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A Cross-National Comparative Perspective on Racial Inequities in Health: The United States versus Canada
  1. Arjumand Siddiqi1,
  2. Quynh C Nguyen2
  1. 1 Dept of Health Behavior & Health Education, UNC Gillings School of Global Public Health, Chapel Hill, United States;
  2. 2 Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, United States
  1. E-mail: asiddiqi{at}


Background: Cross-national comparisons allow the examination of the malleability of associations between race and health. We compared racial inequities in chronic conditions, indicators of health status, and behavioral risk factors between two similar advanced capitalist countries. We hypothesized that racial inequities will be mitigated in Canada compared to the United States.

Methods: Population-based, cross-sectional data from 2002-2003 Joint Canada-United States Survey of Health (JCUSH) with 4953 adult respondents from the United States and 3455 from Canada. Models adjusted for age, sex, foreign-birth, marital status, health insurance, education, income, and home ownership.

Results: Compared to the United States, racial inequities in health were attenuated in Canada. In the US, 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 whites and nonwhites 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 whites and American nonwhites have higher adjusted odds of hypertension, diabetes, and obesity, compared to Canadian whites and Canadian nonwhites respectively. Self-rated health was worse for nonwhite Americans compared to nonwhite 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.

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