Studying racial and ethnic health inequality in Canada: What we need to get right

Health disparities across racial and ethnic groups persist in Canada. But how the country can effectively address them hinges upon how it can better study these differences.

In a recent paper I co-authored, we examine how researchers study racial and ethnic inequalities in health. We identify four persistent problems: unclear categories of race and ethnicity, a white-centred lens, heavy reliance on majority-defined health outcomes and limited explanation of why these disparities arise.

We discuss these issues drawing heavily on evidence from the United States. This reflects the state of the field: Much of the research and many of the frameworks used to study racial and ethnic health inequality come from the U.S. and have been widely applied in Canadian research.

Canada and the U.S. share a history of colonialism, structural racism and white dominance that continues to shape persistent health inequalities across racial and ethnic groups.

But Canada is also different in several important ways. It has a larger immigrant population shaped by selective immigration policies, wider variation in social and economic conditions across regions and communities and a higher proportion of Indigenous Peoples. Data are often more limited, and policies such as universal health care shape how inequality is experienced and addressed.

To better understand and address health inequalities in Canada, Canadians must rethink how race and ethnicity are studied and ground approaches in the Canadian context.

Canada is not the U.S.

Canada’s social policies are distinct from American policies. To begin with, the racial and ethnic makeup of the populations differ. Canada, for example, has a smaller Black population and a larger Asian population than the U.S.. These differences reflect broader historical and institutional contexts that shape how racial and ethnic inequalities are structured in each country.

At the same time, Indigenous Peoples are more central to health inequality in Canada. This is because Canada has a relatively high percentage of Indigenous Peoples compared to the U.S. and many other more economically developed nations. The health of Indigenous Peoples is shaped by a long history of colonialism and ongoing structural disadvantage.

Immigrant population also differs. About one-quarter of Canada’s population is foreign-born, compared to about one in seven in the U.S. Canada’s selective immigration system means many immigrants arrive with relatively high levels of education and good health. This contributes to patterns like “the healthy immigrant effect.”

Research has shown that Canada exhibits the healthy immigrant effect, in which newly arrived immigrants tend to have better health than the Canadian-born population, though this advantage often declines over time with longer residence. Inequality does not line up neatly with race.

Policy matters too. Canada promotes multiculturalism, while the U.S. emphasizes assimilation into a single national culture. Canada has universal health care, which reduces financial barriers to basic care.

But this coverage is partial. Services such as prescription drugs, dental care and mental-health support are not fully covered and often depend on employment benefits or where people live. Since health care is organized at the provincial level, access and quality also vary across regions. These gaps shape who gets timely care and who falls through the cracks.

The problem with ‘visible minority’

The term “visible minority” is prevalent in research on racial and ethnic health disparities in Canada. But it often does more harm than good.

At its core, it lumps all non-white, non-Indigenous people into one group. That means populations with vastly different histories, migration paths and socioeconomic status are treated homogeneously. The ability to see meaningful differences in health across groups like Chinese, South Asian and Black communities is diminished.

Read more:
The diversity within Black Canada should be recognized and amplified

It also mixes up race and immigration. Many studies don’t separate immigrants from Canadian-born racialized populations. This matters because of the healthy immigrant effect. If newer immigrants are healthier on average, combining them with long-settled groups can make inequalities look smaller than they really are.

The term itself is also ambiguous. People do not always understand or interpret it in the same way, and it’s often taken literally to include anyone visibly different, such as those with disabilities or who are transgender, which complicates its use in health research.

In many ways, the problem stems from data. Canada has limited, inconsistent race-based data. Racial categories are not standardized, and detailed race-based data are often hard to access. Due to limited data availability, researchers could only rely on broad racial terms. This aggravates the problem: instead of revealing inequality, it hides it.

We measure health too narrowly

Another issue is how health is defined in the first place. Most studies rely on standard measures such as life expectancy, chronic illness or mortality. These measures are important, but they only tell part of the story. They reflect a narrow, biomedical view, often omitting how diverse racial and ethnic groups actually experience health and well-being.

Considering Indigenous communities as an example, health is not solely about the absence of disease. It includes connections to land, culture, community and spirituality, alongside physical and mental well-being. Defining health narrowly can marginalize groups by neglecting how different groups understand and experience health.

A narrow focus also makes inequality harder to see. Different groups face distinct health risks and barriers. When we rely on only a few measures, important health problems and inequalities can be overlooked.

A Canadian approach

Studying racial and ethnic health inequality in Canada requires a distinctly Canadian approach. The population, data and policy context differ from those in the U.S., and these differences shape both how inequalities emerge and how they should be studied.

This means moving beyond broad categories, improving race-based data, and using more meaningful and diverse measures of health. It also requires closer attention to context, including Indigenous and rural settings, as well as Canada’s social, immigration and health policy landscape.

To effectively address health disparities, research needs to be grounded in Canada’s realities, not simply adapted from models developed elsewhere.