Health Canada recognizes culture is an important determinant of health. An ethno-cultural individual or community is defined by having an ethnic heritage that is not British, French, or Aboriginal. Canada now has over 200 ethnic groups consisting of newcomers and those that have been here for several generations. 18% of the population is foreign-born with almost 80% of new immigrants arriving from Asia, Africa, The Middle East, and South and Central America (Statistics Canada, 2006). Ethno-cultural minorities face barriers such as language, higher rates of mental health and substance use, lack of awareness of services, discrimination, isolation, racism, and social and economic disadvantages (Ibid).
First-generation ethno-cultural minorities immigrating to Canada face uncoordinated policies, including those related to immigration, resettlement, employment, and government funding for health and social services. These present significant barriers to immigrant caregivers, particularly women caregivers. These challenges are compounded by language and separation from family in the home country. Caregivers may then avoid certain formal services for a variety of reasons, including lack of cultural sensitivity (Stewart et al., 2006). While there is little research on this topic, one study found that female caregivers from ethno-cultural minorities were able to overcome these barriers if they had a strong informal support network and connection with at least one community service (Neufeld et al., 2002). Other studies suggest that caregiving arrangements are more costly in both financial and emotional terms, than in their countries of origin (Spitzer et al., 2003).
Financial concerns may become chronic; the Canadian Council for Social Development stated that “recent immigrants are having greater difficulties in the labour market than did previous immigrants, and that their incomes may never reach the Canadian average”. The economic situation of recently-arrived older immigrants is even less secure; the older the age at immigration the more likely one will live in poverty. With little or no work history in Canada (necessary to qualify for Canada Pension Plans) and a 10-year residency requirement to qualify for the Old Age Security benefit, many immigrant seniors are unlikely to be able to access public pensions (National Advisory Council on Aging, 2005).
While culturally diverse caregivers can experience barriers accessing services, it cannot be assumed that every caregiver within these groups have the same experiences. Exclusion that is experienced through membership in an ethno-cultural minority may not be the same across groups of people. A ‘culturally competent’ system and/or service provider recognizes that: 1) caregivers diverse values, beliefs, and behaviours must be taken into consideration in tailoring policies and programs; 2) has an understanding of the communities being served as well as cultural influences on individual beliefs and behaviours, and 3) devises strategies to identify and address cultural barriers to accessing services (adapted from ‘Cultural Competence Guide for Primary Health Care Professionals in Nova Scotia’, 2005). VON has a model for culturally-sensitive program development. Although it focuses on mental health, the framework can be used for a diversity of program development. The National Centre for Cultural Competence has developed a policy assessment tool specific to ethno-cultural issues.