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Revealing the Shape of Knowledge Using an Intersectionality Lens: Report on a Scoping Review on the Health and Health Care Access and Utilization of Ethnocultural Minority Older Adults

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This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping review of published and grey literature on the health and health care access of ethnocultural minority older adults. Our focus was on Canada and countries with similar immigrant populations and health care systems. Approximately 3300 source documents were reviewed covering the period 1980-2010: 816 met the eligibility criteria; 183 were Canadian. Summarized findings were presented to groups of older adults and care providers for critical review and discussion. Here we discuss the extent to which the literature accounts for the complexity of categories such as culture and ethnicity, recognizes the compounding effects of multiple intersections of inequity that include social determinants of health as well as the specificities of immigration, and places the experience of those inequities within the context of systemic oppression. We found that Canada’s two largest immigrant groups— Chinese and South Asians—had the highest representation in Canadian literature but, even for these groups, many topics remain unexplored and the heterogeneity within them is inadequately captured. Some qualitative literature, particularly in the health promotion and cultural competency domains, essentializes culture at the expense of other determinants and barriers, whereas the quantitative literature suffers from oversimplification of variables and their effects often due to the absence of proportionally representative data that captures the complexity of experience in minority groups.
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Please cite published version as follows: Koehn, S., Neysmith, S., Kobayashi, K., &
Khamisa, H. (2012, online). Revealing the Shape of Knowledge Using an
Intersectionality Lens: Report on a Scoping Review on the Health and Health Care
Access and Utilization of Ethnocultural Minority Older Adults. Ageing & Society.
Available at http://dx.doi.org/10.1017/S0144686X12000013 [8/14, 2012]
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Revealing the shape of knowledge using an intersectionality lens:
Results of a scoping review on the health and health care of ethnocultural
minority older adults
Submitted December 22
nd
, 2011
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Revealing the shape of knowledge using an intersectionality lens: Results of a scoping review
on the health and health care of ethnocultural minority older adults
Ab
s
t
r
a
c
t
This paper uses an intersectionality theoretical lens to interrogate selected findings of a scoping
review of published and grey literature on the health and health care access of ethnocultural minority
older adults. Our focus was on Canada and countries with similar immigrant populations and health
care systems. Approximately 3300 source documents were reviewed covering the period 1980-2010:
816 met the eligibility criteria; 183 were Canadian. Summarized findings were presented to groups of
older adults and care providers for critical review and discussion. Here we discuss the extent to which
the literature accounts for the complexity of categories such as culture and ethnicity, recognizes the
compounding effects of multiple intersections of inequity that include social determinants of health as
well as the specificities of immigration, and places the experience of those inequities within the
context of systemic oppression. We found that Canada’s two largest immigrant groups— Chinese and
South Asians—had the highest representation in Canadian literature but, even for these groups, many
topics remain unexplored and the heterogeneity within them is inadequately captured. Some
qualitative literature, particularly in the health promotion and cultural competency domains,
essentializes culture at the expense of other determinants and barriers, whereas the quantitative
literature suffers from oversimplification of variables and their effects often due to the absence of
proportionally representative data that captures the complexity of experience in minority groups.
Key
wo
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d
s
: ethnocultural minority older adults; health; health care; scoping review;
intersectionality; immigrant; visible minority; Canada
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Revealing the shape of knowledge using an i
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ethnocultural minority
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Ethnogerontology focuses on the aging experiences of older adults of distinct ethnic and racial
backgrounds in industrialized nations. This field of study is growing, but its literature is widely
distributed across disciplines that use inconsistent terminologies, and some of the more
comprehensive studies are still found in the grey literature. In Canada, there is currently no academic
program or advocacy group that focuses on and has consolidated research on this topic. As a result,
many such studies are hard to find and health care decision-makers seeking guidance with respect to
the health care needs of this population repeatedly resort to a few more readily accessible sources that
are often ill-suited to their knowledge needs. A scoping review of the literature on the health and
health care access of ethnocultural minority older adults aimed to fill this gap. We were especially
interested in visible minorities (i.e., non white and non Aboriginal) to reflect the predominance of
Asian immigrants to Canada since the 1970s (Statistics Canada 2010a, 2010b).
This paper uses an intersectionality theoretical lens to interrogate selected findings of this review in a
manner that respects the ontological and epistemological complexity that our interdisciplinary and
intersectoral team of academics and knowledge users brought to the table. Specifically, we aim to
summarize the state of this literature in Canada, highlighting the forms it takes, what is covered and
what is missing. Based on this case study, we then interrogate the consequences of using ethnicity as
a descriptive/explanatory category by looking more closely at what the literature is saying about
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Canada’s two largest groups of ethnocultural minority older adults: the Chinese and South Asians.
From this examination, we argue that understanding the diverse experiences of ageing both across and
within ethnocultural groups requires complex theoretical and methodological approaches that move
beyond a focus on differences that seem to be associated with ethnicity and/or culture. In parallel with
a growing number of scholars focused on the interrogation of health inequities (e.g., Iyer et al. 2008;
Guruge and Khanlou 2004; Hankivsky 2011), we suggest that although disparities arising from
biological sex differences, gendered experience,
1
ethnicity and class independently affect well-being,
the relationship is a dynamic one; it is how these dimensions intersect and compound that affects the
health and quality of people's lives as individuals and group members as they age.
Ba
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The ageing literature reflects its time and place
In Canada, as in other western societies, age is an axis along which inequities travel. There is a large
and diverse gerontology literature, but it cannot escape the fact that it is rooted in a society that
devalues old age. This inevitably gets reflected in the assumptions and frameworks that permeate this
literature. Gerontology blossomed in the seventies and eighties as the ageing of European and North
American populations, and their implications, became more visible. The substantive content of the
early literature was heavily influenced by a bio-medical orientation and thus was much about the
illness and costs of the ageing body (Estes and Binney 1989; Neysmith 1999). Other foci came
considerably later. Non-medical social, economic and political issues emerged over time (e.g.,
Walker 1981). Gender was part of this expansion, as were intergenerational concerns around social
support and caring (e.g., Ungerson 1987). Gender / class intersections began to emerge as costs were
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documented; statistics showing that women lived longer and thus used more health services were
juxtaposed to data showing that they also did more of the caring labour (e.g., Dressel, Minkler,
andYen 1997).
Theoretical perspectives that incorporate race/ethnicity/culture are not well developed in the ageing
literature even today. The three concepts are often used interchangeably and in different ways that
vary by country and by discipline (Bhopal 2004; Mateos, Singleton, and Longley 2009). At this
moment there appears to be little consensus on how to use the terms even though there seems to be
agreement that when this dimension is factored in, it accounts for health disparities (Ford and Harawa
2010). In this paper, we view race as a social construct. Racialization or “the process through which
groups and their practices are identified by reference to visible physical characteristics” (Johnson et
al. 2004:255), is of interest as a form of oppression experienced by our target population. Ethnicity
and culture are scrutinized in our consideration of intersectional analysis, below.
The country
of
immigration is more important than that of e
m
i
grat
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on
A nation's immigration and refugee regulations shape the world of those seeking permanent status
there. These forces change over time (usually reflecting policy priorities of receiver countries) and
thus cohorts of immigrants differ. For example, in Canada, changing labour force priorities underpin
a point system that determines who is accepted, and who is not (e.g., Sharma 2006). Established
communities and service availability affect where newcomers settle. Large urban centres have first-,
second- and third (plus)-generation families who have been there for varying lengths of time. For
instance, in Toronto, Canada’s largest city, nearly one half of the population in 2006 reported
belonging to a visible minority group. Of these, 12 per cent were South Asian, 11.4 per cent were
Chinese, 8.4 per cent were Black, 4.1 per cent were Filipino, and 2.6 per cent were Latin American.
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One half of all immigrants to that city had lived in Canada for less than 15 years. By 2031 visible
minorities will make up a projected 63 per cent of the city’s population (City of Toronto 2010;
Statistics Canada 2010b).
With the exception of Aboriginal peoples,
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who are legally defined otherwise, Canada can be defined
as a land of immigrants, and in1971 adopted an official policy of multiculturalism. The focus of
Canadian history and its policy on cultural plurality is distinct from and often compared favourably to
that of the US, where the ‘melting pot’ philosophy that privileges acculturation prevails.
Multiculturalism is not without its critics, however, and some (e.g., Kirmayer and Minas 2000; Henry
and Tator 2006) charge that the failure of the Canadian policy to address racism at the institutional
level impedes access to health and social care for visible minority groups. For example, Brotman
(2000) interrogated the notion of ‘access’ in the context of a publicly funded organization providing
elder care services in Ontario, Canada. She found a considerable disjuncture between older women's
expressed desires regarding access and the way access to services is operationalized in agencies
providing services for older people. She argues that multicultural programs and policies have placed
undue emphasis on the individualized attainment of cultural competency and language skills, but
have not addressed the “institutional structures and power relations marked by racism” that
undermine these efforts and marginalize the women in her sample (Brotman 2003: 209).
In sum, all of these concepts and their debates formed a backdrop to our undertaking a scoping review
of what we finally termed ethnocultural minority older adults. As the findings illustrate, research was
limited to a select number of the many groups that now make up nearly one half of the population in
the country's major metropolitan areas. It also revealed that the literature remains heavily
unidimensional when the focus is on the health needs and service access of this burgeoning sub-
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population of Canada’s older adults, although some authors introduced complexity through a
sensitivity to gender.
Methodology
Data collection: a scoping review of the literature
The Canadian Institutes of Health Research, Canada’s major health research funding agency, defines
scoping reviews as “. . . exploratory projects that systematically map the literature available on a
topic, identifying key concepts, theories, sources of evidence and gaps in the research” (Grimshaw,
2010). Arksey and O’Malley (2005) suggest that scoping reviews that aim to identify gaps in the
literature and publish on those findings can be viewed as a method in their own right rather than a
preliminary step in an ongoing process aimed at producing a systematic review. The intention of our
scoping exercise was to generate a topography of the literature and research on health and healthcare
for ethnocultural minority older adults that would invite critical reflection and thereby inform future
research directions. Arksey and O’Malley’s (2005) five-stage framework provided a useful template.
Their approach entails identifying the research question; identifying relevant studies; study selection;
charting the data; and collating, summarizing and reporting the results. We also conducted a
“consultation exercise” that they recommended as an additional parallel element to inform and verify
our findings.
Based on our familiarity with this field of literature, we knew that we would have to cast our net wide
in order to capture the diverse contributions to this field, and to reflect our interests in the intersecting
influences of social determinants on both health and access to services for this population. In brief,
our five-part research question sought to understand the population health patterns, health risks and
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associated health outcomes, unmet health needs, utilization of health care services, and engagement in
health promotion and disease prevention activities specific to older visible ethnocultural minorities,
i.e., those most likely to be subjected to the ‘processes of differentiation’ or ‘othering’ (racialization,
gendering, sexualization, ethnicization etc.) that our intersectionality framework seeks to interrogate
(Johnson et al. 2004; Dhamoon and Hankivsky 2011). To this end, we also identified the need to
explore within each of these questions: (i) the influence of beliefs, attitudes and values with respect to
‘normal’ aging, health, food, exercise, disease, family relations and social networks, help-seeking, etc.
held by the target population; (ii) how their experience and status as immigrants (trauma, role
changes, legal entitlements, discrimination, etc.) influence this; (iii) the effect of health status on
utilization; and (iv) how each factor is influenced by social determinants (gender, socioeconomic
status [SES], country of origin, location of residence in Canada, etc.). The research questions thus
ensured that health was broadly defined in our study.
The identification and selection of relevant studies was an iterative process that entailed considerable
cross-checking of abstracts between our Research Assistant (RA) and two or more team members.
Using abstracts as the unit of analysis for this study is consistent with scoping review methodology
(Arksey and O’Malley 2005) and necessary in light of the considerable breadth of the search. While
we recognize that this limits what can be confidently inferred about the content of these articles, our
multi-sectoral team agreed that abstracts were an important unit of analysis to consider because their
content often determines whether the reader goes on to retrieve the full article. Decision-makers with
limited time and money access only those reports that are obviously relevant to their needs (Black and
Weiler 2008), hence abstracts are pivotal to effective knowledge translation and research uptake. This
said, full articles were accessed where no abstract existed, and team members often referred to the full
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article in order to ascertain the eligibility of a study.
Different perspectives on the relevance of the articles were introduced and debated by members of
our interdisciplinary and intersectoral team, which included academics from the disciplines of
anthropology, sociology, social work and health services research, as well as knowledge users from
provincial and municipal governments (health, seniors services and social planning), the multicultural
settlement sector, ethnospecific long-term and community care, and psychiatry. This process also
clarified the scope and definition of our search terms.
3
Our search strategy reflected the three dimensions of our field of interest: Ethnicity, Health, and
Chronological Age. We were specifically interested in visible ethnocultural minority groups that had
settled in Canada and countries similar in their composition of immigrants and health care delivery
systems, particularly the United Kingdom (UK), Australia, and New Zealand, and to a lesser extent,
the United States (US). We limited our search to post-1980 published and grey research literature
written in either English or French, but most were in English (see Figure 1).
FIGURE 1 GOES HERE
Our inclusion/exclusion criteria were initially applied to the lead author’s personal database of 634
references on ethnocultural minority older adults, which helped us to identify the most salient
keywords to use for the external search. This included an Ebsco combined search of multiple
databases (Ageline, CINAHL, Medline, Pubmed),
4
the New York Library of Medicine – Grey
Literature Report, SIGLE, UMI Dissertation services, and hand searching references and key
journals. Given our focus on Canada, we employed additional strategies such as focused searches of
grey literature (e.g., Amicus Collections Canada
5
for Canadian theses, and publications from the
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Canadian Ethnocultural Council, Metropolis
6
and other agency websites) that were not employed
with the other countries. The Canadian data is therefore relatively more complete.
It was necessary to simultaneously expand some criteria while imposing constraints on others to
ensure that we captured relevant articles while remaining within the limitations imposed by the
resources and time available for the project. For example, relatively few articles focused on
individuals 65 or older exclusively. In the discussion of these preliminary results, we agreed that
conventional demarcations of “old age” (i.e. the chronological marker of 65) may not be sacrosanct as
a determinant of health status or health care utilization or access, relative to multiple intersecting
determinants for this population. Ultimately, we agreed to include articles falling into one of three
categories with respect to age: (1) the study population was aged 65 and older exclusively (13.1%);
(2) the study population was ‘mixed’, i.e., it included a range of ‘older adults’ other than those aged
over 65 (e.g. 55+) or a sub-group of older adults was clearly identified as part of a larger sample
(36.3%); (3) the age of the population was not specified, but the group being referred to was an older
adult group (e.g. using terms such as 'senior', 'older adult', 'frail elderly' etc) (50.5%). Had we not
made this decision to liberalize the inclusion criteria for age, the majority of relevant articles would
have been excluded from our scope.
We intended to use and derive the meaning of ‘ethnocultural’ (and its components, ‘ethnicity’ and
‘culture’) as presented within the literature because as Bhopal (2004: 445) and our own search
experiences have shown, “ethnicity is replacing the scientifically limited and somewhat discredited
term race in the scientific literature.” The exception is the US literature on the impact of race on
African Americans and Latinos (Kirmayer and Minas 2000). These groups differ from African
Canadians and Latin Americans who arrived in Canada for very different historical reasons (e.g.,
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Attewell et al. 2010; Durand and Massey 2010). For this reason, and because of the overwhelming
volume of such references, we also decided to filter out studies that referred exclusively to African
American and Hispanic populations in the US. Our sample nonetheless contains 120 studies that refer
to these populations because they appear alongside the groups of interest to our review, e.g., Asian
Americans. Similarly, a large number of US articles focusing on barriers to health care access
resulting from a lack of universal health insurance in that country were also excluded.
7
Despite this,
the majority of articles retrieved for the review were from the US (see Figure 2). This is consistent
with its large population base which, at over 313 million, is more than five times that of the UK
and nine times that of Canada (Central Intelligence Agency 2011).
FIGURE 2 GOES HERE
Overall, 3,300 abstracts were reviewed, of which 816 met our eligibility criteria. While more than
70% of the references were articles in peer-reviewed journals, we also included books and book
chapters, theses and dissertations, and unpublished research reports, but not opinion pieces. Articles
were located in a total of 192 journals; however 56% of those articles were published in journals that
appeared only once on our list. The Journal of Cross Cultural Gerontology alone had published more
than 20 articles that met our criteria, and only six more, spanning diverse disciplines, had published
more than ten articles on the topic.
8
In order to accurately chart and summarize the data, we made use of Atlas.ti 5.2.0, commonly used to
code and organize qualitative data into inductive categories. The titles and abstracts of eligible
articles were imported and each was coded along multiple dimensions so as to capture who and what
was studied, where and in what journals. The coding structure was initiated by the RA, but was shaped
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to a great degree by team members who engaged in several in-depth discussions and provided ongoing
feedback as to the relevance and composition of the various dimensions. Ultimately, each source
document was coded along each of the following dimensions: research (sub)question; immigration
(immigrant category and length of time in the country); gender; ethnicity; faith; country of study; health
condition/situation; intervention/service; and other social determinants of health. We have used these
categories and their co-occurrences to explore the data set in numerous ways, and considerable potential
remains to explore it further.
In addition to a detailed report submitted to the funder on the methodology and findings of the review
(Kozak, Koehn and Khamisa 2011), we have also generated annotated, indexed bibliographies on the
Canadian sources, as well as one each on South Asian and Chinese older immigrants internationally.
Within the Canadian subset, we identified groups of abstracts relating to topical areas that matched
the foci or expertise of our team members. Each member was asked to review their group of abstracts
and report on the key messages that they communicated. This exercise provided some insight into
how well the current literature meets the knowledge needs of diverse knowledge users, including
policy makers and/or how clearly key messages from this literature were communicated through the
abstracts.
Finally, we conducted a consultation exercise, taking our summaries of key messages emerging from
the Canadian literature to groups of ethno-cultural minority older adults and those who work closely
with them or advocate for their needs in multicultural settlement and social service agencies in
Toronto and Vancouver. These groups were asked to provide feedback on: (a) if and how the
literature reflected their lived experiences or contradicted them; and (b) topics they viewed as
important that were missing in the literature. Each of these strategies informed our impression of the
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shape and content of the literature on the health and health care access of ethno-cultural minority
older adults in Canada relative to multiple dimensions of difference. Many of the 183 Canadian
sources were already familiar to this article’s authors, and others were reviewed in preparation for
writing this manuscript.
Analysing the literature: seeing older adults through an intersectionality lens
Our analysis of the sources identified by our scoping review is informed by an intersectionality
approach which argues that people experience the effects of a country’s social inequities as
simultaneous interactions between multiple dimensions of social identity (for example, gender, age,
sexual orientation, visible minority and immigration status) that are contextualized within broader
systems of power, domination and oppression (Hankivsky 2011; Schulz and Mullings 2006:308).
Responding to ‘how inequities are experienced’ by individuals and communities in different social
locations characterizes the history of intersectionality theory development (Denis 2008), but age is
rarely included in such analyses (Hulko 2011). Unlike multiple/triple jeopardy, intersectionality is
not an “additive linear model.” Rather, its analysis “usually requires the use of ‘interaction
effects’—or ‘multilevel,’ ‘hierarchical,’ ‘ecological,’ or ‘contextual’ modeling—all of which
introduce more complexity in estimation and interpretation” (McCall, 2005: 1787-88; Winker and
Degele 2011). From this perspective, power imbalances and discrimination, as well as positive
health care experiences, are understood as unique to each individual’s constellation of intersecting
identities, social roles and the broader social and political contexts in which they exist (Guruge and
Khanlou 2004; Dhamoon and Hankivsky 2011). These intersections are at play at each of the micro,
meso, and macro level; that is, relative to our identities, to our interactions with others in different
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socio-cultural contexts, and at the broader societal level wherein norms and values are entrenched as
policies and laws.
Models of intersectionality are diverse and often case-specific. The more general metaphor of a
matrix captures “the idea that systems of domination are mutually dependent but analytically distinct”
and facilitates the necessary examination of the interactions of categories of difference as well as the
interlocking and mutually constructed systems of domination that constitute the broader context
within which they must be considered (Dhamoon and Hankivsky 2011:28). Intersectionality is
nonetheless practiced in at least three ways, according to McCall (2005). The first of these—
anticategorical complexity—questions the ‘givenness’ of categories of difference such as race and
gender, or health related conditions such as “addict” or “homeless person” (e.g., Browne et al. 2011).
Such categories should be understood as complex social constructions within which specific
manifestations may be infinite or at least range along broad continua. Importantly, it entails a shift
away from reducing people to single static identities rooted in Cartesian dualisms or dichotomies such
as male/female, black/white, or ethnic/non-ethnic that underlie ‘othering.’
Thus we must begin by interrogating the categories central to our search. Illife and Manthorpe (2004),
suggest that ethnicity—when defined as particular shared cultural characteristics—may not have great
explanatory power as an analytical category or determinant of health, and may represent a category
fallacy. They suggest instead that immigration, charter language ability, health beliefs and SES are
more salient determinants of health, but tend to be subsumed under the concept of ethnicity.
Similarly, the notion of culture is often viewed uncritically, particularly in the health services
literature on ethnocultural minorities. Differences in health outcomes between ethnic groups often
seem to be attributed to cultural differences (e.g., Jones, Chow, and Gatz 2006). While this is
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probably not the authors’ intention, it speaks to a common trend critiqued by Kleinman and Benson
(2006) of simplistically equating culture with ethnicity, nationality, and language and treating it as
static and homogeneous. While the definition of culture is hotly debated, we agree with these authors
and Wedeen (2002) that it does not refer to essential identifiers of a group; rather, it is a process of
meaning-construction wherein people’s practices—which are embedded in political, economic and
social realities—operate in a dialectical relationship with systems of signification. Culture is defined
in reference to these practices and vice versa. This view of culture is consistent with the underlying
premise of intersectionality that our realities are both constructed yet constrained by broader systems
of oppression. These examples demonstrate that no category can be reduced to a single axis of
difference.
A second type of intersectional analysis—intracategorical complexity (McCall 2005)—zeroes in on a
social location at the intersection of single dimensions of multiple categories. This typically entails
analysis of a single social group at a neglected point of intersection of multiple master categories or a
particular social setting or ideological construction, or both, and is characteristic of much
ethnographic work on ageing (e.g., Sokolovsky 2009). Thus while these studies question “the
homogenizing generalizations that go with the territory of classification and categorization,” they do
not reject them altogether; most important is the “process by which [categories] are produced,
experienced, reproduced, and resisted in everyday life” (McCall 2005: 1783). For example, Hulko’s
(2011) study of experiences of dementia found that the label of dementia was resisted in different
ways relative to social location. More privileged participants were more likely to view dementia
negatively whereas those who were more socially marginalized tended to dismiss its significance.
The third type of intersectional enquiry that McCall describes speaks to efforts to employ this
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approach in quantitative studies. Intercategorical complexity is thus concerned with “the complexity
of relationships among multiple social groups within and across analytical categories” (McCall 2005:
1786). Enquiries of this nature begin with the supposition that relationships of inequality exist
between groups. Social determinants of health, such as age and ethnicity, are viewed as anchors in
understanding inequities, but they are not fixed in their relationship to outcomes because they interact
with other determinants as well as biological factors in different contexts (McCall 2005; Kobayashi
and Prus 2011). Categories are understood to be imperfect and ever-changing, but the necessity of
adopting them provisionally is accepted in order to proceed with cross-sectional analyses that seek to
explicate the relationships among them. Here, relationships of inequality are the focus of rather than
the background to the analysis. Analyses of this nature were not identified in our review but new
contributions are beginning to be published, and will be discussed below.
Fi
nd
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Who’s researched and who’s not?
Taken together, the Chinese and South Asian populations—the two largest groups of immigrants to
Canada since 1991 (Statistics Canada 2010a)—account for two-thirds of post-1980 publications.
Research on older adults of Chinese origin accounted for the majority (almost 45%) of the Canadian
studies that we identified, which exceeds their share of the visible minority older adult population (see
Figure 3). This is due, in part, to the productivity of researchers of Chinese Canadian origin interested
in this population. South Asian sources accounted for almost one quarter of the Canadian studies,
which is comparable to their share of the visible minority older adult population. Upon more detailed
examination, however, coverage of these two groups is more partial than these figures imply.
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FIGURE 3 GOES HERE
Figure 3 requires careful interpretation. It can visually suggest a more substantive presence of an
ethnocultural minority group in the literature than in fact exists because any mention of an
ethnocultural group is reflected here, even if their presence in the study is minimal. When we limit
our consideration to abstracts focusing on a single ethnocultural population, wherein there is
ostensibly space to attend to internal heterogeneity and the effects of intersections between multiple
axes of difference, some groups disappear entirely (see Figure 4). Thus we identified no Canadian
articles that focused exclusively on Arab,
Korean or Filipino older adults, despite the fact that
Filipinos are now the fourth most populous immigrant group in Canada after “blacks” in third place
(Statistics Canada 2010a). The paucity of articles referring to “black”
older adults is also notable
both relative to their 2006 share of the older adult population, depicted in Figures 3 and 4, and in
light of their increasing numbers since that time. The relative proportions of articles on Latin
American and Southeast Asian older adults are also considerably smaller in Figure 4 than in Figure 3.
FIGURE 4 GOES HERE
Gaps in the lite
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e
Our search also examined the focus of the published literature, exploring what areas are represented
in the articles: which were popular and where were the silences? Viewing the abstracts relative to
our coding framework we identified several gaps and opportunities for future research relative to
the disease categories covered in the literature. The disease codes, as with all others, emerged
inductively from the abstracts. Subsequent to coding, however, we decided to compare the extent to
which various disease categories have been researched and reported (number of abstracts) relative to
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the ten categories used in the International Classification of Diseases (ICD) and clustered our codes
accordingly. The ICD-10 is a well-established framework with which to explore health conditions
relevant to older Canadians in the general population vis-à-vis the Canadian literature on
ethnocultural minority older adults. Figure 5 provides a comparative baseline of the leading causes
of death and hospitalization of Canadians aged 65 and above.
FIGURE 5 GOES HERE
By comparison, Figure 6 starkly illustrates the gaps in research on Chinese and South Asian older
adults in Canada. Maintaining the order of the leading causes of death and hospitalization along the
x-axis, we plotted the number of abstracts referring to each disease category for each of the two
ethnocultural groups.
Predispositions to certain diseases exist among particular groups. For example, foreign-born
populations from South Asia experience higher rates of diabetes mellitus and heart disease (Gupta,
Singh, and Verma 2006; Raymond et al. 2009). And these patterns are often gender-specific with
different patterns than those commonly seen in the West—for example, South Asian women are at a
higher risk than men for developing heart disease (Fikree and Pasha 2004)—yet we see very little
research on either Chinese or South Asian older adults that reports on any of the leading causes of
death or hospitalization in the Canadian literature. One apparent exception is the literature on mental
disorders for the Chinese population, particularly that on rates of depression, which were found to be
higher than those for Canadian older adults overall (Lai 2000a, 2000b, 2004a). On closer examination
of the full articles, however, mental disorders were not the main focus of many of these studies, but
were referenced only in general terms. The mental disorders category included inductive codes that
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21
captured alcohol consumption, dementia, depression, post-traumatic stress disorder and general
mental health. Articles are thus spread thinly across these diverse topics. Having reviewed the
abstracts and some of the articles included in this category, cross-cultural psychiatrist Dr. Soma
Ganesan concluded that there is no clear understanding as to whether cultural factors are mediating or
moderating variables in global mental and physical health. With no clear mechanism identified, it is
difficult to develop or implement policy for culturally responsible mental health care for immigrant
older adults, their families and/or their care providers. Thus, even in an area in which relatively more
research has been done, we do not know enough about the intersections among various axes of
inequality and the ways in which these factors influence the health and health care access of
ethnocultural minority older adults.
FIGURE 6 GOES HERE
Missing: intersectional analyses
of
the lite
r
a
t
u
r
e
In seeking to understand if and how an intersectional analysis was actually present, we reviewed
abstracts and often the full-text articles. We probed, for instance, whether ethnocultural attributes
were used to explain variations in phenomena such as diabetes, or if the disparities experienced by
certain ethno-cultural groups were the starting point, with structural and environmental factors
examined to try and account for differences.
Overall, two dominant patterns emerged along methodological lines. The first was seen in the
quantitative literature in which variables such as gender, socio-economic status and other social
determinants of health are routinely explored. The problem here lay with the integration of the
dimensions of age and/or ethnocultural status in ways that meaningfully contributed to the focus of
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22
our study. For example, considerations of the impact of ethnicity on health care utilization rarely
factored in the differential effects of age; although the sample may have included some older adults,
there was little or no analysis of age-based differences. Similarly, studies focusing on age differences
rarely incorporated the dimension of ethnocultural identity. The possibility of considering the
intersection of these two axes of difference with other social determinants of health is thus limited to a
relatively small number of articles where this overlapping consideration is explicit.
In the qualitative literature on barriers to health care access, some studies problematically use culture
as both as an explanation of the issue and as the route for addressing it (Filinson 1992, e.g., Acharya
2004; Masi and Disman 1994). Culture in these studies is often treated as static, failing to account for
the changing dynamics in such populations. This approach is especially apparent in the cultural
competence and health promotion literature that tends to focus on change in the beliefs and
behaviours of individual care providers or care recipients (e.g., Choudhry 1998; Dhaliwal 2002;
Johnson and Garcia 2003). While the development of community capacity that many of these
initiatives seek to engender is important, they do not address the underlying organizational or policy
issues that support the inequities that shape the experiences and capacities of ethno-cultural minority
older adults.
Closer examination of the Canadian abstracts coded as ‘interventions’ provides insights into the
implications of these limitations. This group of codes includes both services as well as preventive or
care approaches (e.g., cultural competency, health promotion) and services offered both formally
(e.g., palliative care, Home Care) and informally (e.g., caregiving by family or friends). The same
five 'intervention' topics emerged as most commonly researched both internationally and in Canada,
although not in the same order (see Table 1). These codes are not mutually exclusive; abstracts were
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23
tagged with multiple codes where appropriate. Here we focus on the Canadian references coded
under any of the following five topics.
TABLE 1 GOES HERE
Five quantitative studies and one qualitative study established that ethnocultural minority older
adults in general or specific groups, e.g., Chinese Canadians, are not adequately represented among
users of services such as long-term care facilities (Wasylenka 2004) or home care (Lai 2004b;
Majumdar, Browne, and Roberts 1995). When variables other than ethnicity were considered as
explanations for this low utilization, they were simply reported as predictors for service use.
Ignoring the underlying power dynamics associated with social determinants of health such as
gender, time since immigration, country of origin or education, and the compounding effects of
these intersections among them, leaves us wondering why and how the variables identified (if any)
influence utilization.
Abstracts included within the top five intervention code groups also attest to the paucity within the
Canadian health care system of linguistically and culturally appropriate services that meet the needs
of an ethnoculturally diverse aging population (e.g., Hossem 2009; Lai and Chau 2007; Mullings
2006). Some research has placed specific emphasis on culturally charged components of the care
experience such as food (Forster- Coull and Koehn 2001) and language and communication styles
(e.g., Saldov and Chow 1994), or explored the cultural appropriateness of models of care (e.g., the
Eden Alternative: Fung 2006). Relatively few researchers (Brotman 2000; Koehn 2009; Mullings
2006) have spoken to the intersecting oppressions experienced by visible minority older adults,
especially women, which influence their admission to and shape their quality of life in long-term
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24
care facilities. Culturally-targeted long- term care facilities are positively evaluated as meeting the
needs of ethnocultural minority older adults (Fung 2006; Kromer 2004; Pereira Lazarowich, and
Wister 1996). This solution nonetheless requires sufficient community capacity, which may not be
available to smaller communities or even sub-populations within communities, as differentiated by
religion, for example (van Dijk 2004). Also noted are the health care system’s (inadequate) efforts
to address through appropriate outreach and health promotion programs a lack of knowledge among
some immigrants and their family caregivers of the availability of relevant services (e.g., Koehn
2009; Sadavoy, Meier and Ong 2004;Sanghera 1991) or of specific illnesses, such as dementia
(Fornazzari, Fischer, Hansen, and Ringer 2009). Thus while multiple variables are often recognized,
they are poorly understood in terms of their contribution to inequities in health or health care access,
are often considered independently of one another rather than interactively, and are rarely situated in
the context of systems characterized by power imbalances and discrimination.
Discussion
Categorical complexity
Categories, although useful and necessary for organizing complex phenomena, hide important
differences even as they highlight others. For instance, the categories used in Figure 3 to classify
ethnocultural minority older adults tend to reflect the immigration histories and policies of the
countries in which people settle. They hide the fact that each group of immigrant older adults, as
defined by Statistics Canada, is extremely heterogeneous. For example, Chinese Canadians hail from
many countries, including China, Hong Kong, Taiwan, or Macau. Others emigrate from Chinese
Diasporas in Malaysia, Vietnam, Singapore, etc. Similarly, South Asians may arrive directly from
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25
India, Pakistan, Bangladesh, or Nepal, while others emigrate from South Asian Diasporas in countries
such as Uganda, Tanzania, Malaysia and the UK. In both cases these immigrants also differ in many
of the determinants of health, such as SES and gender, as well as the length of time they have been in
the country of settlement (some are Canadian-born whereas others have migrated late in life). In
addition, they arrive as different types of immigrants: a relatively small number are refugees, whereas
the majority arrive as economic or family class immigrants. The importance of recognizing this
heterogeneity was underscored when we shared the preliminary results of the scoping study with
community groups. In the ‘Chinese’ community, sessions were held in Cantonese and Mandarin.
Strongly apparent in these discussions were the different ‘cultures’ of both groups and how these
resulted in very different health practices and service use patterns.
Further, similar groups of immigrants are categorized differently in different receiver countries
(Bhopal 2004). Thus, in Canada, we refer to Chinese Canadians and Indo-Canadians; in the US, both
groups fall under the rubric of ‘Asian and Pacific Islanders’. In the UK, they are denoted as ‘Chinese’
and Asian respectively, with the latter term reserved almost exclusively for South Asians.
Recognition of the diversity within these populations, both in terms of religion and country of origin,
is most meticulously and consistently recognized by British researchers. In Australia, Chinese and
South Asians are typically subsumed under the broad umbrella of people of Non-English Speaking
Background (NESB).
Such ‘lumping and splitting’ conventions, borne of the socio-political realities of colonization and
migration, complicate systematic literature searches and strongly influence the shape and content of
each nation’s research interests and agendas (Kirmayer and Minas 2000; Bhopal 2006). While the
theoretical and methodological orientations of researchers and the research questions themselves
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26
influence decisions to combine or isolate groups, so too do national differences in the naming and
categorization of one ‘group’ relative to another. The nature of the data collected is also salient here.
Especially influential is Statistics Canada’s tendency to under-sample ethnocultural visible minority
Canadians in national survey research, yielding under-representations of these populations in the large
datasets. As a result, different ethnocultural groups are commonly clustered into generic categories
(e.g., ‘Asians’) to facilitate ‘meaningful’ secondary data analyses.
Methodological conundrums: where’s the data?
The application of an intersectionality perspective in this domain poses a number of significant
challenges for quantitative researchers. The challenge is largely one of operationalization.
Specifically, data extracted from secondary data sources like the Canadian Community Health
Survey or the National Population Health Survey are limited because the variables that these
datasets yield have been constructed from close-ended survey questions asked at one point in time.
The selection and analysis of this data is thus quite narrow and static. For example, questions that
are used regularly as “cultural markers” in ethnicity and health studies in Canada probe place of
birth (an indicator of immigration status), ethnic group belonging (indicator of ethnic identity), and
charter language ability (an indicator of acculturation status) cross-sectionally (Kobayashi, Prus, &
Lin 2008).
Efforts to address the inherent complexity of the inter-relationships between markers of difference
like ethnicity, socio- economic status, gender, and immigration status are therefore limited when
one-dimensional proxies are the only options available. To truly understand the compounding
influence of the intersections of these markers on health and health care access requires the use of
meaningful interaction terms in multiple regression models. Accounts of this approach have only
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27
been published since the completion of our scoping review. For example, Kobayashi and Prus
(2011) examined the healthy immigrant effect using logistic regression to model health for adults
(45+ years) across immigrant/visible minority groups, and Warner and Brown (2011) scrutinized
intersections of race/ethnicity and gender on the age trajectories of disability among older adults.
Until recently, primary data collection has often been the only real option to researchers interested
in applying intersectionality theory to critical examinations of health in vulnerable populations. This
requires considerable input of time and money to ensure the collection of ample and appropriate data
over time. We therefore suggest that an intersectionality approach will often require research that
uses a mix of methodologies and research designs.
Silenced by the research record: invisible immigrants and stories lost
What is missing in the literature is as telling as what is included. For instance, we need to push
obvious interpretations such as the long time presence or relative size of groups when accounting for
their presence or absence in the research literature. Chinese immigrants, whether from the mainland,
territories or Taiwan, have consistently scored high on the Canadian point system in terms of financial
and educational criteria. Thus, the larger community has the security and the capacity to develop
businesses and services to meet the needs of its ageing population. We juxtapose this situation to
those categorized as Black. In this category reside Afro-Canadians who have lived here since the
American Civil War, immigrants from the Caribbean who may have come directly (many women as
domestics) or indirectly through England, and others who are refugees from a number of African
countries. They have little in common, although many live on very low incomes. They also face
individual and institutional discrimination and have few intra-community resources to advocate for
their priorities. One can posit many reasons for the dearth of studies here, but systemic racism needs
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28
to be factored into any explanation (Henry and Tator 2006; Mullings 2006).
Conclusions and
r
eco
mm
e
nd
a
t
io
n
s
In summary, the application of an intersectionality perspective to the study of health among
ethnocultural minority older adults underscores the importance of understanding the multi-
dimensional nature of health inequities in vulnerable populations. This approach compels us to move
beyond an analysis of one or two possible ‘predictors’ to an exploration of the influence of a number
of markers of difference such as age, gender, socio-economic status, ethnicity/race, marital status,
and sexual orientation, to name a few. Ultimately, this is necessary if we are to acknowledge the
complexity inherent in the ‘production’ of health among ethnocultural minority older adults. There
is recognition in the literature of the need to apply an intersectionality lens when examining the
health and health care of immigrant communities. However, this seems to be honoured more in
principle than in how research is undertaken, or at least how the results are written up. One could
interpret this as reflecting a conscious choice made by researchers to emphasize in their work those
dimensions of difference that they deem most critical to understanding the needs of and/or barriers
encountered by various sectors of the population. However, it is equally plausible that the state of the
literature reflects a focus on those problems that press the health care system and institutional
priorities shaped by their own desire to find ways to alleviate some of the pressure. Health care
issues do take different forms in different ‘ethnocultural communities,’ such as the Chinese and
South Asian groups have detailed above, but other social determinants of health such as employment
history, length of time in the country, sponsorship status, income, housing options, etc., many of
which impact on all Canadians, are also relevant and influence the options available to individuals.
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29
To move the debate forward we suggest that it is important to consider the meaning attached to and
the significance of categorizing a group or an individual as belonging to an ethnocultural group.
Immigrants are constantly adapting cultural practices to their environments. For instance, what would
be the effect on research if the concept of ‘hybridity’ were the starting point for understanding the
immigration experience? This concept centres on the process of change, anticipating the creation of
something new or different, and opening up fresh ground for individuals and groups to renegotiate
meaning and representation. Intersectionality is reflected in concepts like 'hybridity' that are dynamic
rather than fixed; where the immigration experience is viewed as a process involving constant
movement between here and there, we and they, self and other, past and present, and homeland and
host land (Bhatia and Ram 2009; Lowe 2003). At the same time the concept encourages analysts to
recognize the fact that such negotiations are linked to processes that are shaped by political,
economic, historical and cultural practices (Bhabha 2004; Lowe 2003). Such a concept prevents the
absorption of all differences into existing categories, including dominant definitions of what
constitutes universal services (Nederveen Pieterse, 2001). Rather than people having one single
identity embedded in ethnicity, which emphasizes separateness, there is “togetherness-in-difference”
(Ang 2003: 141).
Ongoing research in this area thus requires a conscientious effort by researchers to consider multiple
dimensions of difference and the influence of their intersections for which appropriate raw data are
needed. Regardless of the limitations in the extant literature, we have sufficient evidence to show that
the health care needs of the sizeable ethnocultural minority older adult population in Canada cannot
be met without some assumption of responsibility for the inequities in access to health care
experienced by these older adults. This awareness therefore needs to reach those responsible for the
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30
data collected and the categories conceptualized for large datasets such as the Census of Canada or
the Canadian Community Health Survey, among others. Health and social care organizations as well
as decision makers responsible for immigration, and social and health care policies exert a profound
influence on the capacity of this sub-population of older adults to achieve optimal health, and need to
act accordingly.
Acknowledgements removed for blind copy
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References Cited
Acharya, M.P. 2004. Constructing the Meaning of "Mental Distress": Coping Strategies of Elderly
East Indian Immigrant Women in Alberta. Ph.D. dissertation, University of Alberta, Edmonton,
Alberta.
Ang, I. 2003. Together-in-difference: Beyond Diaspora, into hybridity. Asian Studies Review, 27, 2,
141-54.
Arksey, H., O’Malley, L., Heslington, H. and York, Y. 2005. Scoping studies: Towards a
methodological framework. International Journal of Social Research Methodology, 8, 1, 19-32.
Attewell, P., Kasinitz, P., and Dunn, K. 2010. Black Canadians and Black Americans: Racial income
inequality in comparative perspective. Ethnic and Racial Studies, 33, 3, 473-95.
Bhabha, H. K. 2004. The Location of Culture. Routledge, London.
Bhatia, S., and Ram, A. 2009. Theorizing identity in transnational and diaspora cultures: A critical
approach to acculturation. International Journal of Intercultural Relations, 33, 2, 140-49.
Bhopal, R. 2006. Race and ethnicity: Responsible use from epidemiological and public health
perspectives. The Journal of Law, Medicine and Ethics, 34, 3, 500-07.
Bhopal, R. 2004. Glossary of terms relating to ethnicity and race: For reflection and debate. Journal
of Epidemiology and Community Health, 58, 6, 441-5.
Final before proofs version for self-archiving – please cite published version only
32
Black, R., and Weiler, B. 2008. Factors facilitating and inhibiting the use of research to inform
interpretation practice: A case study of Australian protected area management agencies. Visitor
Studies, 11, 2, 163-80.
Brotman, S. 2000. An Institutional Ethnography of Elder Care Understanding Access from the
Standpoint of Ethnic and Racial Minority Women. Ph.D dissertation, University of Toronto, Toronto,
Ontario.
Brotman, S. 2003. The limits of multiculturalism in elder care services. Journal of Aging Studies, 17,
2, 209-29.
Browne, A. J., Varcoe C., and Fridkin, A. 2011. Addressing trauma, violence, and pain: Research on
health services for women at the intersections of history and economics. In Hankivsky, O. (ed),
Health Inequities in Canada: Intersectional Frameworks and Practices, UBC Press, Vancouver, BC,
295-311.
Central Intelligence Agency 2011. Country comparison: Population. The World Factbook. Available
online at https://www.cia.gov/library/publications/the-world-factbook/rankorder/2119rank.html
[09/20/11].
Choudhry, U. K. 1998. Health promotion among immigrant women from India living in Canada.
Journal of Nursing Scholarship, 30, 3, 269-74.
City of Toronto. 2010. Toronto's racial diversity. Toronto Facts. Available online at
http://www.toronto.ca/toronto_facts/diversity.htm [01/04/11].
Final before proofs version for self-archiving – please cite published version only
33
DeNavas-Walt, C., Proctor, B. D., and Smith, J. C. 2011. U.S. Census Bureau, Current Population
Reports, P60-239, U.S. U.S. Government Printing Office, Washington, DC.
Denis, A. 2008. Review essay: Intersectional analysis. International Sociology, 23, 5, 677-94.
Dhaliwal, S. 2002. Dietary Practices of Older Punjabi Women Living in Canada. Ph.D. dissertation,
Queen’s University, Kingston, Ontario.
Dhamoon, R. K. and Hankivsky, O. 2011. Why the theory and practice of intersectionality matter to
health research and policy. In Hankivsky, O. (ed), Health Inequities in Canada: Intersectional
Frameworks and Practices, UBC Press, Vancouver, BC, 16-50.
Dressel, P., Minkler, M., and Yen, I. 1997. Gender, race, class, and aging: Advances and
opportunities. International Journal of Health Services, 27, 4, 579-600.
Durand, J. and Massey, D. S. 2010. New world orders: Continuities and changes in Latin American
migration. The Annals of the American Academy of Political and Social Science, 630, 1, 20-52.
Estes, C. L. and Binney, E. A. 1989. The biomedicalization of aging: Dangers and dilemmas. The
Gerontologist, 29, 5, 587-96.
Fikree, F. F., and Pasha, O. 2004. Role of gender in health disparity: The South Asian context. British
Medical Journal, 328, 3 April, 823-6.
Filinson, R. 1992. Ethnic aging in Canada and the United States: A comparison of social policy.
Journal of Aging Studies, 6, 3, 273-87.
Final before proofs version for self-archiving – please cite published version only
34
Ford, C. L. and Harawa, N. T. 2010. A new conceptualization of ethnicity for social epidemiologic
and health equity research. Social Science and Medicine, 71, 2, 251-58.
Fornazzari, L., Fischer, C., Hansen, T., and Ringer, L. 2009. Knowledge of Alzheimer's Disease and
subjective memory impairment in Latin American seniors in the Greater Toronto area. International
Psychogeriatrics, 21, 5, 966-69.
Forster-Coull, L. and Koehn, S. 2001. ‘Where’s the Dal?’ Food and Nutrition Experiences of Ethnic
Minority Seniors in Long-Term Care. Prevention and Health Promotion Strategies, BC Ministry of
Health, Victoria, BC. Available online at
http://www2.fiu.edu/~nutreldr/Ask_the.../Where's%20the%20Dal%209.7.pdf [04/27/11].
Fung, J. 2006. Cultural Appropriateness of Person-Centred Care for the Chinese Population. Master’s
thesis, University of British Columbia, Vancouver, BC.
Grimshaw, J. 2010. A guide to knowledge synthesis: A knowledge synthesis chapter. Canadian
Institutes of Health Research. Available online at http://www.cihr-irsc.gc.ca/e/41382 [09/12/11].
Gupta, M., Singh, N. and Verma, S. 2006. South Asians and cardiovascular risk: What clinicians
should know. Circulation, 113, 25, e924-29.
Guruge, S. and Khanlou, N. 2004. Intersectionalities of influence: Researching the health of
immigrant and refugee women. The Canadian Journal of Nursing Research, 36, 3, 32-47.
Hankivsky, O. (ed.) 2011. Health Inequities in Canada: Intersectional Frameworks and
Practices.UBC Press, Vancouver, BC.
Final before proofs version for self-archiving – please cite published version only
35
Henry, F. and Tator, C. 2006. The Colour of Democracy: Racism in Canadian Society, 4th ed.
Thomson Nelson, Toronto, Ontario.
Hossem, A. 2009. The South Asian older adult immigrant's barriers to accessing health services in
Canada: What do we know? What can we do? Indian Journal of Gerontology, 23, 3, 328-42.
Hulko, W. 2011. Intersectionality in the context of later life experiences of dementia. In Hankivsky,
O. (ed.), Health Inequities in Canada: Intersectional Frameworks and Practices, UBC Press,
Vancouver, BC, 198-217.
Iliffe, S. and Manthorpe, J. 2004. The debate on ethnicity and dementia: From category fallacy to
person-centred care? Aging and Mental Health, 8, 4, 283-92.
Iyer, A., Sen, G. and Östlin, P. 2008. The intersections of gender and class in health status and health
care. Global Public Health, 3, 1 (supp 1), 13-24.
Johnson, C. S., and Garcia, A. C. 2003. Dietary and activity profiles of selected immigrant older
adults in Canada. Journal of Nutrition for the Elderly, 23, 1, 23-39.
Johnson, J. L., Bottorff, J. L., Browne, A. J., Grewal, S., Hilton, B. A., and Clarke, H. 2004. Othering
and being othered in the context of health care services. Health Communication, 16, 2,255-71.
Jones, R., Chow, T., and Gatz, M. 2006. Asian Americans and Alzheimer’s Disease: Assimilation,
culture and beliefs. Journal of Aging Studies, 20, 1, 11-25.
Kirmayer, L. J. and Minas, H. 2000. The future of cultural psychiatry: An international perspective.
Final before proofs version for self-archiving – please cite published version only
36
Canadian Journal of Psychiatry, 45, 5, 438-46.
Kleinman, A. and Benson, P. 2006. Anthropology in the clinic: The problem of cultural competency
and how to fix it. PLoS Med, 3, 10, e294-e305.
Kobayashi, K., Prus, S., and Lin, Z. 2008. Ethnic differences in self-rated and functional health: Does
immigrant status matter? Ethnicity and Health, 13, 2, 129-47.
Kobayashi, K. M. and Prus, S. G. 2011. Adopting an intersectionality perspective to the study of the
“Healthy immigrant effect.” In Hankivsky, O. (ed.), Health Inequities in Canada: Intersectional
Frameworks and Practices, UBC Press, Vancouver, BC, 180-97.
Koehn, S.2009. Negotiating candidacy: Ethnic minority seniors' access to care. Ageing and Society,
29, 4, 585-608.
Kozak, J-F., Koehn, S. and Khamisa, H. 2011. A population health approach to the health and
healthcare of ethnocultural minority older adults: A scoping review. Final report. CIHR Knowledge
Synthesis Grant (FRN 91772). Canadian Institutes for Health Research, Ottawa, Ontario.
Kromer, A. 2004. Impact of Ethnic Identity on Nursing Home Placement among Polish Older Adults.
Doctoral dissertation, McGill University, Montreal, Quebec.
Lai, D. W. 2000a. Depression among the elderly Chinese in Canada. Canadian Journal on Aging, 19,
3, 409-29.
Lai, D. W. 2000b. Prevalence of depression among the elderly Chinese in Canada. Canadian Journal
Final before proofs version for self-archiving – please cite published version only
37
of Public Health, 91, 1, 64-6.
Lai, D. W. 2004a. Impact of culture on depressive symptoms of elderly Chinese immigrants.
Canadian Journal of Psychiatry, 49, 12, 820-27.
Lai, D. W. 2004b. Use of home care services by elderly Chinese immigrants. Home Health Care
Services Quarterly, 23, 3, 41-56.
Lai, D. W. and Chau, S. B. 2007. Predictors of health service barriers for older Chinese immigrants in
Canada. Health and Social Work, 32, 1, 57-65.
Lowe, L. 2003. Heterogeneity, hybridity, multiplicity: Marking Asian American differences. In
Braziel, J. E. and Mannur, A. (eds), Theorizing Diaspora: A Reader. Wiley-Blackwell, Malden, MA,
132-55.
Majumdar, B., Browne, G. and Roberts, J. 1995. The prevalence of multicultural groups receiving in-
home service from three community agencies in southern Ontario: Implications for cultural sensitivity
training. Canadian Journal of Public Health, 86, 3, 206-11.
Masi, R. and Disman, M. 1994. Health care and seniors: Ethnic, racial, and cultural dimensions.
Canadian Family Physician, 40, March, 498-504.
Mateos, P., Singleton, A. and Longley, P. 2009. Uncertainty in the analysis of ethnicity
classifications: Issues of extent and aggregation of ethnic groups. Journal of Ethnic and Migration
Studies, 35, 9, 1437-60.
Final before proofs version for self-archiving – please cite published version only
38
McCall, L. 2005. The complexity of intersectionality. Signs: Journal of Women in Culture and
Society, 30, 3, 1771-1800.
Mullings, D. V. 2006. Policy needs of older Caribbean-Canadian women. Caribbean Journal of
Social Work, 5, 143-58.
Nederveen Pieterse, J. 2001. Hybridity, so what? The anti-hybridity backlash and the riddles of
recognition. Theory, Culture and Society, 18, 2/3, 219-46.
Neysmith, S. M. 1999. Critical Issues for Future Social Work Practice with Aging Persons. Columbia
University Press, New York, NY.
Pereira, I., Lazarowich, N. M. and Wister, A. 1996. Ethnic content in long-term-care facilities for
Portuguese and Italian elderly. Canadian Ethnic Studies, 28, 2, 82-97.
Raymond, N. T., Varadhan, L., Reynold, D. R., Bush, K., Sankaranarayanan, S., Bellary, S., Barnett,
A.H., Kumar, S. and O'Hare, J.P. 2009. Higher prevalence of retinopathy in diabetic patients of South
Asian ethnicity compared with white Europeans in the community. Diabetes Care, 32, 3, 410-5.
Sadavoy, J., Meier, R. and Ong, A. Y. 2004. Barriers to access to mental health services for ethnic
seniors: The Toronto study. Canadian Journal of Psychiatry, 49, 3, 192-9.
Saldov, M. and Chow, P. 1994. Ethnic elderly in metro Toronto hospitals, nursing homes, and homes
for the aged: Communication and health care. International Journal of Aging and Human
Development, 8, 2, 117-35.
Final before proofs version for self-archiving – please cite published version only
39
Sanghera, G. S. 1991. The male Punjabi elderly of Vancouver: Their background, health beliefs, and
access to health care services. Master’s thesis, University of British Columbia, Vancouver, BC.
Schulz, A. J. and Mullings, L. (eds) 2006. Gender, Race, Class, and Health: Intersectional
Approaches.Jossey-Bass, San Francisco.
Sharma, N. R. 2006. Home economics: Nationalism and the Making of 'Migrant Workers' in Canada.
University of Toronto Press, Toronto, Ontario.
Siddiqi, A., Zuberi, D. and Nguyen, Q.C. 2009. The role of health insurance in explaining immigrant
versus non-immigrant disparities in access to health care: Comparing the United States to Canada.
Social Science and Medicine, 69, 10, 1452-9.
Snow, R. C. 2008. Sex, gender, and vulnerability. Global Public Health, 3, 1 (supp 1), 58-74.
Sokolovsky, J. (ed.) 2009. The Cultural Context of Aging: Worldwide Perspectives, 3
rd
ed. Praeger,
Westport, Connecticut.
Statistics Canada. 2006. 2006 Census of Canada. Statistics Canada catalogue no. 97-562-
XCB2006016. Unpublished manuscript.
Statistics Canada. 2010a. Ethnocultural Portrait of Canada - Data Table. 2006 Census. Available
online at http://www12.statcan.ca.ezproxy.library.ubc.ca/census-recensement/2006/dp-pd/hlt/97-
562/pages/page.cfm?Lang=E&Geo=PR&Code=01&Table=1&Data=Count&StartRec=1&Sort=2&D
isplay=Page [09/19/11].
Final before proofs version for self-archiving – please cite published version only
40
Statistics Canada. 2010b. Study: Projections of the diversity of the Canadian population. The Daily.
Available online at http://www.statcan.gc.ca/daily-quotidien/100309/dq100309a-eng.htm [01/04/11].
Ungerson, C. 1987. Policy Is Personal: Sex, Gender, and Informal Care. Tavistock, London and New
York.
van Dijk, J. 2004. Role of ethnicity and religion in the social support system of older Dutch
Canadians. Canadian Journal on Aging, 23, 1, 21-34.
Waldram, J. B., Herring, A. and Young, T. K. (2006). Aboriginal health in Canada: Historical,
cultural, and epidemiological perspectives. University of Toronto Press, Toronto, Ontario.
Walker, A. 1981. Towards a political economy of old age. Ageing and Society, 1, 1, 73-94.
Warner, D. F. and Brown, T. H. 2011. Understanding how race/ethnicity and gender define age-
trajectories of disability: An intersectionality approach. Social Science and Medicine, 72, 8, 1236-48.
Wasylenka, K. 2004. Visible Minority Seniors in Long Term Care: Not Many and Frail. Master’s
thesis, University of Regina, Regina, Saskatchewan.
Wedeen, L. 2002. Conceptualizing culture: Possibilities for political science. American Political
Science Review, 96, 04, 713-28.
Winker, G. and Degele, N. 2011. Intersectionality as multi-level analysis: dealing with social
inequality. European Journal of Women's Studies 18, 1, 51-66.
Final before proofs version for self-archiving – please cite published version only
41
Figure 1: Flow chart of exclusion process to identify eligible articles
Final before proofs version for self-archiving – please cite published version only
42
Figure 2: Distribution of articles by country in which research was conducted
Ca na da
25.8%
USA
52 . 8 %
Aus t r al i a
3. 2 %
Ne w Ze al and
0. 6 %
Uni t ed Ki ngdo m
10.5%
Swed e n
0. 1 %
Not Spe ci f i ed
6. 9 %
US A
Ca n a d a
Au st ra l i a
Ne w Z ea la nd
Un it e d K ing do m
S we d e n
No t Sp ec if i ed
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43
Figure 3: Percent of abstracts that mention an ethnocultural minority group
9
compared to Canadian
visible minority population aged 65+
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44
Figure 4: Percent of abstracts that mention only one ethnocultural minority group compared to
Canadian visible minority population aged 65+
Final before proofs version for self-archiving – please cite published version only
45
Figure 5: Leading causes of death and hospitalization of Canadians 65+
Final before proofs version for self-archiving – please cite published version only
46
Figure 6: Number of Canadian abstracts for Chinese and South Asian older adults classified
according to ICD-10 categories
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47
Intervention topic
All
sources
Cana-
dian
Long-term care (LTC): LTC facilities/nursing homes - types of care
administered/available; transition into LTC.
47 20
Caregivers: Primarily informal caregivers - issues related to care provision
for an older adult, e.g. caregiver burden, filial obligation, etc.
63 19
Cultural Competence: Formalized efforts to provide culturally sensitive
care and their effect on care recipients.
70 14
Promotion: Formal health promotion efforts and behaviours deemed to
promote health.
31 11
Home Care: Medical ‘home care’ services and non-medical home
supports for older adults.
23 7
Table
1: Top five ‘Intervention’ topics in the international and Canadian literature
1
The biological differences associated with sex and the gendered socialization that people experience in
different contexts are highly interactive, but should not be conflated in analysis because the effects on
health and the potential for and types of intervention differ for each (Snow 2008).
2
Aboriginal peoples are outside of the focus of this study because they are not considered ethnocultural
minorities in Canada for historical and political reasons. Aboriginal peoples preceded European contact and
most of the inequities arising across the life cycle are rooted in the racist practices of early European
Final before proofs version for self-archiving – please cite published version only
48
settlement (e.g. placing aboriginal children in residential schools where many were physically and sexually
abused), which continued well into the 20th century. The rights of Aboriginal peoples are also treated
separately in the Constitution (Section 13) (Waldram, Herring, and Young 2006).
3
A full accounting of our methodological processes, including our extensive list of search terms is the
subject of a forthcoming paper.
4
Following links from relevant articles to related articles efficiently expanded our Ebsco search.
5
http://amicus.collectionscanada.gc.ca/thesescanada-bin/Main/BasicSearch?coll=18&l=0&v=1
6
http://canada.metropolis.net/index_e.html
7
After their first three months’ residence in any province, all citizens and landed immigrants in Canada are
eligible for affordable health care coverage (http://www.health.gov.bc.ca/msp/), although not all health
services are covered, notably most regular dental and vision care. This nonetheless compares favourably
with the US where, in 2010, 49.9 million Americans (16.3% of the US population) were without medical
coverage (DeNavas-Walt, Proctor and Smith 2011). A study comparing health care access of immigrants in
Canada (all insured) and insured and uninsured immigrants in the United States found that “health care
insurance is a critical cause of differences between immigrants and non-immigrants in access to primary
care” (Siddiqi, Zuberi and Nguyen 2009: 1452).
8
Journal of the American Geriatrics Society, Journal of Gerontological Social Work, Journal of
Gerontological Nursing, International Journal of Geriatric Psychiatry, Generations, Ageing and Society.
9
Articles may refer to more than one ethnic group. VM n.i.e. is used by Statistics Canada (2006) to denote
“Visible Minorities not included elsewhere.”
... The COVID-19 pandemic exposed and exacerbated these pre-existing vulnerabilities in legislation [16]. Changes to the LTC sector are clearly needed; for example, healthcare policy decisions aimed at increasing equitable access to home care and community-based housing with health services, as well as changes to "institutional" care [37]. Two approaches have been highlighted in literature as frameworks to reform or drastically alter the current LTC system and its often-overlooked colonial history. ...
... Two approaches have been highlighted in literature as frameworks to reform or drastically alter the current LTC system and its often-overlooked colonial history. Abolitionist movements (e.g., Disability Justice Network Ontario) emphasize the need to dismantle existing structures and develop voluntary, accessible, community-run services and public infrastructure that is not tied to employment [37]. De-institutionalization and access to "just care work" are key components of abolition. ...
... Rather than separating older adults and individuals with care needs from their communities, abolitionists emphasize adaptations to environments within communities. In contrast, reform movements tend to focus on changing the current LTC system to be more inclusive and intersectional while promoting a need for more LTC homes and an increased level of staffing and care within institutional settings [37]. Although different approaches to change, both movements recognize and support the need for transformation through mobilization of key knowledge users and decision-makers (i.e., policymakers, researchers, cooperation of jurisdictional bodies). ...
Article
Full-text available
Healthcare policy reform is evident when considering the past, present and future of long-term care (LTC) in Canada. Some of the most pressing issues facing the LTC sector include the changing demographic composition in Canadian LTC homes, minimal consideration for the role of intersectionality in LTC data collection and analysis, and the expanding need to engage diverse participants and knowledge users. Using the Transtheoretical Model of Change (TTMC) as a framework, we consider opportunities to address intersectionality in LTC research. Engaging diverse knowledge users in LTC (e.g., unpaid caregivers, paid care staff), community (e.g., advocacy groups, service providers) and policy decision-makers (e.g., provincial government) is crucial. Empowering individuals to participate, modifying environments to support engagement, and facilitating ongoing partnerships with knowledge users are critical aspects of change efforts. Addressing structural barriers (e.g., accessibility, capacity, jurisdictional policies, and mandates) to research in LTC is also essential. The TTMC offers a framework for planning and enacting individual, organizational, and system-level changes for the future of LTC.
... So, little is known about why some PwM share the care within their families and/or with formal care-support, whilst others do not. Moreover, research on PwM caring for an aging family member (with dementia) is often informed by limited and static understandings of ethnicity and culture (Iliffe & Manthorpe, 2004;Koehn, Neysmith, Kobayashi, & Khamisa, 2013;Torres, 2015;Zubair & Norris, 2015). A scoping review on the health and health care of aging people with an ethnocultural minority background (Koehn et al., 2013) revealed that studies often reduce the experiences of entire groups to single categories of difference (ethnicity or culture) that obscure the heterogeneity of PwM. ...
... Moreover, research on PwM caring for an aging family member (with dementia) is often informed by limited and static understandings of ethnicity and culture (Iliffe & Manthorpe, 2004;Koehn, Neysmith, Kobayashi, & Khamisa, 2013;Torres, 2015;Zubair & Norris, 2015). A scoping review on the health and health care of aging people with an ethnocultural minority background (Koehn et al., 2013) revealed that studies often reduce the experiences of entire groups to single categories of difference (ethnicity or culture) that obscure the heterogeneity of PwM. Many scholars emphasize the need to move toward an intersectional exploration of the influence of a number of social categories when studying the health and care-experiences of PwM (see e.g., Iliffe & Manthorpe, 2004;Koehn et al., 2013;Torres, 2015;Zubair & Norris, 2015). ...
... A scoping review on the health and health care of aging people with an ethnocultural minority background (Koehn et al., 2013) revealed that studies often reduce the experiences of entire groups to single categories of difference (ethnicity or culture) that obscure the heterogeneity of PwM. Many scholars emphasize the need to move toward an intersectional exploration of the influence of a number of social categories when studying the health and care-experiences of PwM (see e.g., Iliffe & Manthorpe, 2004;Koehn et al., 2013;Torres, 2015;Zubair & Norris, 2015). Therefore, in order to understand which social categories impact on practices of care-sharing for PwM caring for a family member with dementia, we will incorporate an intersectionality approach (Crenshaw, 1989(Crenshaw, , 1991. ...
Article
Full-text available
Background and objectives: Previous studies show that persons with a migration background (PwM) caring for a family member with dementia often experience access barriers to formal care services, and that family carers often perform the lion's share of care. Yet research offering a detailed account on their experiences of dementia care-sharing is sparse. In this paper, we respond to this knowledge gap by exploring how different social categories impact on practices of care-sharing in our participants and their families. Research design and methods: A qualitative study of six PwM who provide care for a family member with dementia was conducted through two methods: semi-structured, life-story interviews followed by "shadowing" our participants in their daily lives. We were guided by intersectionality as an analytical lens in exploring the multi-faceted experiences of care-sharing. Findings: Throughout our analysis, intersections of migration history and social class stood out the most. We elucidate how they influence the attainment of necessary skills to organize and share care-tasks as well as perceptions of "good care." Additionally, our findings illustrate how one's position within the family, the presence or absence of supportive social networks, religion, gendered care norms, and relationship to the care-recipient are relevant to experiences of care-sharing. Implications: Rather than overemphasizing ethnicity and culture, practice and policy should take into account that intersections of various social categories affect care-sharing and the type of support that is (or is not) organized.
... By reconceptualising migrants' access to aged care as an outcome of relationships of care in specific places, this paper responds to criticisms within the gerontological literature on older migrants and health inequality. Many scholars have argued that much of the gerontological literature relies on essentialist understandings of ethnicity, i.e. that ethnicity is seen as a fixed characteristic of a homogenous social group (Kramer and Barker, 1994;Koehn et al., 2013;Torres, 2015;Zubair and Victor, 2015). This conceptualisation is problematic in research on health inequalities since many of the identified 'barriers of access' faced by different ethnic minority groups are related to migration rather than culture per se. ...
... From this perspective, access to aged care is perceived as an outcome of an individual's embeddedness in a local configuration of relationships of care, which is spatially concentrated in, but not confined to, the city. By shifting the focus from characteristics of ethnic groups to how variables of super-diversity play out in local landscapes of care, the paper responds to criticisms of gerontological research on older migrants' access to care, which is accused of relying on simplified notions of ethnicity (Kramer and Barker, 1994;Koehn et al., 2013;Torres, 2015;Zubair and Victor, 2015). ...
Article
Full-text available
The literature on older migrants often focuses on identifying the characteristics of ethnic groups that constitute ‘barriers’ for members of these populations to access care. This paper offers an alternative conceptualisation of access to care, by combining relational approaches to place and the notion of super-diversity. From this perspective, ‘access to care’ is perceived as an outcome of an individual's embeddedness in relationships of care in urban places. The objective of the study is to identify relationships of care that facilitate access to aged care for older first-generation migrants. Thirty-two semi-structured interviews were conducted with older migrants who were residents of Nijmegen or The Hague, The Netherlands. All interviewees had accessed home care, home aid and/or day care. Both relationships with minority-specific services and informal relationships of care, particularly those within local minority communities, were found to facilitate access to aged care. Past experiences with health and social care were also found to influence current relationships with formal care providers. This study, therefore, suggests that policy makers and care organisations should build long-term positive relationships with new and incoming migrant groups. In addition, it argues that policy makers and care providers should identify locally relevant shared migration-related (rather than ethnic) identities around which communities can be mobilised and targeted with appropriate services.
... However, these disparities are not dichotomised only between CALD-and Anglo-Australians, but also manifest differently between CALD groups. Differences in education and literacy, socio-economic factors, migration histories and culture means there are significant asymmetries between cohorts of CALD older people and carers (Greenwood et al., 2015;Koehn et al., 2012). ...
Article
Full-text available
Evidence suggests that family carers of culturally and linguistically diverse (CALD) people living with dementia experience higher stress and unmet need than the general Australian population. These disparities are often framed as the result of CALD communities failing to seek formal support. Challenging this, we draw on the concept of 'structural burden' to explore how the complexity of health and aged systems contribute to the burden that CALD carers experience. We conducted semi-structured interviews with 104 family carers for CALD people with dementia in Australia, followed by thematic analysis of transcripts. Additional to structural burdens encountered by the general older population, CALD carers faced challenges understanding Australia's Anglo-centric aged care system, locating culturally appropriate care and were required to translate the languages and operations of health and aged care systems into terms their family members understood. This burden was mitigated by the presence of ethno-specific organisations and other navigation support. Australia's aged care system has moved towards centralised governance and consumer-directed care provision. This system involves a confusing array of different programmes and levels, bureaucratic applications and long waiting times. Carers' encounters with these systems demonstrates how some CALD people are being left behind by the current aged care system. While ethno-specific services can reduce this burden, not all CALD groups are represented. Consequently, improving access to dementia care among CALD populations requires entry point and navigation support that is culturally appropriate and linguistically accessible.
... An intersectional perspective describes the entanglement of identity categories within a specific context [13]. Koehn et al. [15] emphasized that it is how these dimensions intersect and compound that affects the health and quality of people's lives as individuals and group members. To beable to analyze intersecting systems of power Winkler and Degele [30] proposed an intersectional multilevel analysis which takes the various levels (such as level of identity, symbolic representation, and social structure) and their reciprocal effects into account. ...
Article
Background: Despite the care and support needs of migrants affected by dementia differing from the population of the country where they live now, most European countries do not provide specific strategies to address migration in their national dementia plans. The concept of intersectionality provides an innovative approach to dementia care perspectives and methodologies. Objective: The aim is to define intersectionality and to provide examples of applying the concept to dementia care research, focusing on people with a migration background. Methods: This article was conceptualized and discussed during virtual INTERDEM taskforce meetings in 2020/2021, while discussing identified literature on intersectionality, migration, and dementia care research. Results: Using an intersectionality framework allows understanding of a person's lived experience by considering the dimensionality, co-occurrence and interlocking of factors (e.g., sex/gender, socioeconomic status, ethnicity, migration status, geographic location/place). Conclusion: Intersectionality can be applied as a conceptual and methodological approach to identify and address gaps in perspectives and in (dementia care) research to overcome the threat of ignorance, exclusion and discrimination.
... The COVID-19 pandemic has disproportionate health, social, and economic impacts on immigrants and racialized communities (Guttmann et al., 2020;Price-Haywood et al., 2020). Older adults within these communities are particularly vulnerable (Garcia et al., 2020) as they are more likely to have declining health, experience social isolation and loneliness, and report greater unmet health needs than the general population (Degelman & Herman, 2016;De Jong Gierveld et al., 2015;Koehn et al., 2013;Salma & Salami, 2020). Targeted and tailored strategies are required to support immigrant and racialized older adults impacted by the pandemic. ...
Article
Full-text available
Community-based participatory research (CBPR) approaches have been important avenues for addressing community vulnerability during pandemics and times of crises. There has been little guidance, however, on how to approach CBPR within the context of the COVID-19 pandemic where physical distancing and closure of essential community organizations became the norm. This study discusses challenges and possibilities of using CBPR during a pandemic to address the needs of immigrant and racialized older adults in Alberta, Canada. Two case studies of active research projects that aim to engage immigrant and racialized older adults are presented. Three key challenges are identified related to research activities during the pandemic: (a) pivoting as new foci emerge, (b) recognizing inequity in research participation, and (c) reflecting on well-being in the research team. Approaches to addressing these challenges are highlighted with recommendations for future considerations in CBPR research within vulnerable communities.
Article
Full-text available
Lifecourse transitions from adulthood into older age are particularly complex for transnationalmigrants, bringing additional challenges and opportunities. Adding to the growing literature on ageing and migration, this article illustrates the ways ICTs facilitate the transnational lifecourse transitions of Vietnamese migrant grandparents in Australia through lifecourse digital learning. Research findings highlight the crucial role that digital citizenship plays in supporting migrant grandparents’ adaptation to increasingly mobile lives through practices of digital kinning and digital homing. These practices include using technological tools to maintain social support networks, exchange transnational caregiving, tackle language, navigation, and social integration barriers, and consume culturally relevant media, all of which support migrant identities and belongings. Findings confirm the importance of ICTs in promoting lifecourse digital learning for older migrants who are often stereotyped for their poor learning capacities and ability to adapt to new living arrangements because of their older age.
Article
This article reports a study on the impact of a Bhagavad Gita (BG) text‐based counselling programme for long‐term immigrant diaspora Hindu older adults in the US and UK. Compared with the journal writing sessions, participants of the BG lessons reported lower stress and better quality of life post‐test (p ≤ 0.025; Hedges' g = −0.65–0.36). Results of the latent class analyses highlighted complex behaviour patterns in the post‐test dataset and foregrounded six classes/subgroups of participants likely to gain most from the BG programme: older adult females, diaspora Hindu older adults with postgraduate‐professional qualifications, widowed older adults, those living alone or with other kith‐kin, those with above threshold programme compliance (defined as those who attended 13–24 (>50%) BG lessons, and completed 13–24 (>50%) BG homework lessons). Overall, the results of the study endorse the connection between age and religiosity and support a BG text‐based counselling programme as a workable strategy for long‐term immigrant diaspora Hindu older adults. The BG text provides a firm ethnoculturally grounded counselling approach to work with diaspora Hindu older adult clients, taking cognisance of their intersectional realities. It may help them cope with the dynamics of the modern, traditional, and continuously shifting realities in a foreign milieu.
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Older immigrants are at higher risks for inactivity due to cultural, environmental, and social barriers in the postmigration context. Community-based physical activity (PA) programs increase PA in older adults, yet little is known about approaches that specifically target older immigrants. This scoping review explores the literature on community-based programs that increase PA and physical fitness in immigrant older adults and identifies barriers and facilitators to PA program participation in this population. A systematic search of electronic databases and gray literature was conducted, and a total of 11 articles met the inclusion criteria after full-text screening. A range of populations and PA program characteristics are described, yet there is a lack of studies on older immigrant men, Black older immigrants, and immigrants from Arab and African countries. There is a need for further research to develop evidence-informed PA programs for this diverse population.
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Across the world, the experiences of women in later life vary enormously, not only along intersectional lines, but also due to cumulative (dis)advantages over an individual’s life course. The current study explores how early-life structural (dis)advantages experienced by older African women (particularly experiences related to economic adversity and the social disadvantages that often accompany it) shape their later life experiences and agency. The life stories used in this paper emerged from a larger qualitative study of aging and gender identities in Tanzania based on fifteen (15) in-depth interviews and ten (10) focus group discussions with women 60 to 82 years old. Analyzing the data from an intersectional perspective and life course approach demonstrated that older women’s situations area result of the complex interaction of various structural and individual factors, and that timing is crucial for exercising agency. The findings also revealed that as a result of gender norms, the majority of older Tanzanian women were vulnerable to discrimination, poverty, and violence. The norms that promote gender discrimination also limit women’s agency and social functioning subject to the constraints imposed. To help protect older women against discrimination and violence, gender-sensitive policies, social programs and legal reforms are critical for speed up the pace of change and foster permanent shifts in harmful gender norms so that aging experiences are no longer all about being a woman.
Article
Full-text available
This paper explores the barriers to an enabling quality of life for older Caribbean-Canadian women who have aged in place. Increasingly, some of these women are forced, through social and financial circumstances, to use long-term care (LTC) residential facilities as an alternative to living in their communities. The article provides a brief description of the contemporary Canadian policy environment, social and historical position of Caribbean Canadians, including their experiences of sexual and racial discrimination, and describes some of the associated challenges that the women may encounter while residing in LTC residential facilities. Finally, suggestions for policy implementation are made to help improve the quality of life for older Caribbean Canadian women in LTC facilities.
Book
A massive shift has taken place in Canadian immigration policy since the 1970s: the majority of migrants no longer enter as permanent residents but as temporary migrant workers. In Home Economics, Nandita Sharma shows how Canadian policies on citizenship and immigration contribute to the entrenchment of a system of apartheid where those categorized as ‘migrant workers’ live, work, pay taxes and sometimes die in Canada but are subordinated to a legal regime that renders them as perennial outsiders to nationalized Canadian society. In calling for a ʼno borders’ policy in Canada, Sharma argues that it is the acceptance of nationalist formulations of ‘home’ informed by racialized and gendered relations that contribute to the neo-liberal restructuring of the labour market in Canada. She exposes the ideological character of Canadian border control policies which, rather than preventing people from getting in, actually work to restrict their rights once within Canada. Home Economics is an urgent and much-needed reminder that in today’s world of growing displacement and unprecedented levels of international migration, society must pay careful attention to how nationalist ideologies construct ‘homelands’ that essentially leave the vast majority of the world’s migrant peoples homeless.
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This book of essays, scholars and academics mediate between different theorizations of diaspora for a better understanding of the importance of diaspora within contemporary discussions of migration and identity. By mapping the trajectory of diaspora studies since the early 1990s, it puts this human phenomenon, involving the displacement, movement and separation of people, within a historical perspective, hence linking its past politics with its potential future. Anthropologists, literary theorists and cultural critics present divergent strains of multiple diasporas - Jewish, Black African, Chinese, South Asian and Caribbean, and study them within their ideological, cultural, national, transnational and post-national perspective. The book is organized into four thematic sections. Part 1 probes the economic, political and cultural relations of diaspora and globalization as a phenomenon defining modernity; Part 2 includes essays exploring the subjective terrains of diaspora and migration and examines diaspora in relation to social construction of ethnicity; in Part 3 the contributors suggest ways in which gender and sexuality inflect diaspora formations; it Part 4 the essays discuss the cultural aspects of diaspora and diasporic communities in film, literature and identity politics. The editors conclude the book with a postscript that examines the role of cyberscapes in shaping future diasporic paths.
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Rethinking questions of identity, social agency and national affiliation, Bhabha provides a working, if controversial, theory of cultural hybridity - one that goes far beyond previous attempts by others. In The Location of Culture, he uses concepts such as mimicry, interstice, hybridity, and liminality to argue that cultural production is always most productive where it is most ambivalent. Speaking in a voice that combines intellectual ease with the belief that theory itself can contribute to practical political change, Bhabha has become one of the leading post-colonial theorists of this era.
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Numerous studies, inquiries, and statistics accumulated over the years have demonstrated the poor health status of Aboriginal peoples relative to the Canadian population in general. Aboriginal Health in Canada is about the complex web of physiological, psychological, spiritual, historical, sociological, cultural, economic, and environmental factors that contribute to health and disease patterns among the Aboriginal peoples of Canada. The authors explore the evidence for changes in patterns of health and disease prior to and since European contact, up to the present. They discuss medical systems and the place of medicine within various Aboriginal cultures and trace the relationship between politics and the organization of health services for Aboriginal people. They also examine popular explanations for Aboriginal health patterns today, and emphasize the need to understand both the historical-cultural context of health issues, as well as the circumstances that give rise to variation in health problems and healing strategies in Aboriginal communities across the country. An overview of Aboriginal peoples in Canada provides a very general background for the non-specialist. Finally, contemporary Aboriginal healing traditions, the issue of self-determination and health care, and current trends in Aboriginal health issues are examined.