Canada’s healthcare system is often described as one of the most defining and commendable features of the country. The notion of “universal” healthcare carries an implicit promise of fairness: that everyone, regardless of background, will receive the care they need when they need it (Public Health Agency of Canada [PHAC] 2020). Before beginning my master’s, I accepted that narrative. I understood that gaps existed, but I perceived them primarily as procedural challenges rather than structural ones. Over the duration of my education and through critical engagement with research, patient experiences, and systemic analyses, which understanding changed substantially. I now recognize that universal access does not equate to equitable care, and that institutional racism plays a significant role in affecting health disparities in the Canadian healthcare system (PHAC, 2020).
Initially, my understanding of racism in healthcare was grounded in individual interactions. I associated racism with overt acts, being dismissed, spoken to disrespectfully, or treated unfairly because of assumptions or stereotypes. While these individuals’ experiences remain deeply important, the course materials made it increasingly clear that looking solely at interpersonal racism overlooks the wider structures that consistently disadvantage Indigenous and racialized populations. Racism is embedded within polices, institutional practices, and historical backgrounds that influence health long before an individual seeks care (PHAC, 2020; Hamad et al., 2022).
This realization forced me to reexamine not only my understanding of health equity but also my professional practice as a Patient Relations Manager. In patient relations, concerns are often framed as isolated incidents, unfortunate interactions, communication breakdowns, or service delays. Over time, however, patterns emerge. The course helped me understand that recurring themes, particularly those raised by Indigenous and racialized patients, are rarely coincidental. They are often indicators of systemic issues instead of isolated failures.
One of the most impactful components of my educational experience was exploring Indigenous experiences within the healthcare system. In an earlier blog, I examined reports of Indigenous patients feeling dismissed, stereotyped, or not believed, particularly in emergency department settings. At the time, I understood these experiences as serious but specific. Further engagement with course readings altered that perspective. Research has steadily shown that Indigenous-specific racism is not confined to certain environments but is widespread across healthcare settings in Canada (Allan & Smylie, 2015). These experiences are deeply connected to colonial legacies that continue to shape institutional culture and health system design (Allan & Smylie, 2015; PHAC, 2020).
From a patient relations perspective, this understanding adds crucial context to the concerns raised by Indigenous patients and families. Complaints should not be interpreted solely as dissatisfaction with a single encounter, but as expressions of accumulated harm. Research indicates that experiences of racism significantly reduce trust in the healthcare system and contribute to delays in seeking care, and in some cases, can lead to individuals avoiding the system altogether (Allan & Smylie, 2015). When viewed this way, patient relations work not only as responsive but also as preventative, focusing on identifying and resolving systemic harms before they result in inequity.
Another recurring theme across my earlier blogs was access to care, particularly wait times and delays. Initially, I framed these challenges in operational terms, emphasizing workforce shortages, capacity constraints, and increasing demand. While these factors certainly influence access, education pushed me to question who is most affected by these pressures. Research suggests that implicit bias and systemic racism can influence clinical decision making, triage processes, and how urgency is interpreted, especially during periods of strain such as the COVID-19 pandemic (Canadian Institute for Health Information [CIHI], 2021; Brown et al., 2016).
This insight resonated strongly with my occupational experiences. Many patients’ concerns involve perceptions of being deprioritized or unheard, particularly among racialized populations (PHAC, 2020). The course helped me see that these perceptions may be rooted in real systemic patterns rather than misunderstandings. Access is not simply about the availability of services; it is also about how systems respond to patients and whose needs are seen as legitimate.
The concept of social determinants of health (SDoH) provided an essential framework for including these insights. In earlier blogs, I explored how income, education, housing, and access to resources shape health outcomes, particularly for chronic illnesses such as diabetes. Over time, it became increasingly clear that racism is not separate from these determinants; it reinforces many of them. Racism influences where people live, the quality of employment available to them, their exposure to stress, and their ability to navigate complex systems like healthcare (PHAC, 2020).
Racism has been repeatedly identified as a determinant of both physical and mental health. Experiences of discrimination have been associated with chronic stress, increased risk of illness, reduced engagement with healthcare, and poorer overall outcomes (Williams et al., 2019; Hamed et al., 2022). This helped me interpret earlier discussions about chronic illness management. Conditions such as diabetes cannot be fully understood through individual behaviour alone. They are determined by structural inequities that limit access to preventative care, culturally safe education, and consistent follow-up.
Mental health appeared as another area where systemic inequities are particularly visible. In a blog focusing on youth mental health during and following the COVID-19 pandemic, I initially emphasized social isolation, disrupted schooling, and reduced access to services (Mental Health Commission of Canada, 2021). I now understand that these challenges were not experienced equally. Racialized youth often faced additional barriers to others. These included limited access to culturally appropriate mental health supports and systemic inequities that intensify stress and vulnerability (CIHI, 2021). Research shows that experiences of racism can negatively impact mental health, contributing to increased stress, anxiety, and reduced access to resources for help (Hamed et al., 2022; Paradies et al., 2015).
For me, this strengthened the importance of approaching mental health concerns through an equity lens. From a patient relations standpoint, complaints related to mental health services are often complex and emotionally charged. Understanding the systemic factors that shape both access to and experiences of care allows for more compassionate and informed responses.
Across all units, one consistent theme stood out: racism in healthcare is rarely overt and is often unintentional. Even so, its impact is significant and far-reaching. For patients already managing chronic conditions or navigating vulnerable moments in their lives, feeling dismissed or stereotyped can discourage engagement and worsen outcomes. These experiences compound over time, reinforcing cycles of inequity.
As a patient relations manager, furthering my education through this first course has reshaped my understanding of my role. Patient relations is often positioned as a function focused on resolution and customer service. While those factors remain important, this course emphasized the role patient relations can play in identifying systemic issues, advocating for organizational accountability, and supporting equity-oriented change. Addressing racism in healthcare is not separate from quality improvement or patient safety; it is central to both.
This learning has encouraged me to listen more carefully for patterns, to question assumptions embedded in policies and practices, and to recognize when patient concerns reflect systemic rather than individual failures. It has also reinforced the importance of ongoing self-reflection, particularly in leadership roles within healthcare systems that were not designed with equity as a foundational principle.
Upon reflection, I recognize how my understanding has evolved from seeing health inequities as a collection of isolated challenges to understanding them as interrelated outcomes rooted in systemic racism. This integrated perspective is essential if healthcare systems are to move beyond intention towards meaningful change. Equity requires more than access; it requires structures, policies, and practices that actively counteract historical and ongoing disadvantage (Allan & Smylie, 2015; Brown et al., 2016).
Moving forward, this understanding will continue to shape my professional practice. It will influence how I engage with patients, support staff, and advocate within organizational systems. Most importantly, it has highlighted that improving healthcare is not only about efficiency or capacity, but about justice, trust, and dignity. These values must remain central if the promise of universal healthcare is to be realized in a way that truly serves everyone.
References
Allan, B., & Smylie, J. (2015). First Peoples, second-class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. Wellesley Institute. https://www.wellesleyinstitute.com/publications/first-peoples-second-class-treatment/
Browne, A. J., Varcoe, C., Ford-Gilboe, M., & Wathen, C. N. (2016). Equitable health care requires attention to structural racism. Canadian Journal of Nursing Research, 48(4), 133-138. https://journals.sagepub.com/doi/10.1177/0844562116666457
Canadian Health Institute for Health Information. (2021). Unintended consequences of COVID-19: Impact on healthcare services. CIHI. https://www.cihi.ca/en/covid-19-resources
Hamed, S., Bradby, H., Ahlberg, B. M., & Thapar-Bjorkert, S. (2022). Racism in healthcare: A scoping review. BMC Public Health, 22(988). https://doi.org/10.1186/s12889-022-13122-y
Mental Health Commission of Canada. (2021). Lockdown life: Mental health impacts of COVID-19 on youth in Canada. https://mentalhealthcommission.ca/public-resources/equityindiverstiy/lockdown-life-mental-health-impacts-of-covid-19-on-youth-in-canada/
Paradies, Y., Ben, J., Denson, N., Priest, N, Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a determinant of health: A systematic review. PLos ONE, 10(9), e0138511. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138511
Public Health Agency of Canada. (2020). Social determinants of health and health inequities. Government of Canada. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
Williams, D. R., Lawrence, J. A., & Davis, B. A. (2019). Racism and health: Evidence and needed research. Annual Review of Public Health, 40, 105-125. https://www.annualreviews.org/doi/10.1146/annurev-publhealth-040218-043750