Service Provision by Representative Institutions and Identity
Cynthia Baker Université de Moncton
[email protected]
Commissioned by the Department of Canadian Heritage for the Ethnocultural, Racial, Religious, and Linguistic Diversity and Identity Seminar Halifax, Nova Scotia November 1-2 2001
Available on-line in English and French at www.metropolis.net The views expressed in this paper do not necessarily reflect those of the Department of Canadian Heritage.
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Diversity has existed in Canada since its inception as a nation. In the last two decades, however, this has increased faster than at any other period of its history (Samuel and Schachhuber 2000). Institutions in a wide variety of policy domains are being challenged to respond with equity and with cultural sensitivity to a significant expansion of ethnic, linguistic, religious, and racial groups in the society. Current notions of equity in these policy domains have their roots in the Employment Equity Act introduced in 1986. This legislation shifted thinking about redressing disadvantage through equal treatment by prescribing an economic inclusiveness that accommodates differences and targets the removal of access barriers (Ng 1999). Acknowledgment of cultural differences in Canada was formally enshrined in 1988 with the passage of the Multiculturalism Act. The Act recognizes the diversity of ethnic, religious, racial, and cultural identities of Canadians as a fundamental characteristic of the nation. The federal government has committed itself to the explicit goal of fostering a society that respects and reflects a diversity of cultures. There is widespread agreement that Canada’s representative institutions should adjust their policies and practices to accommodate the pluralism of Canadian society (Troper and Weinfeld 1999). Moreover, studies suggest that institutional acknowledgement of diverse identities contributes to Canadians’ sense of belonging and ultimately to social cohesion. Recent reviews of existing research, for instance, have concluded that ethnic identities provide individuals with greater self confidence and this results in increased attachment to a larger national identity (Canadian Heritage 1998). What is less clear, however, are the actual adjustments necessary for representative institutions to accommodate pluralism. This has raised complex questions in domains such as education, health care, social services, policing and justice, arts and culture, the media, and politics. Common, overlapping issues have emerged in these domains regarding institutional responses to diversity. An overview of some of these issues will be examined first. This will be followed by an historical review of the literature addressing the impact of services on diverse identities in the education, health and social services fields. These domains were selected as they have developed an extensive body of work concerned with service provision in a pluralistic society. The paper will conclude by discussing the implications of this literature for policy and further research. Issues of Institutional Accommodation Common issues related to institutional accommodation of pluralism have included the representation of diverse groups in or by mainstream institutions, the sensitivity of services to a diverse public, and the creation of alternative organizations or associations to serve specific minority groups. Representation The under-representation of various ethnic, racial, or religious groups—either as providers or as consumers of mainstream services—has been identified as a major issue in many public domains. This has included concerns about the underrepresentation of certain minority groups in professional fields such as education
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(Carr and Klassen 1996), policing (Nancoo 2000), arts (Tator and Henry 1998), the media (Bortolussi 1999) as well as in political office (Biles 1998). A study by Siemiatycki (1998) illustrates this last under-representation. While 37.3% of the city of Toronto’s population belonged to a visible minority in 1997, they held only 12% of seats on city council (7 of 58). The under-representation of ethnocultural minorities as consumers of health care and social services due to linguistic and/or cultural barriers has also been an issue (Anderson and Reimer Kirkham 1998). In marked contrast, the over-representation of Aboriginal Canadians and people of colour in the prisons of the justice system has been another significant representation issue (Nancoo 2000). Issues around representation have also included controversies about the way in which members of the dominant culture represent minority group identities in areas such as the arts, the media, and in school textbooks versus the rights of minority groups to choose how their identities will be defined (Tator and Henry 1998; Nancoo and Nancoo 2000). The essence of the issue from the perspective of many minority group members was captured by Haroon Siddiqui (1993) who commented in the Toronto Star that “visible minorities are portrayed in the media as a dazzling array of trouble spots:…stumping immigration authorities, cheating on welfare, or battling among themselves or with their families” (p. D-1). In incidents of public resistance to negative stereotypes, visible minority group members have articulated their opposition to a number of cultural productions in terms of the assertion of collective minority rights (Tator and Henry 1998). In contrast, sponsoring organizations, the media, and the cultural producers themselves have mounted counter-resistance campaigns invoking principles of democracy and individual rights to defend the particular production in question (Tator and Henry 1998). Parallel Organization A second issue has been the accommodation of diversity through separate services tailored to a specific minority group either by matching minority professionals with minority communities or through alternative organizations (Troper and Weinfeld 1999). In policing, for instance, in order to provide role models and improve culturally congruent services to the community, efforts have been made to increase the proportion of First Nation officers responsible for policing First Nation communities (Bortolussi 1999). Similarly, schools in many First Nation communities have come under the control of the community. An ambivalence about this approach has been found among a number of visible minority teachers who fear that too much of this may lead to separate, educational ghettos (Couton 1999). Separate organizations have generated debates about collective minority rights especially when public funding has been involved. Tator and Henry (1998) illustrate this in an analysis of a controversy surrounding a publicly-funded Writing through Race Conference in which participation was by invitation only and was restricted to writers of colour and to First nation writers. On the one hand, the conference affirmed participants’ identities as minority group members and served as a forum to support their resistance
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to the imposition of a Eurocentric view of literature. On the other hand, critics argued this affirmation of identity incorporated an exclusionary rather than an inclusive policy. Religious schools in Canada provide another example where separate services have accommodated pluralism by restricting diversity. Whether funded publicly, as is the case for instance, with Catholic schools in some provinces, or funded privately, such schools affirm identities by separating children from Canada’s multifaith society. Lauwer, a lawyer who has often acted on behalf of Catholic school boards argues that pluralism and multiculturalism are only meaningful if exercised in matters of importance such as religion and sustained by practical measures (Sweet 1997). In contrast, the philosopher, Kymlicka, argues that the very separateness of religious schools makes it difficulty for them to provide appropriate citizenship education for a multicultural society (Sweet 1997). Culturally Sensitive Services The case for mainstream institutions to provide culturally sensitive services has been made in many domains on the grounds of both equity and efficacy (Troper and Weinfeld 1999). Developing culturally sensitive practices, however, raises issues about which and how many cultural and linguistic specificities can be accommodated. In order to illustrate these dilemmas, Troper and Weinfeld (1999) ask, for instance, whether public schools should provide language instruction for all linguistic minority groups, some or none. Respect for cultural diversity has also been challenged by cultural practices perceived to clash with mainstream norms, values or laws. For example, the type of corporal punishment of children sanctioned by some cultural groups has created dilemmas for social work institutions. Female genital mutilation provides an example of a custom that has been problematic for health care service providers (Baker 1997; Levine 1999). Canadian Context of Education, Health and Social Services In the Canadian division of labour between government tiers, education is a provincial responsibility. The provinces manage health and social services although the federal government created Canada’s social safety net and ensures national standards by providing or withholding financial resources. Perspectives on serving a diverse population in the literature of each of these fields, however, have reflected the current federal understanding of Canadian identity. As the national vision has changed considerably over time, it will be reviewed briefly first (Samuel and Schachuber 2000; Simmons 1999; Abu-Laban 1998). The literature in education and in the fields of health and social services will be situated in the context of the evolving national vision. Prior to the 1960s, Canadian identity was inextricably linked to Western European culture and to being white (Samuel and Schachhuber 2000). An explicitly racist immigration policy favoured the entry of white, preferably British-origin, Protestants (Abu-Laban 1998). Newcomers were encouraged to adapt to Canadian ways and
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cultural assimilation of immigrants and Aboriginals was promoted (Harper 1997 Samuel and Schachhuber 2000). Principles of universalism gained ascendancy following the Second World War and The Universal Declaration of Human Rights in 1948 (Harper 1997; Abu-Laban 1998). The Canadian Bill of Rights was passed in 1960, and in 1966, the White Paper on Immigration advocated a universally applicable framework for the selection of immigrants. The immigration laws of 1967 explicitly stated there would be no discrimination of race and colour or religion and created the universally applicable point system. Equality of opportunity was emphasized, differences among Canadians downplayed, and a vision of a national identity that transcended ethnicity, race, and class was promoted (Harper 1997). The emphasis shifted from universalism to differences with the adoption of the Official Languages Act in 1969 and the introduction of the policy of official Multiculturalism in 1971. A new vision of Canada as a mosaic within a bilingual framework defined cultural pluralism as the very essence of Canadian identity. Members of all ethnic groups in Canada were encouraged to maintain and share their language and cultural heritage (Esses and Gardner 1996). Although the principles of equality and social justice were an explicit element of the policy, it was largely put into practice through support of cultural programs celebrating cultural diversity (Esses and Gardner 1996). By the end of the 1980s, the 1967 immigration laws as well as the acceptance of refugees from developing countries had significantly increased the proportion of foreignborn Canadians from non European regions and the number of visible minorities (Beaujot 1999). The focus of multiculturalism programs was redirected from cultural support to redressing inequities and combating prejudice, discrimination and racism (Department of Canadian Heritage 2001). In 1990, Quebec, which has had unique responsibilities in the recruitment and resettlement of immigrants, adopted the policy of intégration pluraliste. Provision of School Services Schools in Canada have traditionally been designated as the central institution for both the preservation and the transformation of ethnic, racial, linguistic and religious identities. The British North American Act of 1867 guaranteed protection of denominationally-based schools already in place when the province joined the federation. This created a patchwork in which some provinces publicly fund separate denominational schools whose aim is to preserve and reinforce the religious identity of a subgroup in the population, whereas others support only one public school system (Sweet 1997). Apart from this religious pluralism, at the start of the twentieth century many educational services in Canada confronted diversity among students with a clear assimilation mission. By the end of the millennium, this had evolved into an anti-racist agenda.
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The Assimilation Mission During the first half of the twentieth century, ethnicity tended to be conceptualized as a temporary phenomenon. Acculturation models predicted that cultural and linguistic manifestations of ethnicity would be replaced with a mainstream national identity through schooling (Davidson 1996). In line with the national assimilation project of the period, many Canadian schools gave themselves the mandate of assimilating diverse students (Cummins 1996). In an historical review of educational services, Harper (1997) concluded that schools in Canada specifically intended to ensure conformity to a narrowly defined Canadian identity during this period. As most immigrants in Quebec were integrated into the English rather than the French school system before Bill 101 in 1977, this identity reflected Anglo-Saxon culture and Western European values (Harper 1997). Residential schools for Aboriginal children provide the most extreme examples of school services in Canada with an explicit and aggressive assimilation mission. As early education documents retrieved by Cummins (1996, p. 6) reveal, removal of children from the influence of their homes “for at least five years” was deemed to be “a necessary condition for their civilization.” Impact of Assimilation on Identities The effect of this assimilation mission on ethnic, racial, and Aboriginal identities was mixed. Sociological studies of ethnic persistence indicate that second generation members of some groups assimilated into the mainstream society as predicted; some retained an ethnic identity while participating in mainstream institutions, and some continued to live much of their lives within ethnic enclaves (Breton 1964; Herberg 1989). The long-term effects of the residential schools on the identities of Aboriginal students are still being reported (Royal Commission on Aboriginal Peoples 1996). Paulo Freire (1970) conceptualized this type of experience as a process of cultural invasion and Cummins (1996) argues that Aboriginal students internalized a negative personal identity as a result of this process. Universalism and Social Mobility Following the Second World War, theories of many educational reformers of the period reflected principles of universalism (Harper 1997). There was an increasing skepticism among them that ethnicity or cultural differences explained differences in academic performance (Curtis, Livingston, and Smaller 1992). Schools were to create a meritocracy with success based on individual ability, energy and motivation. Equality of opportunity for all students was prescribed and discriminatory practices condemned (Harper 1997). Impact of Universalism on Identities A cornerstone belief associated with principles of universalism linked school services to identity. This was the conviction that education offers people of different ethnocultural
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backgrounds a route to social mobility and to full participation in the mainstream society (Davidson 1996). Although some studies have found educational services have helped minority Canadians overcome disadvantage (Herberg 1990; Pineo and Porter 1985), recent research data suggest, however, that school services work better for members of some groups than for others. An analysis of 1991 census data revealed that although the educational level of many ethnic group members was at or above the national level, Black/Caribbean and Aboriginal groups ranked substantially below it (Lian and Mathews 1998). Similarly, a study of Portuguese Canadians also using 1991 census statistics as well as survey questionnaires and focus groups found that a disproportionate number of Portuguese-Canadian youth had dropped out of high school and significantly fewer than the general average had entered post-secondary education (Numes 1998). During the 1960s and 1970s, evidence in the United States that education was often more reproductive than transformative stimulated research into the reasons for group differences in academic achievement (Davidson 1996). Ogbu (1978) developed a macro-sociological theory linking historical experience of ethnocultural groups to group ideology and to identity. He argued that academic success seems futile to involuntary minorities with a history of oppression. They disengage and develop secondary cultural differences as markers of an oppositional identity to resist the mainstream society. In contrast, children from voluntary minorities, whose families have chosen to immigrate to the society, do not perceive adopting behaviours required for school success as a threat to their ethnocultural identity. They view them, instead, as additives to their ethnic identity (Ogbu 1992). Ogbu’s work has been used by scholars in Canada to explain group differences but recent studies of a voluntary minority in Montreal—second-generation, Haitian youth— suggest that they also construct oppositional identities (Potvin 1999). Despite having parents who are francophones, many young Haitians, a group who face racism, are bilingual and use English at school intentionally as a confrontational strategy in order to define a personal identity vis-à-vis teachers or other francophone youths (Laperrière et al. (1989-1991). Data collected in 1992-1993 reveal that many had developed ties with Montreal’s Black Anglophone youths, rejected the ethnic Haitian identity of their parents, and constructed instead, a pan-national Black identity defined in terms of an African diaspora. Promoting Cultural Pluralism During the 1970s and 1980s, a multicultural education movement emerged in support of the cultural pluralism envisioned in the national multiculturalism policy (Bruno-Jofré and Henley 1999; Harper 1997; Gamlin, Berndorff, Mitsopulos, and Demetriou 1994). Schools began to supplement their curriculums with information about the food, festivals, and folklore of various cultures (Kehoe and Mansfield 1993; Gamlin, Berdoff, Mitsopulos and Demetriou 1994). In Ontario, for example, the Ministry of Education revised its curriculum policy for Grades 1 to 6 to provide all children with the opportunity to retain an identity informed by the historical roots of their culture and to promote an
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appreciation of other ethnic and cultural groups (Ontario Ministry of Education 1977). The Quebec government developed a policy of interculturalism recognizing French as the language of public life, but affirming a respect for pluralism. In British Columbia, efforts were directed towards ESL programs and the teaching of non-official languages designated as heritage languages (Bruno-Jofré and Henley 1999). Heritage language programs expanded and increased in number throughout the late 1970s and 1980s in Alberta, Saskatchewan and Manitoba (Tavares 2000). The Atlantic provinces, the least heterogeneous region of Canada, took longer to do so but also introduced multicultural agendas in schools (Bruno-Jofré and Henley, 1999). The major thrust of the different initiatives in multicultural education was to provide support for cultural retention and to promote respect for cultural differences (Bruno-Jofré and Henley 1990; McLeod and Krugly-Smolska,1997; Harper 1997). Impact of Cultural Pluralism on Identities The contribution of multicultural education to identity during this period is difficult to assess as evaluation research was scarce. An extensive literature review by Gamlin, Berndorff, Mitsopulos and Demetriou (1994) revealed most publications about the topic were descriptive. Critiques, however, accumulated suggesting the impact on students’ identities was limited and in some cases may have been negative. Tator and Henry (1991), for example, described multicultural education as additive rather than integrative and questioned whether superficial information about cultures increased knowledge or understanding among students. Thomas (1987) challenged the underlying assumption that culture is a stable, unified and distinct object transmittable by anyone, even those lacking experience of the culture. Recently, Bruno-Jofré and Henley (1999) pointed out that proponents of multicultural education in the 1970s and early 1990s ignored the nationalist visions being put forward by Quebecers and by Aboriginal Canadians who defined themselves as nations rather than ethnocultural communities. Equity, Inclusion, and Anti-Racism Education By the end of the 1980s and during the 1990s, many schools were serving an increasingly diverse body of students, especially in Montreal, Toronto, and Vancouver. Between 1991 and 1996, for instance, Toronto received 42% of all immigrants to Canada. By 1996, the amalgamated City of Toronto had become home to almost 1,125,000 immigrants from over 169 countries of origin (Siemiatychi 1998). In response to these demographic changes, a new emphasis emerged in education around the issues of equity and inclusion, with equity being understood in the sense of a level playing field (Ng 1999; McLeod and Krugly-Smolska 1997). Attention shifted from affirming cultural differences among students to addressing differences in privilege and power. A number of scholars made a clear distinction between the notions of anti-racist education and multicultural education (Troyna 1987; Harper 1997; Dei 2000). They defined multicultural education as being concerned with creating a greater degree of tolerance among students through positive representations of diverse customs in school activities, textbooks, and the curriculum (Solomon and Rasky 1996). Arguing that race
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is a social construction used to perpetuate inequities, proponents of anti-racist education charged educators with the task of challenging this social construction in the classroom as well as other, intersecting forms of oppression stemming from sexism and classism. This movement incorporated both the universalism of Human Rights and an acknowledgment of the differences experienced by diverse groups. Dei (1993a) developed a theoretical anti-racist education framework for a transformative and inclusive curriculum. It emphasized power relations in schools and in society, highlighted the importance of students’ lived realities as a source of knowledge, and encouraged the exploration of the perspectives of different social groups in society. This framework called for open discussions in class of social inequities and the validation of the experiences of students, whatever their background. Provincial governments began developing policies to combat racism and discrimination in schools. In 1985, for instance, the Ontario government issued a policy on race relations. School boards were encouraged to develop appropriate policies and practices (Ontario Provincial Advisory Committee 1987). The provincial Education Act was amended in 1992 making it mandatory for all school boards in its jurisdiction to develop and implement an antiracism and ethnocultural equity policy (Ontario Ministry of Education and Training 1993). Unlike other areas of the country, the Halifax County Bedford District School Board adopted an anti-racist policy in response to the demands in 1989 of youth who belong to the indigenous Black community in Nova Scotia rather than to an immigrant community (Tider and Jones-Darrell 1993). Impact of Anti-Racism on Identities A substantial body of research supports arguments for anti-racist education in Canada. Studies document that visible minority students experience racism in schools throughout Canada regardless of the proportion of visible minorities in the area. For example, as noted earlier, young Haitians in Montreal face racism and social exclusion. Similarly, Dei (1994) found that Black/African-Canadian students in the Ontario public school system felt unconnected to the school system as a result of racism. Their parents were also deeply concerned about structural conditions in schools which discriminate against visible minority students (Dei 1993b). In a grounded theory study, Black students in two Edmonton high schools, an area with no real geographic concentration of Black/African Canadians, described themselves as highly visible and under the gaze of Whites in general and authority in particular (Kelly 1998). And a recent study of Black and Aboriginal adolescents in New Brunswick, a province with few visibly different students, revealed that they had confronted racially-based harassment from other students throughout their schooling but these incidents had consistently been ignored or dismissed by teachers and counselors (Baker, Varma, and Tanaka 2001). Studies have also supported arguments of the anti-racist education movement about the negative impact of racism and the need to discuss racism openly. A review of research, for instance, found a strong association between a child’s perceptions of teachers’ racial attitudes and the child’s perception of her or his value (The Scarborough
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Board of Education 1991). Although teachers have expressed concerns that talking about racism will increase the phenomenon (Tatum 1992), an experimental study by Aboud and Doyle (1998) showed children high in prejudice who discuss racial evaluations with less prejudiced children are likely to become less prejudiced. Findings regarding the actual effect of anti-racist educational policies in transforming identities are scarce. In addition, several studies suggest that there may be a gap between the policy and what happens in practice. For example, an extensive research project on children of Latin American immigrants, their teachers, and families in Toronto identified differences between policies valuing parent-teacher partnerships and the reality experienced by the parents of this study (Bernhard, Freire, Pacini-Ketchabaw and Vilanueva 1998). Parents were not involved in their children’s schools and felt teachers devalued their skills. They also felt placed outside the decision-making regarding their children’s education. A survey of the implementation of anti-racist education conducted among 1002 teachers from five school jurisdictions across Canada also found a discrepancy between policies and practice (Solomon and LevineRasky 1996). Most teachers agreed with the broad goals of anti-racist education but their support for the practice of it was 26.9% lower. Teachers’ concerns included their perception that anti-racist education threatens principles of meritocracy and individualism. One third viewed anti-racist education as a passing trend. Many perceived differences in language, religion, traditions and custom, especially those of new immigrants, to be a source of division. Provision of Health and Social Services In contrast to public schooling in Canada, health and social services are not provided in order to transmit or transform the identities of the nation’s citizens. Nevertheless, as noted earlier, access and utilization of health and social services are influenced by linguistic, ethnic and racial identities. The way services are delivered may be affected by and have consequences for such identities. Identity-related issues are also among the reasons people require health and social services. As with education, perspectives regarding the provision of health and social services to culturally diverse clients have reflected shifts in federal policies. Literature addressing this topic, however, was sparse until the 1980s. Health and social service providers were also slower than educators to respond to the Multiculturalism Policy (Tsang and George 1998; Masi 1988; Masi, Mensah, and McLeod 1993). Assimilation Biases and Vulnerabilities Before the 1970s, the limited literature on health and social services to diverse ethnocultural groups focused primarily on deficiencies or inferiorities to be corrected. They tended to reflect biases of the assimilation perspective (Tsang and George 1998; Casas 1985; Sue, Arredondon and McDavis 1992). Members of given racial or ethnic groups were variously identified as at risk for diseases (Padilla 1981), for deviant social behaviour (Rubingon and Weinberg 1971), and for social disorganization
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(Moyniham 1965). Immigrant status was also viewed as potentially pathological, placing the person at risk for mental health problems and for social maladjustment (Tsang and George 1998). Impact of Assimilation Biases and Vulnerabilities The deficiency-based perspectives have been discarded and there is no systematic research evaluating their effects on identity. The impact of immigration on health and adjustment, however, continues to be investigated without the implicit inferiority assumptions of the earlier work. As some findings in this body of work have implication for identities, it will be reviewed briefly. In 1988, The Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees concluded that immigrant status in itself is not a risk factor for mental health problems. However, if one of seven conditions is present, the immigrant is at an increased risk for a psychiatric disturbance. These include a drop in personal socioeconomic status following migration, the inability to speak the language of the host country, separation from family, lack of a friendly reception from the surrounding host population, lack of an ethnocultural community to provide support, a traumatic experience or prolonged stress prior to migration, and finally, migrating during adolescence or after age sixty-five. Later studies indicate that the prevalence of the socio-economic and linguistic risk factors identified by the Task Force diminishes after the initial resettlement period. Ten years following entry into Canada, immigrant incomes and employment levels were found to approximate those of the Canadian-born population (Beiser et al. 1997; De Voretz 1995). Similarly, an analysis of census data indicated that 90% of the foreign born population of Canada who spoke neither English nor French when they entered the country had acquired one of these languages by 1991 (deVries 1999). Despite these positive findings, immigrant women, immigrant children, refugees and victims of torture continue to be identified as vulnerable populations requiring additional social support. For example, a study of Canadian suicide mortality rates and trends (Strachan et al. 1990) showed that immigrant Canadian women have higher suicide rates than women born in Canada. Factors identified with the increased vulnerability of women immigrants compared with their male counterparts are linked to issues of culture and ethnic identity. These include a greater tendency than men to emigrate to accompany or rejoin a male relative, to be socially isolated, and to speak neither of the official languages (The Report of the Task Force on Mental Health Issues Affecting Immigrants and Refugees 1988). Analysis of census data support arguments regarding a linguistic disadvantage among immigrant women. 8% of foreign-born women compared with 4% of foreign-born men spoke neither English nor French in 1991 (deVries 1999). Immigrant children and youth are also considered vulnerable because of conditions impinging on identity. Stressors identified include intergenerational conflict due to differential rates of acculturation between parents and children (Gil and Vega 1992; Roy, Rhéaume, Hétu 1998), disruption in their education and social networks as a result
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of migration (Rumbaut 1991), and isolation from peers because of language barriers and racism (Dei 2000). Despite these stressors, a recent analysis of data from the National Longitudinal Survey of Children and Youth revealed that new immigrant children had lower rates of conduct disorders, hyperactivity, and emotional disorders than children in the national population even though 30% of their families were poor in comparison with 13.2% of the non-immigrant families (Beiser, Hou, Hyman, and Tousignant ,1998). Implicit and Explicit Universalism A second approach to ethnocultural diversity in the earlier literature was either to simply ignore it (Masi 1988), or to insist that all clients be treated equally and in the same way whatever their gender, culture, ethnicity or race (Cooper 1973; Tsang and George 1998). The former approach was manifested in curricula for health and social service professionals which, for the most part, provided very little information on ethnocultural and racial diversity until the end of the 1980s (Masi 1988; Tsang and George 1998; Canadian Task Force on Issues Affecting the Mental Health of Immigrants and Refugees 1988). Impact of Difference Denial on Identity Studies indicated that some implicit assumptions associated with this universalism were problematic. These include the assumptions that health and well-being are culture-free concepts (Anderson 1992), that service providers and clients are colour blind (Christensen,1995), and that ethnicity and race are irrelevant to clients’ reality (Griffith 1977; Proctor and Davis 1994). Intercultural counselling studies in the United States, for example, indicate that ethnicity, race and culture influence service providers’ interpretations, diagnoses and treatment (Arthur and Januskowski 2001; Pedersen 2001). Similarly, Bibeau and associates (1992) found that immigrant parents in Quebec have been unjustifiably referred to Youth Protection Services as a result of misunderstandings about cultural differences in child-care. The Canadian Task Force on the Mental Health Issues Affecting Immigrants and Refugees (1988) also concluded that racial stereotypes may bias client assessment and that a lack of understanding of patients’ culture may lead to misdiagnoses. Responding to Cultural Pluralism During the 1980s, the cultural diversity of health and social service consumers became increasingly evident to mainstream institutions in metropolitan centers. A movement calling for multicultural care was initiated in the early 1980s and gained momentum throughout the decade (Masi, Mensah, and McLeod 1993). Its impetus came primarily from front-line service providers and ethnocultural community leaders (Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees, 1988). From its inception, the concept of multicultural care included the notions of equity, nondiscrimination, and anti-racism (Masi, McLeod, and Mensah 1993). Nevertheless, as in
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education, the principal emphasis was initially on the culture of the clients’ being served. The problem areas most commonly singled out were differences in language and differences in beliefs, values and customs. Studies found the lack of cultural sensitivity and linguistic proficiency of service providers to be distressful for culturally diverse clients and significant barriers to service access (Canadian Task Force on the Mental Health Issues Affecting Immigrants and Refugees 1988). For example, the Chinese-Canadian respondents of a study conducted in Montreal perceived mainstream agencies to be unlikely to understand their problems and distrusted the service providers (Christensen 1987). Reports also indicated that the ad hoc use of untrained and unofficial translators resulted in poor quality interpretations and increased client distress (Masi 1988; Canadian Task Force on Mental Health Issues Affecting Immigrants and Refugees,1988; Canadian Council of Multicultural Health 1989). In response to language barriers, a number of programs were established to train cultural interpreters to act as sensitive brokers in interactions between professionals and culturally diverse clients (B.C. Multicultural Health Coalition 1989; Cairncross 1989). Agencies also began to translate their educational materials into some of the languages spoken by members of ethnocultural communities being served. Following a needs assessment, for example, the Vancouver-Burnaby Branch of the Canadian Mental Health Association had pamphlets on mental health issues translated for distribution to the Indo-Canadian, Chinese, and Latin-American populations (B.C. Multicultural Health Coalition 1989). The literature on multicultural care discussed the influence of culture on a wide range of behaviours such as dietary customs, rituals related to birth, terminal illness, and death, beliefs about health and illness, communication styles and non verbal cues, time orientation, folk medicines, family structure and gender roles, and world view (Leininger 1984; Henderson and Primeaux 1982; Kleinman 1989; Masi 1988). A number of mainstream institutions and service agencies developed policies and practices respecting some of these cultural differences among clients. For example, hospitals attempted to respect patients’ cultural or religious beliefs about food, such as vegetarianism, rituals related to death and dying, and customs surrounding childbirth. Information booklets listing beliefs, values, and customs of various cultures were developed as quick references to be consulted by service providers as needed. Service providers received cultural sensitivity training. Another response to the call for culturally and linguistically sensitive care was the alternative service approach discussed earlier in this paper, in which culturally specific organizations provide services to their own communities. For instance, Aboriginal service providers began developing programs designed specifically for Aboriginal clients. These programs incorporated a distinct Aboriginal world view as well as traditional healing approaches such as the healing circle and the healing lodge (Morissette, McKenzie, and Morissette, 1993). They often integrated empowerment objectives through the affirmation of Aboriginal identity. One example is the
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Ma Mawi Wi Chi Itata Centre, a family service agency in Winnipeg. This agency developed a model of social work practice incorporating four key principles: recognition of a distinct Aboriginal world view; the development of Aboriginal consciousness about the impact of colonialism; cultural knowledge and traditions as an active component of retaining aboriginal identity; and empowerment as a method of practice (Morissette, Mckenzie and Morissette 1993). Members of ethnocultural communities in metropolitan areas also set up ethno-specific services. An example was the Fong Hook Association (Fong Hook meaning health and happiness) in Toronto, which consisted of a group of Chinese professionals. In 1982, this Association obtained provincial funding to provide community mental health services to Chinese and Southeast Asians (Lo and Lee 1993). Impact of Cultural Sensitivity on Identities The impact of these various initiatives on identity was not systematically evaluated. Some institutions, however, evaluated services using patient satisfaction questionnaires and reported the feedback was positive (B.C. Multicultural Health Coalition 1989). Critics, however, described many of the programs in mainstream institutions as “cook book” responses based on the false assumption that culturally-diverse clients belong to stable entities and uniformly subscribe to easily identifiable sets of beliefs, values, and customs (Kleinman 1989; Matsuoka and Sorenson 1991). Problems identified included the lack of acknowledgment of the linguistic and ethnic differences of groups from the same country of origin or of the internal divisions of ethnic groups related to gender, class, political orientation, and in the case of immigrants, length of time in the host country. To illustrate some of these points, Matsuoka and Sorenson (1991) described divisions among immigrants and refugees from Ethiopia. Many Eritreans, for instance, vehemently rejected the imposition of an Ethiopian identity by service providers and expressed a mistrust of Amharic-speaking Ethiopians. Some parallel services appeared to have supported the retention of ethnic or Aboriginal identities by reinforcing culture as well as networks based on group membership (Christensen 1987). Others, however, may have reinforced intergroup conflicts by serving a group of communities who are divided for political, religious or linguistic reasons (Matsuoka and Sorenson 1991). A difficulty with this model has been the tenuous and inadequate funding coupled with difficulties finding qualified personnel (Jacob 1994; McNicoll and Christensen 1996). Parallel services may remove access barriers stemming from cultural insensitivity but introduce inequities in terms of the actual resources they are able to provide. Issues of Equity and Inclusiveness In the last decade or so, the emphasis in the literature on services to ethnocultural communities has revolved around the issues of equity and inclusiveness. There has been an interdisciplinary quest to develop an inclusive science for cross-cultural counselling (Pederson 2001). An anti-racist movement is emerging in the social work
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field and racism has begun to be studied as a determinant of health. At the organizational level, service models involving partnerships between mainstream agencies and ethnocultural communities have been implemented (Seebaran 2000). The search for more inclusive approaches to counselling began in the United States in the 1980s. Green (1982) presented a model of ethnic competence defined as the ability “to conduct one’s professional work in a way that is congruent with the behaviour and expectations that members of a distinctive culture recognize as appropriate among themselves” (p. 52). The concept involved counsellor awareness of her or his own cultural limitations, openness to cultural differences, a client-oriented, learning approach, appropriate use of cultural resources, and a respect for other people’s culture. A variety of models of cultural competence was subsequently developed in counselling, nursing, social work and psychology. Cross and associates (1989), for instance, extended the notion of cultural competence to include the service agency, or organization as well as the service providers. Sue, Arredondo, and McDavis (1992) provide a framework of cultural competence for psychologists involving cultural selfawareness, understanding of the world view of the culturally different client; and culturally appropriate intervention strategies and techniques. Dyche and Zayam (1995) criticized the expectation in the cultural competence concept that counsellors can become knowledgeable about the particular cultural system internalized by every client encountered (Tsang and George 1998). To counter this difficulty, they proposed a more experiential and phenomenological approach to cross-cultural counselling in which the counsellor learns from the client (Dyche and Zayas 1995). There has been a recent increase in the attention given to racism as a barrier to equitable services. As in education, some social workers and academics have advocated an anti-racist approach as an alternative to multiculturalism (Christensen 1995; James 1996). They argue for interventions that attend to racial experiences, intersecting oppressions, empowerment and the development of critical consciousness. Tsang and George (1998), for example, have proposed a cross-cultural counselling model which is explicitly committed to an anti-discriminatory and antioppression position. At the organizational level, bridging models rather than separate, ethno-specific services have been developed in order to address issues of equity and inclusiveness. They involve partnerships between mainstream agencies and members of ethnocultural communities. Their goal is to facilitate access to mainstream resources and at the same time, provide culturally congruent services to diverse clients (Matsuoka and Sorenson 1991; McNicoll and Christensen 1991). For example, the settlement counsellors of the Surrey Delta Immigrant Service Society (who are members of ethnocultural communities and speak both English and the language of the community) work in collaboration with the family therapists of the White Rock Family Therapy Institute. The settlement counsellors provide counselling and consult with family therapists through case reviews. They also act as co-therapist in family therapy in the role of cultural consultant (Grant, Henley, and Kean 2001).
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Impact of Models of Inclusiveness on Identities Little systematic research has evaluated or compared the effect of the various crosscultural counselling models on outcomes. Moreover, their overall impact on service provision has not been assessed (Tsang and George 1998). Studies, however, continue to find cultural differences are barriers in actual practice situations despite the existence of cross-cultural counselling models. For example, Stephenson (1995) identified problematic interpretations of patient symptoms to be a major barrier to appropriate care for Vietnamese refugees in Victoria. Similarly, a study of group homes serving immigrant youth in Montreal, revealed that the service providers did not use an intercultural approach in their interventions with the young immigrants. Surprisingly, many had adopted an acultural stance despite the significant role cultural conflict had played in the youths’ difficulties (Roy, Rhéaume, and Hétu 1998). Aboriginal clients’ perceptions of encounters with mainstream service providers support arguments for the integration of anti-racism and anti-oppression components in crosscultural counselling models. In several qualitative studies of interactions between Aboriginal clients and mainstream health care institutions, negative caregiver stereotypes and power imbalances were significant issues (Browne 1995; Baker and Cormier-Daigle 2000; Browne, Fiske and Thomas 2001). Health researchers have also begun to assess the effects of racism on identity, health and well-being. In this literature, perceived racism or discrimination is treated as a stressor and is studied using the transactional theory of stress and coping. This stress paradigm centers on transactions between the individual and her or his social environment (Harrell 2000). Findings support the hypothesis that perceived racism jeopardizes the physical and mental health of ethno-racial minority group members (Harrell 2000; Rollock and Gordon 2000; Beiser, Kaspar, Hou, and Rummens 1999). Qualitative studies of the experience of racial discrimination have also demonstrated its negative impact on the victims’ sense of self and identity (Essed 1991; Baker, Varma and Tanaka 2001). In the transactional model of stress, coping with stressors includes both instrumental responses to alter the problem or palliative regulation of one’s emotional response to the stressor (Lazarus 1980). A recent study among Southeast Asian refugees in Canada investigated the interaction of coping style with ethnic identity in moderating risk for depression associated with perceived discrimination. Responding with forbearance, an emotionally focused coping strategy that is consistent with cultural values in this community, diminished the strength of the association between depression and perceived racism. This positive effect was significantly greater among those with stronger attachments to the ethnic community and was ineffective for those who no longer identified with traditional ethnic values and practices (Beiser, Kaspar, Hou and Rummens 1999). Social support is a significant stress buffering factor. Little is known, however, about how best to provide ethnic-specific social support to individuals who have experienced
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racism. The need for further research in this area was illustrated in a grounded theory study of the contexts for managing depression among Black West Indian Canadian women, all of whom had experienced racism (Schreiber, Stern, and Wilson 1998). One problem identified in this study was the paucity of literature available to assist nurses and other care providers to meet the needs of these women. Although the research is limited, evaluations of bridging models have been positive (McNicoll and Christensen 1001; Grant, Henley, and Kean 2001). For instance, an external qualitative evaluation of the family therapy program was conducted in 1997 involving clients from four different ethnic groups. The combination of cultural congruence and counselling competence was identified as the major strength of the model. In addition, in 1998, 59% of the clients served were self-referred members of ethno-cultural communities. Research and Policy The literature reviewed in education, health and social services has policy and research implications for the three common issues facing representative institutions discussed at the outset of this paper. Notwithstanding a multitude of intercultural and anti-racist policies and practice models, consumer under-representation continues to be an issue in these domains. Studies indicate that for some Canadians, race, religion, ethnicity, and language are barriers to access and to effective utilization of the public services available to them in these fields. A contributing factor identified in some studies was a gap between the policies adopted by an institution and the actual practices of service providers. Further research needs to be conducted examining the factors impeding or facilitating the implementation of prescribed practice models by front-line service workers. Mainstream service providers also need more knowledge about responding to individuals who have experienced discrimination and racism. At the policy level, continued public awareness campaigns are important in order to foster a general climate that is conducive to the uptake by service providers of multicultural and antiracist policies. Similarly, existing efforts to ensure adequate content on diversity in the curricula of professional schools in the education, health, and social services fields needs to be sustained. Additional research is necessary on the access and utilization barriers from the point of view of disadvantaged minority groups to develop future policy agendas. The limited data available on this indicate that minority groups may perceive the services being delivered quite differently from the way they are perceived by the providers in mainstream institutions. Moreover, many of the current initiatives adopted by institutions to remove access or utilization barriers have been based more on conviction or anecdotal evidence than on systematic evaluation of the needs of specific minority groups. In addition to needs assessments, participatory action research would be a useful vehicle for ensuring a good fit between an institution’s practices and the needs of specific minority communities.
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As far as the second issue of alternative services is concerned, the literature in education, health and social services provides descriptions of a variety of models of minority matching and of culturally specific alternative services. There is insufficient evidence available, however, to inform the policy question of whether or not societies should try to match the ethnocultural identities of professionals providing services to a community with the identities of those receiving it. Similarly, there has been little systematic evaluation of services offered in parallel organizations in terms of outcomes. Although findings of studies of bridging models are encouraging, additional research is necessary to assess the immediate and long term advantages and disadvantages of this type of model before developing policy agendas fostering this approach. Finally, the major emphasis of both contemporary and past literature on service provisions to a diverse population in the areas reviewed has concerned the third issue of the sensitivity of mainstream institutions to differences. Acknowledgement, recognition, and respect of diverse identities are central in the current approaches to cultural competence or anti-racism being recommended. Existing practice models, however, do not address the questions about which and how many cultural and linguistic specificities can be accommodated by mainstream institution. There is also insufficient evidence regarding their impact on outcomes. Studies need to assess the effects of different approaches on the identities of individuals from different ethnocultural backgrounds, living in areas with differing degrees of ethnocultural diversity, and in different regions of the country. In summary, research has demonstrated that racism jeopardizes the health of those who experience it and continues to compromise access to and effective utilization of public institutions. Ethno-cultural differences also create barriers to services. Existing knowledge in education, health, and social services supports the need for the current policy goals of the Multiculturalism Program to combat discrimination and racism and to enable marginalized people to influence public institutions to eliminate systemic barriers preventing them from responding to and reflecting Canada’s diversity. Institutional policies and practice models have been adopted to reduce these disadvantages but evaluation research on outcomes is limited. Further research is necessary on the prevention of discrimination and racism in the provision of services. Additional research is also necessary on appropriate interventions by service providers when clients suffer negative health consequences as a result of racism.
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