Hundreds of students are beginning their healthcare training journeys this month. September is a good time to think about primary care – the foundation of the healthcare system. Primary care is the point of first contact for patients and serves as a conduit to other types of specialty care. Despite the importance of primary care, 2.5 million people in Ontario – 17 per cent of the population – do not have a family doctor.
Evidence continues to emerge that some equity-deserving groups face the greatest barriers accessing primary care. For example, Black adults are 10 per cent less likely to have regular contact with healthcare providers. People living in poverty are less likely to be formally attached to a family doctor or be enrolled in any other primary care model. And members of the 2SLGBTQ+ community are less likely to receive the preventative care they need, an important part of primary care.
With funding from Ontario’s Ministry of Health, Wellesley Institute recently conducted a review to better understand the barriers to accessing primary care that face racialized and 2SLGBTQ+ individuals, and people living with low incomes in the province. There are many, particularly because good primary care access goes beyond mere “access” to the service. Access is also about eliminating financial, geographic and social barriers and providing relevant care to specific population groups in a way that is acceptable to the patient.
Our research shows discrimination is a major barrier for members of the 2SLGBTQ+ community, racialized groups and people who live in poverty. This discrimination causes them to feel unsafe when accessing primary care and to mistrust the healthcare system.
The research also revealed that healthcare professionals lack training about the needs of equity-deserving populations. For example, in addition to language and cultural barriers, traditional biomedical concepts in primary care services are sometimes insufficient, especially for people who hold a non-Western concept of health, such as Afrocentric or Traditional Chinese Medicine. There is a need for training that helps healthcare professionals better understand the social and cultural factors of health. Our research also suggests that healthcare providers often feel unprepared to provide services for the 2SLGBTQ+ population due to gaps in their training.
Short appointment times can also be challenging for members of equity-deserving groups who have broad-ranging health-related concerns linked to their social environment, for example, housing and income. These individuals often require greater flexibility and time.
There are key opportunities for improving access to primary care for equity-deserving communities. Examples include translation services, disease-prevention programs that support 2SLGBTQ+ communities, and poverty screening tools and training for physicians to help them better understand the income status of their patients. Healthcare providers can also consider how cost might create barriers to care for certain populations and how this can be addressed.
Most of all, it’s important to consider the perspectives and the priorities of the communities themselves if we want to enhance their access to primary care. Wellesley Institute is now conducting research to identify these by engaging healthcare providers and individuals having difficulty accessing primary care to explore potential solutions. In particular, the research will focus on people living with a low income in Ontario who identify as belonging to the East Asian, South Asian, Southeast Asian, Black or 2SLGBTQ+ communities.
We look forward to sharing more proposals for change to ensure the promise of healthcare can be fairly realized by everyone in Ontario.
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Learn if you are eligible to participate in Wellesley Institute’s current research on the barriers and enablers of healthcare access and services for people living with a low income in Ontario who identify as belonging to the East Asian, South Asian, Southeast Asian, Black and 2SLGBTQ+ communities.