Adam Kassam is a Toronto-based rehabilitation physician who writes about health care, public policy and international affairs.
It feels remarkable to say that this now feels routine, given how rarely it was said in the past, but there is increasing and real awareness about this crucial fact: Mental health struggles are universal. It’s become a flashpoint for advocacy, and in the North American context, society has grown more accepting about mental illness and how it has a basis in organic, biological disease. This perspective has allowed people with mental health problems to make themselves more visible and more heard, which has in turn led to more investment and infrastructure development.
This is all good. But as the global health-care community continues to learn about the ways in which disease affects the human condition, it’s becoming evident there is a diversity of experience within different patient populations. It has been well documented that ethnic variation between people dictates to some degree how susceptible individuals are to the type and severity of illness.
Progress on varied approaches to medicine is long overdue. So it’s heartening to see Toronto’s Centre for Addiction and Mental Health’s (CAMH) recent announcement that it will spearhead the development of a specialized psychotherapy program for Canadians of South Asian descent.
This specific additional support for the South Asian community is part of a broader growth in understanding of its unique general-health needs.
South Asians are known to have a higher risk profile for cardiac disease than the general North American population, and a recent study named MASALA, by researchers at Stanford and Northwestern University, demonstrated that this community is more prone to high blood pressure, elevated cholesterol levels and diabetes, even when at lower body weights.
This unorthodox paradigm led to the novel inclusion of ethnicity as a risk factor for cholesterol guidelines developed by the American Heart Association. And so for the first time, a crucial element of a patient’s personal and family history – their race – will be factored into how doctors screen for and treat cardiac disease.
It is important to recognize that this epidemiological blind spot was built on a foundation of limited medical research conducted on minority populations, because most of the institutions and allocated funding have traditionally focused on the Caucasian population.
Complicating matters is the overlay of cultural considerations for these populations. Not only does one’s genetic code affect disease prevalence and penetration, but the interpretation of disease through the lens of specific customs and traditions will alter how receptive patients are to the potential benefits of Western medicine and treatment.
The CAMH initiative, then, is especially noteworthy. Its goal of adapting cognitive-behavior therapy in a way that is culturally sensitive – led and administered by South Asian professionals – is an admiringly ambitious shift in mindset. It should be noted that it builds on previously successful adaptations of Western therapies to other racialized communities.
In this way, Canada has a unique opportunity to become a world leader in what is rapidly becoming a culturally bespoke approach to health-care delivery. By leveraging the breadth of diversity in our country and empowering the lived experience of minority groups, Canada could be the global model for inclusive health care.
But in order to accomplish this, our nation needs to be more bold with its road map for success. This means giving individuals from a diverse array of backgrounds a seat at the table so that their voices are heard. It means being unapologetic about collecting diversity data and implementing strategies, including legislation, to promote and encourage visibility for these under-represented communities at the most important levels of decision-making.
The growth in precision medicine as an industry does not come without potential drawbacks. Most concerning is the possible risk of deepening existing disparities in access to health-care resources. And without careful regulation, the cost of newly tailored treatments might also price would-be patients out of the market, thereby perpetuating a system of haves and have-nots.
Ultimately, at a time of rapid acceleration in personalized health care, a collaborative approach between patients, health-care professionals, industry and lawmakers will be necessary to create sustainable progress that is reflective of our diverse society.
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