Black adults in Canada are more likely not to fill prescriptions because of financial constraints than white adults, according to a new study that highlights disparities in prescription medication coverage as a major barrier to equitable health care.
The study was published in the Canadian Medical Association Journal on Monday. Its authors concluded that the prevalence of cost-related prescription non-adherence – defined as the inability to fill a prescription or delaying, splitting or skipping doses because of financial pressures – was 75 per cent higher among Black adults than white adults.
Coverage for prescription medications was also lower among Black adults, the study showed. In 2022, for example, 72.5 per cent of Black adults were covered compared with 80 per cent of white adults.
One of the study’s authors, Oluwabukola Salami, a Canada Research Chair in Black and racialized peoples’ health at the Cumming School of Medicine at the University of Calgary, said this study is the first of its kind and broadens the understanding of how Black Canadians experience health inequities.
“We know that Black people are more likely to have cardiovascular disease, to have certain types of cancer and to die from any of these conditions. But we always looked at how access to care is a challenge to Black people,” Dr. Salami said.
“This study presents new findings related to medication specifically.”
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It is well documented that Black people in Canada experience significant health disparities, such as higher rates of diabetes, hypertension and HIV/AIDS mortality, the study notes. Health care access is also hindered by such barriers as racism and discrimination, geographic and financial limitations and a mistrust of providers.
Some provinces are collecting voluntary race and ethnicity-based health data to help address such inequalities. Prince Edward Island is the latest province to do so, after Nova Scotia and Manitoba, and said it will lead to a better understanding of health outcomes, gaps in care and how to improve services.
The new research showed that the annual prevalence of cost-related prescription non-adherence ranged from 15.3 per cent in 2015 to 9.5 per cent in 2022 for Black adults, compared with 6 per cent and 5.5 per cent, respectively, among white adults.
The study interpreted data from five cycles of the Canadian Community Health Survey from 2015 to 2022. The survey is conducted by Statistics Canada and collects information on health status, health care use and determinants of health.
“Although factors such as education, income, chronic conditions, health perceptions and insurance coverage partially mediated this association, Black racial or cultural background remained independently associated with a higher prevalence of cost-related prescription nonadherence,” the authors concluded.
“Furthermore, having insurance coverage significantly reduced the prevalence of cost-related prescription nonadherence among both Black and White adults.”
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They said additional research is needed to explore the underlying factors contributing to the disparities, as well as possible interventions.
Dr. Salami said the study is also significant in the context of the Pharmacare Act, which was passed into law in October, 2024, under Justin Trudeau’s Liberal government. She said equity must be considered with any pharmacare policies in Canada.
Pharmacare is a publicly funded insurance program for medications, including for diabetes and contraception. The federal government has entered into agreements with British Columbia, Manitoba, Prince Edward Island and Yukon. It is unclear whether the Liberals under Mark Carney are planning additional agreements.
Roughly 80 per cent of Canadians are not covered by the existing pharmacare agreements.
Dr. Salami said Canada must alter its approach to drug coverage to appropriately address inequities in health outcomes, the burden of disease and time lost because of non-productivity. She said the long-term effects of policy changes should also be tracked.
“We need universal prescription drug coverage that is not based on who can afford what, but based on need,” she said. “Even though pharmacare does not currently include all or most medications, we need to move toward that universal coverage.”
Dr. Salami added that attention must also be paid to systemic racism in employment and how that affects health insurance coverage.