Table 2.

Typology of literature

Literature typology on racism and access to medicines	Author and date	Type of literature	Key findings
Literature describing systemic racism and access	Bajgain et al. (2020)	Systemic review	• Immigrant parents face challenges accessing routine care for their children • Linguistic barriers impede communication between providers and immigrant patients
	Carter and McPherson (2013)	Report	• Systemic racism coupled with provider bias has also contributed to disparate allocation of harm reduction services in racialized communities and denial of medication to people
	Levy et al. (2013)	Report	• Poorer access to quality health care, because of systemic barriers in the health system or the conscious or unconscious bias of health care providers, is one of the pathways that may contribute to racialized health inequities
	Robson and Ackford (2020)	Report	• COVID-19 disproportionately impacts indigenous and racialized communities in Ontario • Structural system creates and reinforce racial inequities
	Wylie and McConkey (2019)	Qualitative study, interviews	• Indigenous patients are denied pain medication by medical staff with implicit biases • Health care system quality improvement strategy is needed to resolve issue of discrimination
Literature describing institutional racism and access	Bajgain et al. (2020)	Systematic Review	• Immigrant clients reported racism in their experiences accessing health care • African immigrants reported more negative experiences than other immigrants
	Bodkin et al. (2020)	Commentary	• Prisons and jails often delay or deny access to evidence-based opioid use treatment • People incarcerated in Canada’s federal prisons and provincial-territorial jails are likely to have experienced the effects of racism and colonialism
	Carter and McPherson (2013)	Report	• Barriers to accessing methadone maintenance treatment • Aboriginal people in Canada are overrepresented in prison for drug-related offences
	Chiefs of Ontario (2014)	Regional Health Survey People’s Report	• Ontario First Nations communities face barriers to accessing healthcare
	Levy et al. (2013)	Toronto Public Health Report	• In Toronto, Black, South/West Asian, Arab East/Southeast Asian men, and women reported difficulty in scheduling routine healthcare appointments and/or barriers to accessing their doctors for an emergent health problem
	Monchalin et al. (2020)	Longitudinal cohort study	• Implicit bias is rooted in racism and has a deleterious impact on patients who encounter clinicians in healthcare settings • Implicit bias has led to Métis patients’ denial of pain meds
	Phillips-Beck et al. (2020)	CBPR Qualitative Study	• Quality of healthcare provided is affected by unresolved stereotypes and persistent racism • Conscious or unconscious bias impacts diagnoses and prescribing behavior • Conscious or unconscious biases have led to denial of medication or inappropriate prescribing
	Wylie and McConkey (2019)	Qualitative study, interviews	• Stereotypes that Indigenous people have an alcohol or substance use problem persist despite statistics to the contrary • Physicians or the medical staff are reluctant to give Indigenous patients needed pain meds
Literature describing racism and geospatial barriers to access	Bell et al. (2013)	Geospatial study	• Language can be a barrier to health care services • French and English primary language speakers had higher access to primary care than other language speakers
	Law et al. (2011)	Geospatial study	• Geographical access to pharmacies is an essential factor in ensuring access to medicines and related professional services • Found that 73.3% of urban residents but only 40.9% of rural residents live within 5 km of a pharmacy, but the study did not investigate urban neighborhood characteristics as a factor in pharmacy access in Ontario
	Levy et al. (2013)	Toronto Public Health Report	• Racialized groups disproportionately live in neighborhoods with limited access to healthcare services (including pharmacies) compared to non-racialized groups
	May (2021)	Commentary	• Race is a factor that could create a barrier to the equitable distribution of vaccines during a pandemic
	Phillips-Beck et al. (2020)	CBPR Qualitative Study	• Lack of consideration by Canadian society for the circumstances of First Nation peoples, e.g., geographic obstacles to healthcare
	Shah et al. (2016)	Geospatial study	• Substantial variations in geographical accessibility to public health care services both within and among urban areas • High percentage of urban indigenous population resides in neighborhoods with poor accessibility scores
	Wang and Ramroop (2018)	Quantitative Geospatial study	• Importance of geographical access to community pharmacies for vulnerable populations in the Greater Toronto Area • Geographic accessibility to community pharmacies is important for health and well-being of communities • Racialized groups, low-income families with young children, newcomers, and older immigrant women often live where housing is affordable; however, transportation is inadequate and a barrier to health services, medicines, and pharmaceutical care
Literature describing racism and financial barriers to access	Grignon et al. (2020)	Commentary	• 8% of Canadians did not fill a prescription because they could not afford the cost and did not have insurance coverage or had inadequate coverage • Prescription drugs not financed through employer-based insurance or public programs are paid for out-of-pocket
	Levy et al. (2013)	Report	• User fees, prescription drug expenses, and the cost of transportation to health care appointments were mentioned as financial barriers to health care for racialized individuals surveyed.)
	Medical Officer of Health (2013)	Report	• Undocumented immigrants are vulnerable; they are medically uninsured and have limited options to access health care • Uninsured children and youths might not have access to vaccination that could prevent or reduce likelihood of infectious diseases • Language barriers impact access to healthcare services
	Mahabir et al. (2021)	Semi-Qualitative, Concept mapping	• Racialized workers in Ontario were found to have lower prescription drug coverage in a study of racism in Toronto’s health care system • Uninsured and undocumented residents faced more financial barriers in relation to prescription drugs and user fees in comparison with other Canadians
	Phillips-Beck et al. (2020)	CBPR Qualitative Study	• First Nations and Métis adults face barriers to accessing medications because some prescription drugs were not covered by NIHB and Métis peoples are ineligible for non-insured health benefits
	Weaver et al. (2013)	Community-based survey	• There are positive correlations between HIV vaccine accessibility, employment status, and income • Out-of-pocket medication costs, stigma, and discrimination were reported as concerns by Black Canadian and African American women
Literature describing BIPOC response to racism affecting access	The Inner-City Health Strategy Working Group. (2010)	Research Report, focus groups	• Experiences of racism at the hands of health practitioners and administrators discouraged them from using health services
	Jacklin (2017)	Qualitative study, focus groups	• Memory of negative childhood experiences led to avoidance and resistance to healthcare providers • Experiences of racism were a deterrent to accessing needed care
	Levy et al. (2013)	Report	• Experiences of racism were a deterrent to accessing needed care
	Phillips-Beck et al. (2020)	CBPR qualitative study	• Experiences of racism were a deterrent to accessing needed care
	Wylie and McConkey (2019)	Qualitative study, interviews	• Many Indigenous people admitted their unwillingness to continue accessing health services after experience of discrimination
Literature describing governance, racism and access to medicines	Ahmed et al. (2021)	Qualitative study, interviews	• Differences in resource allocation for certain communities point to systemic discrimination, neglect, and a lack of prioritization of black communities which are in need the most • Anti-Black racism experience contributes to health inequity for Black individuals • Collection of Canadian race-based data is needed to inform meaningful policy • Anti-Black racism identified in pandemic response necessitates adoption of equitable health policies
	Carter and McPherson (2013)	Report	• Institutional racism enshrined in federal, provincial, and municipal policies and in professional practices such as health care leads to severe deficiencies in funding for substance use
	Chambers and Burnett (2017)	Commentary	• Jurisdictional challenges between the federal government and provincial government create a service gap for people on reserve
	The Inner-City Health Strategy Working Group (2010)	Research report, focus groups	• Health disparities exist within the current healthcare system • institutional policies and practices that address racism and health inequity are needed
	Mahabir et al. (2021)	Semi-qualitative, concept mapping	• Anti-racist policies are needed to eliminate institutional racism • Racial hierarchy ideology influences access to resources, quality of care policy allocation of resources, medical decisions, and interactions