
Scan your office, practices, and intake and interview forms to ensure you are creating a welcoming environment for a diversity of patients/clients. You can put up posters and offer resources that signal that you are welcoming and respectful of ALL your patients.
Speak up if you see colleagues being disrespectful or misusing their authority
If you see colleagues mistreating or disrespecting a patient, speak up, either in the moment or in private, during staff meetings, directly or not, to supervisors, etc. There are many ways to go about it but the important thing is to interrupt the behavior itself and what would make it likely that it will happen again. Be aware of the significance of language. What we say and how we say it can be hurtful. It is not appropriate to laugh or make jokes at people’s expense or to share harmful stereotypes about entire communities.
Consider the implication of policies and practices in your work environment
If you do notice that some people are systematically barred from accessing services, put under surveillance, identified in stigmatizing ways (for example, a visible sticker on their file marked HIV+), or are never coming back, look into what could be contributing factors on your end.
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