A cross-national comparative perspective on racial inequities in health: the USA versus Canada

Abstract

Background: Cross-national comparisons allow the examination of the malleability of associations between race and health. Racial inequities in chronic conditions, indicators of health status and behavioural risk factors between two similar advanced capitalist countries were compared. It was hypothesised that racial inequities will be mitigated in Canada compared with the USA.

Methods: Population-based, cross-sectional data from the 2002-3 Joint Canada-USA Survey of Health (JCUSH) with 4953 adult respondents from the USA and 3455 from Canada. Models adjusted for age, sex, foreign birth, marital status, health insurance, education, income and home ownership.

Results: Compared with the USA, racial inequities in health were attenuated in Canada. In the USA, racial inequities in chronic diseases and fair or poor self-rated health were largely driven by inequities found among the native born. Strikingly, in Canada, however, there were few significant racial inequities and those occurred exclusively among the foreign born. Within strata of race and foreign birth, Canadians fared better, with both white people and non-white people reporting better health than their American counterparts. Foreign-born Canadians and Americans were more similar to each other in terms of health than native-born Canadians and Americans. Only among the native born did American white people and American non-white people have higher adjusted odds of hypertension, diabetes and obesity than Canadian white people and Canadian non-white people respectively. Self-rated health was worse for non-white Americans than non-white Canadians regardless of foreign birth.

Conclusion: The influence of race on health is context dependent. There is no necessary link between race and a variety of health indicators.