Fostering Healthy Sight in Canada: Focus on Culturally Diverse Groups

CONSENSUS FROM ROUNDTABLE

CONTRIBUTORS

Vi Tu Banh, O.D. Trevor Ludski, B.A., M.Ed. Uxbridge, ON Markham, ON

Michael Kaplan, O.D. Richard Winn, Optician Toronto, ON Yellowknife, NT

Upen Kawale, O.D. Wael Yassein, Optician Toronto, ON Oshawa, ON

Overview Understanding Diverse Ethnic minorities in Canada are quickly becoming the During discussion, participants identified several Populations in Canada The majority of South Asians live in Ontario or British majority. In fact, by the year 2031, visible minorities strategies for overcoming challenges, including treating This section overviews the content presented during 1 Columbia, specifically the Toronto and Vancouver areas. alone will make up 32 percent of all Canadians. As the each patient as a person rather than as a minority; individual presentations. face of the nation continues to change, more eyecare showing respect for individual cultures; increasing From 2001 to 2031, the South Asian population in Toronto is expected to climb from 11 to 24 percent. professionals are experiencing a culturally diverse patient cultural sensitivity through staff training; and creating FOCUS ON ASIAN CANADIANS: base with unique vision care and communication needs. a welcoming environment by hiring a multilingual Spotlight on Chinese and South Asian Populations staff or by making available multilingual or Chinese Canadians1 Chinese Canadians are a close second to the South Seeking to provide insights for eyecare professionals in-language materials. A Growing Demographic Asian population in terms of current numbers – but not and to help guide its multicultural efforts in Canada, Asian Canadians make up the largest demographic in growth. Today, they make up 24 percent of Canada’s Transitions Optical, Inc. brought together a panel of Participants also identified a need for all eyecare group in Canada – comprising 66 percent of the country’s visible minority population and close to 4 percent of experts for a roundtable discussion on May 3, 2010, professionals to become more “culturally aware”– taking visible minority population and 11 percent of the in Toronto, Ontario – where more than 63 percent of the time to understand the health needs and risks for each overall population.2 residents are expected to belong to a visible minority by demographic, as well as where their patients are coming % of Canada’s 1 Asian Canadian 2031. During the event, participants identified the needs from and how to improve communication. Participants In 2006, 2.5 million Canadians reported being of Asian Visible Minority Subgroups of the country’s largest ethnic minority populations, expressed a need for increased diversity among optical ethnicity. By 2031, this number is expected to reach Population and explored strategies for delivering more culturally professionals, and stressed the importance of promoting 1 a staggering 7.1 million – making targeting Asian South Asians 24.9% appropriate vision care. cultural sensitivity training in the workplace. Canadians a smart business consideration for Chinese 24.0% eyecare professionals. The roundtable featured in-depth presentations on the This consensus paper overviews the content presented Filipinos 8.1% eye- and overall-health needs, along with cultural and during the roundtable and captures subsequent Southeast Asians 4.7% linguistic considerations, for three demographic groups: discussions. After reading this consensus paper, you will Koreans 2.8% Asian Canadians (with a focus on Chinese and South have a better understanding of: Japanese 1.6% Asian populations), African Canadians and Aboriginal peoples (including First Nations, Métis and Inuit 1. The eye health- and communication-needs Source: Statistics Canada, 2006 populations). Under Canada’s Employment Equity Act, of the largest demographic groups in Canada, Asian Canadians and African Canadians are considered including Asian Canadians, African Canadians The spending power of Chinese visible minorities. While the Aboriginal population is and Aboriginal populations. not considered a visible minority, this group is large and South Asian Canadians and growing. 2. Strategies for promoting culturally appropriate vision care within your own practice. exceeds $40 billion per year. Presentations were delivered by eyecare professionals with experience serving these three demographics in Canada’s overall population. The Chinese subgroup is expected to grow in size from 1.2 million to between 2.4 their practice. The roundtable was also attended by an By 2031… education consultant and former school superintendent, and 3.0 million by 2031 – making up - Visible minority groups will comprise 63% who provided insights into educational priorities and 21 percent of the visible minority of the population in Toronto; 59% in Vancouver; strategies for reaching ethnic children and their parents population. and 31% in Montreal. about the importance of regular vision care and the - Half of Canada’s visible minority population proper eyewear options to protect and enhance The term “Asian Canadian” is broad, and encompasses This anticipated decline will be Asian Canadian. their vision. several different subgroups. The two largest are the from 24 to 21 percent is - The African Canadian population will South Asians and Chinese. Other groups include Filipinos, attributed to low fertility double in size. Participants addressed the numerous challenges faced Southeast Asians (including Vietnamese, Cambodian, rates among Chinese - Nearly half of Canadians 15 and older will by specific groups to receive quality vision care and Malaysian and Laotian), Koreans and Japanese. women, along with be foreign-born, or will have at least one vision wear. The most significant and consistent challenge higher emigration foreign-born parent. 1 identified was the higher incidence of eye and systemic South Asians rates. Despite this, the - Up to 32% of Canadians will have a mother diseases among these groups, paired with their lower South Asians – including East Indian, Pakistani and Sri Chinese population tongue other than English or French. awareness of the need for preventative care. Unique Lankan populations – make up 25 percent of Canada’s will remain large over cultural characteristics and barriers to receiving adequate visible minority population and 4 percent of Canada’s the next several decades care were also addressed for each population. overall population. In 2006, this group numbered 1.3 and will continue million, and by 2031, it will number between 3.2 and 4.1 to make up a million – or 28 percent of the visible minority population. significant

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2 3 patient base for Cataract4 Signs of diabetes can often be seen in the eye, even Canadian eyecare Asian Canadians are before symptoms occur. Because of this, the eye doctor professionals. more likely to develop Did You Know? is often the first health professional to detect the disease. This reinforces the importance of regular eye exams for cataract than the > Cumulative UV exposure can lead to the Similar to South general population. this group, or anyone at risk. development of sight-stealing diseases like Asians, the majority of Cataracts are more Chinese Canadians live common with age, cataract and age-related macular degeneration. Hypertension in Ontario or British and it is believed that Photochromic Transitions® lenses block South Asians are three times more likely than the general Columbia. In 2001, cumulative exposure population to develop hypertension – and are more likely 100 percent of UVA and UVB rays – helping to 9 82 percent of those to UV radiation is a to get it at an earlier age. reporting Chinese origin risk factor in their protect the eyes, while adapting to changing lived in one of these development – light to allow patients to see more clearly and Hypertension – or high blood pressure – can sometimes be detected through an eye exam. Untreated, it can lead two provinces. By 2031, making UV-blocking comfortably, all day, every day. the Chinese population eyewear an important in Vancouver alone is consideration for expected to climb this group. from 18 to 23 percent. corrected with eyewear, people with myopia are three 7 times more likely to develop glaucoma – reinforcing the The emergent Asian Canadian population represents a Age-Related Macular Degeneration (AMD)5 importance of regular eye exams. significant opportunity for eyecare professionals to grow Prevalence of AMD among Chinese Canadians is twice as their practices. Today, the spending power of Chinese and high as the overall population, and is a leading cause of OVERALL HEALTH ISSUES South Asian consumers in Canada exceeds $40 billion. severe vision loss for people over the age of 50. AMD has There are many systemic diseases affecting the Asian In the Toronto area alone – where South Asian consumers a strong genetic link, and smokers have up to four times Canadian population, which could have implications have formed a significant market segment – purchasing the risk for developing it. The progression of AMD, like for vision. power is nearly $10 billion.3 cataract, has also been linked to cumulative UV exposure.

It is also important to recognize that the South Closed-Angle Glaucoma5 Asian and Chinese populations are younger than Asian Canadians are more likely to develop the Canadian average, thus representing closed-angle glaucoma, which is the second a growth opportunity for the future. leading cause of blindness among Canadians. More than 250,000 Canadians have some EYE HEALTH ISSUES form of glaucoma, but only half are aware Considering the growing impact of the Asian they have it. Canadian population, it is important to be aware that this group is at heightened risk for several Myopia eye diseases and issues. Asian Canadians are much more likely to be nearsighted than the general population – with prevalence of myopia reaching 90 percent.6 Myopia also affects As many as Asian populations at a younger age. Chinese Canadian Diabetes 90% of Asian children at the age of Diabetes can lead to serious complications throughout 6, for example, have a the body and eye, including diabetic retinopathy. Asian Canadians are prevalence rate of 22.4 Canadians are at higher risk for developing both diabetes percent, compared to a and diabetic retinopathy, and Chinese Canadians may 5 affected by rate of 6.4 percent for have twice the rate of diabetic retinopathy than whites. non-Chinese Canadian Because weight is a risk factor for developing diabetes – myopia. children.5 While myopia and Asian Canadians are less likely to be obese than is not vision-threatening the general population – doctors may be late in 8 and can often be diagnosing it.

5 4 patient base for Cataract4 Signs of diabetes can often be seen in the eye, even Canadian eyecare Asian Canadians are before symptoms occur. Because of this, the eye doctor professionals. more likely to develop Did You Know? is often the first health professional to detect the disease. This reinforces the importance of regular eye exams for cataract than the > Cumulative UV exposure can lead to the Similar to South general population. this group, or anyone at risk. development of sight-stealing diseases like Asians, the majority of Cataracts are more Chinese Canadians live common with age, cataract and age-related macular degeneration. Hypertension in Ontario or British and it is believed that Photochromic Transitions® lenses block South Asians are three times more likely than the general Columbia. In 2001, cumulative exposure population to develop hypertension – and are more likely 100 percent of UVA and UVB rays – helping to 9 82 percent of those to UV radiation is a to get it at an earlier age. reporting Chinese origin risk factor in their protect the eyes, while adapting to changing lived in one of these development – light to allow patients to see more clearly and Hypertension – or high blood pressure – can sometimes be detected through an eye exam. Untreated, it can lead two provinces. By 2031, making UV-blocking comfortably, all day, every day. the Chinese population eyewear an important in Vancouver alone is consideration for expected to climb this group. from 18 to 23 percent. corrected with eyewear, people with myopia are three 7 times more likely to develop glaucoma – reinforcing the The emergent Asian Canadian population represents a Age-Related Macular Degeneration (AMD)5 importance of regular eye exams. significant opportunity for eyecare professionals to grow Prevalence of AMD among Chinese Canadians is twice as their practices. Today, the spending power of Chinese and high as the overall population, and is a leading cause of OVERALL HEALTH ISSUES South Asian consumers in Canada exceeds $40 billion. severe vision loss for people over the age of 50. AMD has There are many systemic diseases affecting the Asian In the Toronto area alone – where South Asian consumers a strong genetic link, and smokers have up to four times Canadian population, which could have implications have formed a significant market segment – purchasing the risk for developing it. The progression of AMD, like for vision. power is nearly $10 billion.3 cataract, has also been linked to cumulative UV exposure.

5 4 to hypertensive retinopathy, which causes blurry vision Understanding and being sensitive to unique cultural TIPS FOR YOUR PRACTICE: and can eventually lead to blindness. Research shows characteristics is a good practice builder for eyecare FOCUS ON ASIAN CANADIANS that the longer Asian immigrants live in North America, professionals. While most Asian Canadians feel a sense of As Presented by the Roundtable Participants the more likely they are to have high blood pressure – belonging to Canada, approximately 60 percent say they reinforcing the importance of preventative care.10 still identify with their own ethnic group. ••Offer bilingual or in-language materials. Even if a patient speaks fluent English or Tuberculosis11 LANGUAGE French, he or she may feel more comfortable The number of cases of tuberculosis – or TB – has Language is a core aspect of any group’s culture – and speaking or reading materials in another increased globally since the mid-1980s. Prevalence is important to consider because of the increased language. By hiring a bilingual staff, or simply among Asian Canadians is significantly higher than the opportunities it can present for eyecare professionals to offering in-language materials in the top general population. Over time, TB can lead to serious connect with and educate patients. Consider this: upon Asian Canadian languages spoken, eyecare infections in the eye, including ocular tuberculosis. arrival to Canada, 42 percent of immigrants speak neither professionals can improve communication and English nor French.13 show respect for individual cultures. ACCULTURATION12 in new, larger homes, resulting in higher household Asian Canadians make up a diverse population comprised expenditures. ••Be inclusive of family members. Some of of many generations, and therefore have varied levels of 85% of Chinese and 65% your Asian Canadian patients may bring family acculturation. Differences in cultural values and potential of South Asians speak another >TIP: Eyecare professionals can expand their patient members with them to their appointments. language barriers may vary depending on how long a base by encouraging their Asian Canadian patients to Make a point to include them in the exam or person has lived in the country. language at home. schedule appointments for all family members. decision-making process, if they’re interested. Don’t forget to encourage all members of the The majority of Asian Canadians are foreign-born – and Education12 family to set up appointments. most immigrants arrived in Canada over the past decade. While most Asian Canadians speak at least one of Many Asian Canadians take pride in their academic In 2001, approximately 70 percent of Chinese and South Canada’s official languages, many have a mother tongue achievements, and tend to seek higher levels of ••Be respectful of personal space and Asian Canadians were born outside of Canada, compared other than English or French and speak another language education. This is often encouraged by parents, and doing privacy. Understand how cultural values may to 18 percent of all Canadians. The most common at home. In fact, Chinese is the third largest mother well professionally is seen as a great accomplishment. impact how you conduct an exam or fitting. For countries of origin for Chinese Canadians include China, tongue in Canada.14 example, some Asian Canadian women may Hong Kong and Taiwan. More than 25 percent of Chinese and South Asian prefer not to make direct eye contact with their Chinese Canadians14 Canadians have a university degree, compared with 15 physician – or some may want to try frames on While 85 percent can converse in either English or French, percent of the general Canadian population. While South for themselves rather than have the eyecare the same percentage speaks another language at home. Asian men are more likely than their counterparts to professional place the frames on them. In most cases, the language is Cantonese or Mandarin. receive higher levels of education, South Asian women are still more likely than other Canadian women to have a 15 South Asian Canadians university degree. Men and women of Chinese origin are Religion12 Approximately 93 percent can converse in English or equally likely to attend school full-time. Canadians of South Asian origin are more religious French, but 65 percent have another mother tongue. than the general population. They are almost equally The most common languages spoken by South Asian >TIP: Considering the value placed on education, eyecare divided among the Sikh (28 percent), Hindu (28 percent) Canadians are Punjabi (29 percent); Tamil (10 percent); professionals should mention the link between healthy and Muslim (22 percent) faiths. Another 16 percent Urdu (9 percent); Gujurati (6 percent); Hindi (6 percent); vision and school performance, especially for children. are Christian, and just 4 percent report no and Bengali (3 percent). For example, correcting problems, like religious affiliation. myopia, early on can positively CULTURAL VALUES impact school On the other hand, more than half of Chinese In order to better serve your Asian Canadian patients, performance. Canadians report no religious affiliation. it is important to understand their unique cultural values The most commonly practiced and virtues. religions include Buddhism, Catholicism and Protestantism. Family12 For many Asian Canadians, family is the central focus >TIP: It is helpful for eyecare of life. They are more likely to marry than the general professionals to understand that population, and less likely to live alone. South Asians different religious beliefs may in Canada are also more likely to live in multi-family affect a patient’s behavior or multi-generational households. They tend to live or values.

6 7 to hypertensive retinopathy, which causes blurry vision Understanding and being sensitive to unique cultural TIPS FOR YOUR PRACTICE: and can eventually lead to blindness. Research shows characteristics is a good practice builder for eyecare FOCUS ON ASIAN CANADIANS that the longer Asian immigrants live in North America, professionals. While most Asian Canadians feel a sense of As Presented by the Roundtable Participants the more likely they are to have high blood pressure – belonging to Canada, approximately 60 percent say they reinforcing the importance of preventative care.10 still identify with their own ethnic group. ••Offer bilingual or in-language materials. Even if a patient speaks fluent English or Tuberculosis11 LANGUAGE French, he or she may feel more comfortable The number of cases of tuberculosis – or TB – has Language is a core aspect of any group’s culture – and speaking or reading materials in another increased globally since the mid-1980s. Prevalence is important to consider because of the increased language. By hiring a bilingual staff, or simply among Asian Canadians is significantly higher than the opportunities it can present for eyecare professionals to offering in-language materials in the top general population. Over time, TB can lead to serious connect with and educate patients. Consider this: upon Asian Canadian languages spoken, eyecare infections in the eye, including ocular tuberculosis. arrival to Canada, 42 percent of immigrants speak neither professionals can improve communication and English nor French.13 show respect for individual cultures. ACCULTURATION12 in new, larger homes, resulting in higher household Asian Canadians make up a diverse population comprised expenditures. ••Be inclusive of family members. Some of of many generations, and therefore have varied levels of 85% of Chinese and 65% your Asian Canadian patients may bring family acculturation. Differences in cultural values and potential of South Asians speak another >TIP: Eyecare professionals can expand their patient members with them to their appointments. language barriers may vary depending on how long a base by encouraging their Asian Canadian patients to Make a point to include them in the exam or person has lived in the country. language at home. schedule appointments for all family members. decision-making process, if they’re interested. Don’t forget to encourage all members of the The majority of Asian Canadians are foreign-born – and Education12 family to set up appointments. most immigrants arrived in Canada over the past decade. While most Asian Canadians speak at least one of Many Asian Canadians take pride in their academic In 2001, approximately 70 percent of Chinese and South Canada’s official languages, many have a mother tongue achievements, and tend to seek higher levels of ••Be respectful of personal space and Asian Canadians were born outside of Canada, compared other than English or French and speak another language education. This is often encouraged by parents, and doing privacy. Understand how cultural values may to 18 percent of all Canadians. The most common at home. In fact, Chinese is the third largest mother well professionally is seen as a great accomplishment. impact how you conduct an exam or fitting. For countries of origin for Chinese Canadians include China, tongue in Canada.14 example, some Asian Canadian women may Hong Kong and Taiwan. More than 25 percent of Chinese and South Asian prefer not to make direct eye contact with their Chinese Canadians14 Canadians have a university degree, compared with 15 physician – or some may want to try frames on While 85 percent can converse in either English or French, percent of the general Canadian population. While South for themselves rather than have the eyecare the same percentage speaks another language at home. Asian men are more likely than their counterparts to professional place the frames on them. In most cases, the language is Cantonese or Mandarin. receive higher levels of education, South Asian women are still more likely than other Canadian women to have a 15 South Asian Canadians university degree. Men and women of Chinese origin are Religion12 Approximately 93 percent can converse in English or equally likely to attend school full-time. Canadians of South Asian origin are more religious French, but 65 percent have another mother tongue. than the general population. They are almost equally The most common languages spoken by South Asian >TIP: Considering the value placed on education, eyecare divided among the Sikh (28 percent), Hindu (28 percent) Canadians are Punjabi (29 percent); Tamil (10 percent); professionals should mention the link between healthy and Muslim (22 percent) faiths. Another 16 percent Urdu (9 percent); Gujurati (6 percent); Hindi (6 percent); vision and school performance, especially for children. are Christian, and just 4 percent report no and Bengali (3 percent). For example, correcting problems, like religious affiliation. myopia, early on can positively CULTURAL VALUES impact school On the other hand, more than half of Chinese In order to better serve your Asian Canadian patients, performance. Canadians report no religious affiliation. it is important to understand their unique cultural values The most commonly practiced and virtues. religions include Buddhism, Catholicism and Protestantism. Family12 For many Asian Canadians, family is the central focus >TIP: It is helpful for eyecare of life. They are more likely to marry than the general professionals to understand that population, and less likely to live alone. South Asians different religious beliefs may in Canada are also more likely to live in multi-family affect a patient’s behavior or multi-generational households. They tend to live or values.

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Cultural Virtues16 One roundtable participant also found in a review of his A patient’s cultural virtues may impact how he or By 2031, the African own practice that the percentage of cataract diagnosed she communicates with the eyecare professional, so was higher among his African Canadian patients.23 understanding and recognizing cultural virtues is key. Canadian population is Since cumulative UV exposure can contribute to cataract For example, common virtues among the Chinese development, recommending UV-blocking eyewear is Canadian subgroup may include patience, perseverance, expected to double. one of the simplest ways eyecare professionals can self-sacrifice, maintenance of inner strength, self-restraint serve this population. and humility. With the growth of the African Canadian population comes an opportunity for eyecare professionals to OVERALL HEALTH ISSUES >TIP: Understand common cultural virtues. For example, gain new customers and form lasting relationships – African Canadians are one of the hardest-hit demographic some Asian Canadian patients may nod their heads “yes” increasing both patient satisfaction and sales. While the groups when it comes to having higher prevalence rates out of politeness, even if they mean “no”. average income for African Canadians is lower than the general population, significant buying power still exists – of systemic diseases and conditions. Many of these especially in heavily populated markets such as Toronto issues can take a toll on vision, making routine eye BARRIERS TO EYE CARE exams a must. In addition to potential language barriers, eyecare and Montreal. professionals may encounter several other obstacles to Diabetes providing care for their Asian Canadian patients. EYE HEALTH ISSUES African Canadians are at risk for several eye health Diabetes is estimated to be 2.5 times more common among African Canadian populations, and diabetic In a U.S. study, Asian Americans showed a lack of issues, including glaucoma and cataract. retinopathy also occurs at higher prevalence.24 African understanding of the need for regular vision care and Canadians are at higher risk for developing type 2 proper vision wear. More than one third did not believe Glaucoma diabetes – the type that is better managed and even eye exams were necessary unless they Glaucoma is six to eight times more common among FOCUS ON AFRICAN African Canadians – and is more likely to surface at an preventable if caught early, potentially through an were experiencing a vision problem. 25 20 eye exam. In the same study, Asians were also CANADIANS earlier age. African Canadians who have glaucoma are the least likely to believe that vision also more likely to suffer from blindness. In a U.S. study, A GROWING DEMOGRAPHIC correction can greatly improve glaucoma was four times more likely to cause blindness Behind the South Asians and Chinese, performance and everyday activities.17 in African Americans than in whites, and 15 times more African Canadians represent the third largest likely to cause blindness in those between the demographic group in Canada. They currently 21 Asian Canadians may also have ages of 45 and 64. make up 15 percent of the country’s visible lower awareness of health issues. minority population, and 2.5 percent of the Chinese Canadians, for example, Cataract overall population.2 By 2031, the number have low awareness of their While there is little data in of African Canadians is expected to risks for hypertension and its Canada to confirm that cataract double, reaching 1.6 million.1 complications.18 affects the African Canadian population at a higher rate, it The African Canadian population is Similarly, this group may be less remains a concern – especially primarily distributed among four likely to take the steps necessary among the older population. provinces: Ontario, Quebec, British to preserve their overall health. Studies in the U.S. and Barbados Columbia and Alberta.19 Ontario is A study of Chinese and Southeast have shown black populations home to approximately 60 percent of Asian Canadians revealed that are 1.5 times more likely African Canadians. This demographic these groups are less likely than to develop cataract, also forms the largest visible minority the overall population to eat and five times group in Quebec, comprising 29 the recommended amounts of more likely to percent of the province’s visible fruits and vegetables. Chinese go blind as a minority population. African Canadians 22 Canadians are also less likely to result. are largely concentrated in urban be physically active.8 areas, including Montreal, Toronto, Ottawa-Gatineau and Winnipeg.2

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8 29 Hypertension While most African Canadians (83 percent) identify with BARRIERS TO EYE CARE Incidence of high blood pressure is approximately double Canadian culture, 71 percent say they have not lost sense among African Canadians compared to whites.26 It is also of their own unique cultural heritage. important to note that rates of obesity – which can be TIPS FOR YOUR PRACTICE: linked to high blood pressure and diabetes – are higher CULTURAL VALUES FOCUS ON AFRICAN CANADIANS among African Canadian women compared to white In order to provide the best possible care and patient As Presented by the Roundtable Participants women.24 Counseling patients on the potential impact of experience, it is helpful for eyecare professionals to hypertension on vision is one way to help motivate them understand the unique cultural values of their African ••Understand that African Canadians are a to keep their blood pressure under control. Canadian patients. diverse group. As with any group, it is important not to make assumptions or to stereotype. Treat Family and Independence30 each patient like a person rather than as an Diabetes is 2.5x more While family remains an important value among African “African Canadian.” Canadians, out of every ethnic group in Canada, they common among Look out for all members of the family. are the least likely to get married and most likely to get •• African Canadians divorced. African Canadians are also the most likely to If a person comes in with another family member have common-law relationships – reinforcing strong for an appointment, make sure he or she is taking HIV/AIDS27 commitment that stops short of marriage. care of their own eye health needs, too. Offer Although the overall prevalence of HIV and AIDS to set up regular, comprehensive exams for all has decreased, the number of cases among African >TIP: Even if not married, African Canadians can still members of the family. Canadians has increased. While African Canadians make have strong family relationships. Ask about the health of up just over 2 percent of Canada’s overall population, in their loved ones in general. ••Create a welcoming environment. Even though you may not need to use bilingual 2003, they made up 20 percent of all AIDS cases. Late- It can lead to problems in the eye, including Sjogren’s materials for this group, it is important to display stage AIDS can lead to complications in the eyes, such Syndrome – which occurs in one in five to 10 people with Religion29 education and point-of-sale materials that show as cytomegalovirus retinitis – which can cause retinal lupus. In this condition, the immune system attacks the The most common religions among African Canadians positive, African Canadian imagery. detachment and blindness within two to six months. glands that produce fluids to lubricate the eye. are Protestantism (30 percent), Catholicism (23 percent) and Muslim (22 percent). 27 • Get involved. Research suggests that your Sickle-Cell Anemia One in 10 people with lupus will develop conjunctivitis, • African Canadian patients may be more receptive Sickle-cell anemia affects more African Canadians than and some may also get an overactive thyroid gland that >TIP: If religion plays an important role in your patient’s to practices that give back to their community.34 any other racial group, and an estimated one in 12 African can cause prominence of the eyeballs. Rarely, lupus will life, be considerate of how certain beliefs may impact the Canadians carries the sickle-cell trait. Sickle-cell anemia affect the blood vessels in the eye, leading to pain and way you interact with that patient. For example, in the is an inherited blood condition characterized by pain and reduced vision. Use of long-term steroids to treat lupus Islamic faith, some Muslims may avoid direct eye contact swelling of the joints, fever and respiratory infections. can increase the risk of developing cataract and glaucoma with members of the opposite sex.31 It can lead to vision problems and blindness when blood – so regular eye exams are critical for patients with lupus. vessels in the eye become blocked with sickle-shaped cells. Education29 While language barriers may not be an issue, Sarcoidosis African Canadians are slightly more likely than the eyecare professionals should be aware of other Lupus27 African Canadians experience sarcoidosis at a rate of general population to hold university degrees, with men potential obstacles to providing care to the African While lupus is not 10 to 15 times higher than the general population.24 more likely than women to report having an education. Canadian population. extremely common, Sarcoidosis is a disease of unknown cause in which it affects African inflammation occurs in the lymph nodes, lungs, liver, >TIP: Never assume a level of understanding or level of First, research shows that many African Canadians are Canadian women at a eyes, skin or other tissue. Approximately 25 to 50 percent education. unfamiliar with the Canadian healthcare system and are much higher rate than of people with Sarcoidosis have eye-related problems, not using it in the most effective way. African Canadian the general population with the most common issue being uveitis.28 Role of Women32 women are also less likely to utilize preventative health (one in 250 versus one in Historically, women play a play a large role in the African programs, such as pap tests and mammograms, than the 2,000). Lupus is a chronic ACCULTURATION29 Canadian family. Many report feeling pressure to play the general population.24 autoimmune disease in Around half of all African Canadians were born outside “strong black woman” role, and subsequently put other which the immune system of Canada. Most African Canadians report one or more people’s needs ahead of their own. Additionally, while visible minorities have higher begins to malfunction origins, with the most popular being Caribbean (50+ unemployment rates in general, African Canadians and attack different percent) and African (42 percent). Other origins include >TIP: Encourage African Canadian women to make experience double the unemployment rate of others. parts of the British Isles (12 percent), Canadian (11 percent) and appointments for themselves in addition to their They also report lower salaries than other visible minority body, causing French (4 percent). family members. populations, despite their greater likelihood of holding a inflammation. university degree.33 This, however, should not

10 11 Hypertension While most African Canadians (83 percent) identify with BARRIERS TO EYE CARE Incidence of high blood pressure is approximately double Canadian culture, 71 percent say they have not lost sense among African Canadians compared to whites.26 It is also of their own unique cultural heritage. important to note that rates of obesity – which can be TIPS FOR YOUR PRACTICE: linked to high blood pressure and diabetes – are higher CULTURAL VALUES FOCUS ON AFRICAN CANADIANS among African Canadian women compared to white In order to provide the best possible care and patient As Presented by the Roundtable Participants women.24 Counseling patients on the potential impact of experience, it is helpful for eyecare professionals to hypertension on vision is one way to help motivate them understand the unique cultural values of their African ••Understand that African Canadians are a to keep their blood pressure under control. Canadian patients. diverse group. As with any group, it is important not to make assumptions or to stereotype. Treat Family and Independence30 each patient like a person rather than as an Diabetes is 2.5x more While family remains an important value among African “African Canadian.” Canadians, out of every ethnic group in Canada, they common among Look out for all members of the family. are the least likely to get married and most likely to get •• African Canadians divorced. African Canadians are also the most likely to If a person comes in with another family member have common-law relationships – reinforcing strong for an appointment, make sure he or she is taking HIV/AIDS27 commitment that stops short of marriage. care of their own eye health needs, too. Offer Although the overall prevalence of HIV and AIDS to set up regular, comprehensive exams for all has decreased, the number of cases among African >TIP: Even if not married, African Canadians can still members of the family. Canadians has increased. While African Canadians make have strong family relationships. Ask about the health of up just over 2 percent of Canada’s overall population, in their loved ones in general. ••Create a welcoming environment. Even though you may not need to use bilingual 2003, they made up 20 percent of all AIDS cases. Late- It can lead to problems in the eye, including Sjogren’s materials for this group, it is important to display stage AIDS can lead to complications in the eyes, such Syndrome – which occurs in one in five to 10 people with Religion29 education and point-of-sale materials that show as cytomegalovirus retinitis – which can cause retinal lupus. In this condition, the immune system attacks the The most common religions among African Canadians positive, African Canadian imagery. detachment and blindness within two to six months. glands that produce fluids to lubricate the eye. are Protestantism (30 percent), Catholicism (23 percent) and Muslim (22 percent). 27 • Get involved. Research suggests that your Sickle-Cell Anemia One in 10 people with lupus will develop conjunctivitis, • African Canadian patients may be more receptive Sickle-cell anemia affects more African Canadians than and some may also get an overactive thyroid gland that >TIP: If religion plays an important role in your patient’s to practices that give back to their community.34 any other racial group, and an estimated one in 12 African can cause prominence of the eyeballs. Rarely, lupus will life, be considerate of how certain beliefs may impact the Canadians carries the sickle-cell trait. Sickle-cell anemia affect the blood vessels in the eye, leading to pain and way you interact with that patient. For example, in the is an inherited blood condition characterized by pain and reduced vision. Use of long-term steroids to treat lupus Islamic faith, some Muslims may avoid direct eye contact swelling of the joints, fever and respiratory infections. can increase the risk of developing cataract and glaucoma with members of the opposite sex.31 It can lead to vision problems and blindness when blood – so regular eye exams are critical for patients with lupus. vessels in the eye become blocked with sickle-shaped cells. Education29 While language barriers may not be an issue, Sarcoidosis African Canadians are slightly more likely than the eyecare professionals should be aware of other Lupus27 African Canadians experience sarcoidosis at a rate of general population to hold university degrees, with men potential obstacles to providing care to the African While lupus is not 10 to 15 times higher than the general population.24 more likely than women to report having an education. Canadian population. extremely common, Sarcoidosis is a disease of unknown cause in which it affects African inflammation occurs in the lymph nodes, lungs, liver, >TIP: Never assume a level of understanding or level of First, research shows that many African Canadians are Canadian women at a eyes, skin or other tissue. Approximately 25 to 50 percent education. unfamiliar with the Canadian healthcare system and are much higher rate than of people with Sarcoidosis have eye-related problems, not using it in the most effective way. African Canadian the general population with the most common issue being uveitis.28 Role of Women32 women are also less likely to utilize preventative health (one in 250 versus one in Historically, women play a play a large role in the African programs, such as pap tests and mammograms, than the 2,000). Lupus is a chronic ACCULTURATION29 Canadian family. Many report feeling pressure to play the general population.24 autoimmune disease in Around half of all African Canadians were born outside “strong black woman” role, and subsequently put other which the immune system of Canada. Most African Canadians report one or more people’s needs ahead of their own. Additionally, while visible minorities have higher begins to malfunction origins, with the most popular being Caribbean (50+ unemployment rates in general, African Canadians and attack different percent) and African (42 percent). Other origins include >TIP: Encourage African Canadian women to make experience double the unemployment rate of others. parts of the British Isles (12 percent), Canadian (11 percent) and appointments for themselves in addition to their They also report lower salaries than other visible minority body, causing French (4 percent). family members. populations, despite their greater likelihood of holding a inflammation. university degree.33 This, however, should not

10 11 be a deterrent from offering higher-performing, percent).37 Smokers are three to four times more likely premium products. From 1996 to 2006, Canada’s to develop AMD than non-smokers. Finally, Aboriginal Canadians living off-reserve are more likely to be obese.35 Stress as a result of racism and adjusting to a new Aboriginal population Studies have linked obesity with the potential progression location is also common among the African Canadian of AMD. population. Various Canadian studies have pointed to grew 6x faster than other the increasing prevalence of depression, anxiety and populations. Cataract38 schizophrenia among the African Canadian population – Another concern for Aboriginal populations in Canada 24 with racism identified as a major cause. Inuit is cataract, with risk factors including age, smoking The Inuit population in Canada is young and growing. and cumulative UV exposure. While little data exists FOCUS ON ABORIGINAL While this group currently comprises just 4 percent of on prevalence, one study confirmed that First Nations Aboriginal peoples in Canada, it makes up a majority of in Canada are more likely to develop cataract than the POPULATIONS: the population in several areas. general population. Spotlight on First Nations, Inuit and Métis Populations The Inuit primarily live in four regions within an area Glaucoma called “Inuit Nunangat”: the Territory of Nunavut First Nations and Métis populations in Canada are A GROWING DEMOGRAPHIC35 (meaning “our land”); Nunavik in Quebec; the Inuvialuit more likely than other demographics to develop While not counted as a “visible minority” in the Canadian 39 region in the Northwest Territories; and Nunatsiavut in closed-angle glaucoma. Inuit populations, on the other Census, the Aboriginal population in Canada is large northern Labrador. The Inuit comprise the majority of hand, are more likely to develop primary open-angle and growing. Aboriginal peoples make up 3.8 percent of residents in all four regions, including up to 90 percent of glaucoma (POAG). The prevalence of POAG among Canada’s total population, or 1.2 million people – larger those living in Nunavut, Nunavik and Nunatsiavut, and Canadian Inuit women is up to 40 times higher than than the African Canadian population. 5 Northwest Territories, 20 percent in the Yukon Territory, nearly 60 percent of the Inuvialuit region. in non-Inuit women. and 10 percent in Saskatchewan and Manitoba. Between 1996 and 2006, the Aboriginal population in As a group, Aboriginal Canadians are significantly OVERALL HEALTH ISSUES Canada grew 45 percent – nearly six times faster than the Métis younger than the general population. This represents an Aboriginal populations in Canada are hit the hardest when rate of non-Aboriginal populations. Approximately 34 percent of Canada’s Aboriginal opportunity for eyecare professionals to reach out to this it comes to overall health issues that can population is Métis – meaning they identify as having growing group and develop long-lasting relationships affect vision. Although 80 percent of Aboriginal Canadians live in one parent of European descent and one of First with Aboriginal patients and their families. In 2006, the Ontario and the western provinces, the fastest increase Nations descent. The Métis make up the fastest-growing median age of all Aboriginals in Canada was 27 – which Diabetes over the past decade occurred east of Manitoba. The Aboriginal group, having increased in size by 91 percent is 13 years lower than the non-Aboriginal population. The A rise in diabetes leading Aboriginal population grew 95 percent in Nova since 1996. This growth rate can be attributed to higher median age for the Inuit population was 22. to diabetic retinopathy Scotia, 67 percent in New Brunswick, 65 percent in fertility rates and an increasing trend for people to is at the root of increased Newfoundland and Labrador, 53 percent in Quebec and identify themselves as Métis. EYE HEALTH ISSUES vision loss among 65 percent in Ontario. While many Aboriginal Canadians Aboriginal Canadians are disproportionately affected by Aboriginal Canadians. live on reserves, more than half live in urban areas. Although the Métis represent just over 1 percent of eye health issues – and face more barriers to eye care Because of poor diet, Canada’s total population, they account for larger shares than any other group. One in four Aboriginal people in this group is The Aboriginal population in Canada is divided into three of the population in the West – including 9 percent of Canada report a problem with their vision, compared to developing main groups: First Nations (known in the those living in the Northwest Territories, 6 percent of one in 10 in the general population.36 This reinforces the diabetes U.S. as North American Indians), Métis those in Manitoba, 5 percent in Saskatchewan and 3 vital role eyecare professionals can play in educating their earlier and Inuit. percent in both Alberta and the Yukon Territory. Aboriginal patients about the need for regular in life – vision care. First Nations More than 60 percent of Age-Related Macular Degeneration Aboriginal Canadians identify Breakdown of Canada’s Aboriginal Population While little data exists on prevalence of AMD among themselves as First Nations. First Nations 60+% Aboriginal Canadians, as a group, they have more risk The majority of First Nations Métis 34% factors for developing the disease. First, Aboriginal live in Ontario and western Canadians are at a significantly higher risk for diabetes, provinces. They also Inuit 4% which increases risk for AMD.36 Research also shows that represent 30 percent of Source: Statistics Canada, 2006 Aboriginal Canadians are much more likely to smoke those living in the than the general population (41.6 percent versus 22.7

12 13 be a deterrent from offering higher-performing, percent).37 Smokers are three to four times more likely premium products. From 1996 to 2006, Canada’s to develop AMD than non-smokers. Finally, Aboriginal Canadians living off-reserve are more likely to be obese.35 Stress as a result of racism and adjusting to a new Aboriginal population Studies have linked obesity with the potential progression location is also common among the African Canadian of AMD. population. Various Canadian studies have pointed to grew 6x faster than other the increasing prevalence of depression, anxiety and populations. Cataract38 schizophrenia among the African Canadian population – Another concern for Aboriginal populations in Canada 24 with racism identified as a major cause. Inuit is cataract, with risk factors including age, smoking The Inuit population in Canada is young and growing. and cumulative UV exposure. While little data exists FOCUS ON ABORIGINAL While this group currently comprises just 4 percent of on prevalence, one study confirmed that First Nations Aboriginal peoples in Canada, it makes up a majority of in Canada are more likely to develop cataract than the POPULATIONS: the population in several areas. general population. Spotlight on First Nations, Inuit and Métis Populations The Inuit primarily live in four regions within an area Glaucoma called “Inuit Nunangat”: the Territory of Nunavut First Nations and Métis populations in Canada are A GROWING DEMOGRAPHIC35 (meaning “our land”); Nunavik in Quebec; the Inuvialuit more likely than other demographics to develop While not counted as a “visible minority” in the Canadian 39 region in the Northwest Territories; and Nunatsiavut in closed-angle glaucoma. Inuit populations, on the other Census, the Aboriginal population in Canada is large northern Labrador. The Inuit comprise the majority of hand, are more likely to develop primary open-angle and growing. Aboriginal peoples make up 3.8 percent of residents in all four regions, including up to 90 percent of glaucoma (POAG). The prevalence of POAG among Canada’s total population, or 1.2 million people – larger those living in Nunavut, Nunavik and Nunatsiavut, and Canadian Inuit women is up to 40 times higher than than the African Canadian population. 5 Northwest Territories, 20 percent in the Yukon Territory, nearly 60 percent of the Inuvialuit region. in non-Inuit women. and 10 percent in Saskatchewan and Manitoba. Between 1996 and 2006, the Aboriginal population in As a group, Aboriginal Canadians are significantly OVERALL HEALTH ISSUES Canada grew 45 percent – nearly six times faster than the Métis younger than the general population. This represents an Aboriginal populations in Canada are hit the hardest when rate of non-Aboriginal populations. Approximately 34 percent of Canada’s Aboriginal opportunity for eyecare professionals to reach out to this it comes to overall health issues that can population is Métis – meaning they identify as having growing group and develop long-lasting relationships affect vision. Although 80 percent of Aboriginal Canadians live in one parent of European descent and one of First with Aboriginal patients and their families. In 2006, the Ontario and the western provinces, the fastest increase Nations descent. The Métis make up the fastest-growing median age of all Aboriginals in Canada was 27 – which Diabetes over the past decade occurred east of Manitoba. The Aboriginal group, having increased in size by 91 percent is 13 years lower than the non-Aboriginal population. The A rise in diabetes leading Aboriginal population grew 95 percent in Nova since 1996. This growth rate can be attributed to higher median age for the Inuit population was 22. to diabetic retinopathy Scotia, 67 percent in New Brunswick, 65 percent in fertility rates and an increasing trend for people to is at the root of increased Newfoundland and Labrador, 53 percent in Quebec and identify themselves as Métis. EYE HEALTH ISSUES vision loss among 65 percent in Ontario. While many Aboriginal Canadians Aboriginal Canadians are disproportionately affected by Aboriginal Canadians. live on reserves, more than half live in urban areas. Although the Métis represent just over 1 percent of eye health issues – and face more barriers to eye care Because of poor diet, Canada’s total population, they account for larger shares than any other group. One in four Aboriginal people in this group is The Aboriginal population in Canada is divided into three of the population in the West – including 9 percent of Canada report a problem with their vision, compared to developing main groups: First Nations (known in the those living in the Northwest Territories, 6 percent of one in 10 in the general population.36 This reinforces the diabetes U.S. as North American Indians), Métis those in Manitoba, 5 percent in Saskatchewan and 3 vital role eyecare professionals can play in educating their earlier and Inuit. percent in both Alberta and the Yukon Territory. Aboriginal patients about the need for regular in life – vision care. First Nations More than 60 percent of Age-Related Macular Degeneration Aboriginal Canadians identify Breakdown of Canada’s Aboriginal Population While little data exists on prevalence of AMD among themselves as First Nations. First Nations 60+% Aboriginal Canadians, as a group, they have more risk The majority of First Nations Métis 34% factors for developing the disease. First, Aboriginal live in Ontario and western Canadians are at a significantly higher risk for diabetes, provinces. They also Inuit 4% which increases risk for AMD.36 Research also shows that represent 30 percent of Source: Statistics Canada, 2006 Aboriginal Canadians are much more likely to smoke those living in the than the general population (41.6 percent versus 22.7

12 13 Nearly 20% of First Nations

peoples have diabetes. MOST POPULAR ABORIGINAL LANGAUGES IN CANADA50

LANGUAGE # OF SPEAKERS AS FIRST LANGUAGE SPOKEN AT HOME likely to have high blood pressure as a result of diabetes 99,950 78,885 47,190 than the general population – and are more likely to CREE develop it at an earlier age.42 Aboriginal Canadians living INUKTITUT 35,690 32,010 25,290 off-reserve are 2.5 times more likely to be overweight OJIBWAY 32,460 11,115 11,115 or obese than non-Aboriginals, putting them at higher risk for both hypertension and diabetes, and their ocular complications.43 There are 11 major Aboriginal language families in >TIP: Eyecare professionals can connect with their Tuberculosis44 Canada, made up of more than 65 distinct dialects. Of Aboriginal patients by asking about their families and While incidence of TB in Canada is low, the highest rates these dialects, only Cree, Inuktitut and Ojibway have demonstrating community involvement. by far are reported among Aboriginal populations. The TB enough population of fluent speakers to be considered rate among Inuit populations has doubled in the past four viable to survive long-term.48 Traditional Cultures of Ancestors years to an alarming 186 times higher than that of non- The traditional cultures of ancestors – shaped by nature – Aboriginal Canadians. The rate of First Nations is 31 times Two of Canada’s territories give official status to native exert a strong influence over many Aboriginal Canadians, higher. This can be attributed to poor socio-economic languages. In Nunavut, Inuktitut and Inuinnaqtun from their spirituality to political attitudes.52 They share conditions where many of them live. TB can lead to a are official languages alongside English and French. a deep-seated belief of living in harmony with the earth number of infections throughout the eye. Inuktitut is a common vehicular language in territorial and its creatures.51 government. In the Northwest Territories, the Official HIV/AIDS Languages Act declares 11 different languages, with the >TIP: Encourage your staff to celebrate Rates of HIV are estimated to be three times higher most common dialects being Chipewyan, Cree, Dogrib holidays or participate in community among Aboriginal Canadians.45 As a group, Aboriginal and South Slavey.49 events recognizing the history and allowing more time for sight-threatening complications Canadians are disproportionately affected by many social, culture of local tribes. to develop. Their higher rates of obesity and likeliness to economic and behavioral factors – such as higher rates of Although the Canadian Census reports an overall 40 smoke also put them at greater risk. poverty, substance abuse, sexually transmitted diseases decline in the number of Aboriginals with a Religion53 and limited access to or use of health care services – mother tongue other than English or French, Spirituality plays an important role Aboriginal Canadians are three to five times more likely which can increase their vulnerability to HIV infection.46 approximately nine out of 10 people with in Aboriginal culture, with two out to develop type 2 diabetes than the general population. Over time, AIDS can lead to serious ocular infections and knowledge of one of the top languages of three Aboriginal Canadians With rates so high, it is considered to be an epidemic even blindness. regularly use the language at home.47 considering themselves Christian. among this group.41 Prevalence of diabetes is highest Aboriginal teenagers in Canada among First Nations adults at 19.7 percent, followed by LANGUAGE CULTURAL VALUES are more likely than the general the Métis at 6 percent. Diabetes is much less common While most Aboriginal Canadians speak at least one of Aboriginal Canadians share many population to say they value their among Inuit populations, with prevalence at just 2 Canada’s national languages, native languages still play cultural values. Understanding these religion, and less likely to reject the percent. Complications from diabetes are, in general, a vital role in their values can help eyecare professionals churches attended by their parents 41 more severe among Aboriginal Canadians. overall culture – provide higher levels of care to this and grandparents. and can contribute growing demographic. Approximately two out of three Aboriginal Canadians to potential >TIP: Be considerate of spiritual and diagnosed with diabetes are women – and Aboriginal communication Family and Community51 religious beliefs. women’s rates are five times higher than the general barriers. As with other demographics, Aboriginal population. This is of great concern for women of child- Approximately Canadians place tremendous value on Use of Herbal Remedies and bearing age, when health complications may arise for one in four family and community. Common traditional Traditional Medicine54 27 both the woman and baby. Aboriginal strengths among Aboriginal Canadians Aboriginal Canadian patients Canadians can include community conscience and shared may turn to herbal medicines Hypertension converse in sense of responsibility. There is also great and remedies before seeking More than 15 percent of Aboriginal Canadians suffer another Aboriginal respect for elders, who are seen as reliable professional care. More than three from hypertension. Aboriginal Canadians are also more language.47 sources of knowledge and wisdom. out of 10 Métis adults report having

14 152 Nearly 20% of First Nations

peoples have diabetes. MOST POPULAR ABORIGINAL LANGAUGES IN CANADA50

14 152 Common Eye- and Overall-Health Issues Among Ethnic Populations in Canada

ASIAN CANADIANS AFRICAN CANADIANS ABORIGINALS

Eye Health traditional medicines, healing or wellness practices BARRIERS TO EYE CARE available in their community of residence. In addition to being hit the hardest with eye- and overall- Age-Related A leading cause of severe vision Assumed to be at lower risk, but Have more risk factors for developing loss. Prevalence 2x as high factors such as UV exposure and AMD, including higher rates of diabetes health conditions, Aboriginal Canadians face the most Macular among Chinese Canadians. Risks smoking can still contribute to and obesity, and increased likelihood >TIP: Ask your patients if they are using any herbal barriers to receiving adequate vision care and are Degeneration include UV exposure, smoking. development. to smoke. supplements or traditional remedies that could affect disproportionately affected by many social, economic 55 Remains a concern among older their vision. and behavioral factors. First Nations Canadians more likely More likely to develop cataract populations. U.S.-specific data to develop cataract than the general Cataract than the general population. confirms higher risk among population. Other Traditional Strengths51 Many Aboriginal populations in Canada experience higher African Americans. Aboriginal Canadians also tend to place values on: rates of poverty and unemployment, which can lead - Sharing, humility and not hurting others to dependency on welfare or exposure to substandard First Nations and Métis more likely to Cooperation and non-competition living conditions.56 Even though unemployment rates More likely to develop closed- 6-8x more common among develop closed-angle glaucoma. Inuit - angle glaucoma – the second African Canadians. More likely populations more likely to develop primary Glaucoma - Good mental health, or being in balance with family, are dropping for Aboriginal Canadians, the group is still leading cause of blindness among to get it earlier and develop open-angle glaucoma (POAG). Prevalence community and the environment twice as likely to be unemployed.57 Rates of substance Canadians. blindness. of POAG 40x higher in Inuit women vs. non-Inuit women. abuse are also significantly higher among Aboriginal 55 populations. Prevalence not as high, but still Prevalence of myopia among Aboriginal TIPS FOR YOUR PRACTICE: Prevalence rates up to 90%. exists among African Canadian Myopia Canadians is not as well known. population. FOCUS ON ABORIGINAL Geographic isolation can make it difficult for many CANADIANS Aboriginal Canadians to receive the care they need. Even Overall Health As Presented by the Roundtable Participants though care is typically provided by the government, Poor diet leads to earlier development. there is a shortage of eyecare professionals in many At higher risk for developing Aboriginals 3-5x more likely to develop 2.5x more common among diabetes and diabetic retinopathy. type 2 diabetes. Prevalence highest • Know the languages spoken. Aboriginal-inhabited areas, such as the Northwest African Canadian populations. • Chinese Canadians have 2x among First Nations (19.7%) and lowest Diabetes Diabetic retinopathy occurs at If any languages other than English or French Territories. In 2001, just 40 percent of Aboriginal women rate of diabetic retinopathy among Inuit (2%). Aboriginal women higher incidence. are spoken, offer bilingual or in-language and 32 percent of Aboriginal men reported seeing an vs. whites. 5x more likely to have diabetes than non-Aboriginal women. resources in the right dialects. Know that subtle eye doctor.58 differences may exist. For example: a standard Late-stage AIDS can lead to Trending upward in African Rates of HIV 3x higher among Aboriginal greeting in Nunavut may be “ublaakut” in the Some Aboriginal Canadians may also have a general cytomegalovirus retinitis, which Canadian populations. Can lead Canadians. Can lead to ocular infections, 60 HIV/AIDS can cause retinal detachment and to ocular infections, including East, and “uulaakut” in the West. distrust for non-Aboriginals. To combat potential trust including cytomegalovirus retinitis. blindness within two to six months. cytomegalovirus retinitis. issues, eyecare professionals may want to consider hiring • Create an office that reflects their an Aboriginal staff member.59 • South Asians 3x more likely cultural values. Understand what is to develop hypertension, and Affects 15% of Aboriginal Canadians. more likely to get it early. The More likely to have high blood pressure important to your Aboriginal patients and Incidence is double. Can lead to longer Asian immigrants live in as a result of diabetes. More likely to Hypertension hypertensive retinopathy. reflect those values in your own practice. For North America, the more likely develop it at an earlier age. Can lead to example, you may choose to promote a more they are to have it. Can lead to hypertensive retinopathy. hypertensive retinopathy. earth-friendly practice. Studies show more common Affects African Canadian among Asian Canadian women at higher rates than ••Learn national holidays. Encourage your women than white women. general population (1 in 250 vs. Can lead to visual problems including entire staff to learn holidays celebrated by Lupus Can lead to visual problems 1 in 2,000). Can lead to visual Sjogren’s Syndrome, conjunctivitis and including Sjogren’s Syndrome, problems including Sjogren’s overactive thyroid gland. local tribes so they can acknowledge and conjunctivitis and overactive Syndrome, conjunctivitis and respect them. National Aboriginal Day on thyroid gland. overactive thyroid gland. June 21, for example, recognizes the cultures Rate 10-15x higher than general and contributions of the First Nations, Inuit Does not appear to be as Does not appear to be as common among population. Can cause eye-related Sarcoidosis common among this population. this population. and Métis populations in Canada. Nunavut problems, including uveitis. celebrates Nunavut Day on July 9.

Affects more African Canadians • Promote eye- and overall-health. than any other racial group. • Sickle-Cell Does not appear to be as Does not appear to be as common among One in 12 carries sickle-cell trait. Since Aboriginal patients are at higher risk common among this population. this population. Disease Can lead to visual problems for many eye- and overall-health conditions, and blindness. encourage them to set up regular exams for Highest rates reported among Aboriginal Prevalence significantly higher In U.S., rates 8x higher in African themselves and all family members. populations. Rates 186x higher among Inuit among Asian Canadians. Can lead Americans vs. whites. Can lead to Tuberculosis populations and 31x higher among First to ocular infections. ocular infections. Nations. Can lead to ocular infections.

16 17 Common Eye- and Overall-Health Issues Among Ethnic Populations in Canada

ASIAN CANADIANS AFRICAN CANADIANS ABORIGINALS

16 17 KEY TOPICS OF DISCUSSION Participants felt strongly that all eyecare professionals Top priorities discussed included raising awareness of: should strive to be more “culturally aware.” To effectively • The need for preventative vision care for Following presentations, roundtable participants overcome obstacles, eyecare professionals should eye- and overall-health, including getting regular collaborated to discuss strategies for overcoming take time to understand their patient base – focusing eye exams and wearing UV-blocking eyewear. obstacles to providing culturally sensitive, quality vision on each patient as an individual and identifying any • Systemic health factors – such as diabetes – and care to ethnic minority populations in Canada. Topics of potential barriers to care. Regardless of race or ethnicity, their impact on vision. discussion included: educational priorities for both the participants agreed that improving the quality of • The link between vision and performance in school public and the industry; what eyecare professionals can communication with patients is essential – and that the or at home. do in their own practices and communities; and what goal should always be to ensure the patient understands • The benefits of eyewear beyond vision correction the optical industry can do to further support current what has happened during the exam and is aware of any (seeing more clearly and comfortably). and future eyecare professionals in meeting the needs next steps to protect and preserve vision. • Access to health- and vision-care services. of culturally diverse patients. PROFESSIONAL EDUCATION Participants agreed that simply recognizing potential EDUCATION PRIORITIES Participants agreed that cultural competency education challenges is a good first step that eyecare professionals and training should be offered to staff members on can take to improve overall patient care. It is important PUBLIC EDUCATION an ongoing basis. This will help to improve everyday to acknowledge that while each demographic group Roundtable participants expressed an urgent need for interactions with patients. has unique health- and communication-needs, within public education to reach ethnic minorities – as well as each group there may still be variations in languages the general population – about the importance of regular Roundtable participants also reinforced a need used, cultural values and levels of understanding. vision care and the benefits of sight-enhancing to educate and raise cultural awareness These differences can make communicating with eyewear options. among students. Cultural sensitivity patients more challenging. training should be introduced in opticianry and optometry schools early on, and multicultural resources and education should be made available throughout the education curriculum. This will help reinforce the importance of applying these learnings outside of school and in their own practices.

18 19 KEY TOPICS OF DISCUSSION Participants felt strongly that all eyecare professionals Top priorities discussed included raising awareness of: should strive to be more “culturally aware.” To effectively • The need for preventative vision care for Following presentations, roundtable participants overcome obstacles, eyecare professionals should eye- and overall-health, including getting regular collaborated to discuss strategies for overcoming take time to understand their patient base – focusing eye exams and wearing UV-blocking eyewear. obstacles to providing culturally sensitive, quality vision on each patient as an individual and identifying any • Systemic health factors – such as diabetes – and care to ethnic minority populations in Canada. Topics of potential barriers to care. Regardless of race or ethnicity, their impact on vision. discussion included: educational priorities for both the participants agreed that improving the quality of • The link between vision and performance in school public and the industry; what eyecare professionals can communication with patients is essential – and that the or at home. do in their own practices and communities; and what goal should always be to ensure the patient understands • The benefits of eyewear beyond vision correction the optical industry can do to further support current what has happened during the exam and is aware of any (seeing more clearly and comfortably). and future eyecare professionals in meeting the needs next steps to protect and preserve vision. • Access to health- and vision-care services. of culturally diverse patients. PROFESSIONAL EDUCATION Participants agreed that simply recognizing potential EDUCATION PRIORITIES Participants agreed that cultural competency education challenges is a good first step that eyecare professionals and training should be offered to staff members on can take to improve overall patient care. It is important PUBLIC EDUCATION an ongoing basis. This will help to improve everyday to acknowledge that while each demographic group Roundtable participants expressed an urgent need for interactions with patients. has unique health- and communication-needs, within public education to reach ethnic minorities – as well as each group there may still be variations in languages the general population – about the importance of regular Roundtable participants also reinforced a need used, cultural values and levels of understanding. vision care and the benefits of sight-enhancing to educate and raise cultural awareness These differences can make communicating with eyewear options. among students. Cultural sensitivity patients more challenging. training should be introduced in opticianry and optometry schools early on, and multicultural resources and education should be made available throughout the education curriculum. This will help reinforce the importance of applying these learnings outside of school and in their own practices.

18 19

FOCUS ON KIDS WHAT EYECARE e all know that healthy vision is instrumental to good school performance. Unfortunately, many children do PROFESSIONALS CAN DO W not get the eye care they need or deserve – particularly those belonging to an ethnic minority. In fact, some There are many steps eyecare professionals can take in hiring a multilingual staff or taking advantage of children may not even realize they’re not seeing their best. interpreter services. their own practices to ensure the best possible eye care The topic of kids and student education played an important role in the roundtable experience for their patients. Participants discussed the 7. Make the effort. Even if you do not speak the discussion – and participants agreed that eyecare professionals can make a following strategies: same language, your patients will most likely difference by becoming educators and eye health advocates within their local appreciate your efforts to better understand and communities. 1. Know your patients. Take a close look at your meet their needs. patient base. What demographics do you serve? Former school superintendent Trevor Ludski encouraged eyecare Do any of your patients have specific needs? Do 8. Train your staff. To be considered a culturally professionals to take advantage of opportunities within schools – saying that language barriers exist? A simple assessment can sensitive practice, all your staff members need to while he has seen many schools visited by dentists or safety professionals, help you address potential barriers before they be on board. Remember the saying: one bad apple he has rarely seen visits by eyecare professionals. Ludski reinforced that become an issue. can spoil the bunch. Reinforce the importance most elementary teachers would be more than willing to have an eyecare of culturally appropriate care and provide staff professional come in and guest lecture about the importance of healthy 2. Know more than your patients. Your patients are members with ongoing training opportunities, as well vision and regular eye exams. A good first step, he said, would be to contact online – and, chances are, they may “Google” what as resources to use with patients. local principals to find out where opportunities exist. you say. In fact, they may have even done some research before their appointment. Whether you’re in 9. Become involved in the community. Make eye Getting involved with local schools is a great way for eyecare professionals the exam room or dispensary, keep up to date on the health a priority in your community by becoming an to distribute literature about good vision and school performance that latest eye health and product information so you can advocate at local health fairs and events, or in local kids can take home to their parents – encouraging them to schedule a remain more educated than your patients. schools. Make sure any literature or goodies you comprehensive eye exam. Depending on resources and staff available, hand out prominently display your practice’s name eyecare professionals can also benefit from offering to provide 3. Work with your patients. Vision care should and information, so potential patients will know complimentary vision screenings to students – then work with the school be a collaborative effort between the doctor and where to find you! to send letters home to parents when potential vision problems are

patient. There needs to be a solid, open line of identified. Including practice information is an effective way communication during all steps of the exam. WHAT THE OPTICAL to reach potential new patients. 4. Be respectful of cultures. Put yourself in your INDUSTRY CAN DO patients’ shoes. Take time to understand where Participants agreed that the optical industry should take your patients are coming from, and how their cultural workforce will allow practices to more effectively hire Community Outreach an active role in supporting eyecare professionals in their values or beliefs may impact the way you conduct staff members who are representative of the communities More consumer education in the community efforts to provide more culturally appropriate vision care. the eye exam or eyewear fitting. Purchase a that they serve. One of the participants referenced is needed to raise awareness about eye health. This section overviews the top priorities identified by multi-faith calendar to be in the know of holidays how his staff includes ophthalmologists of Asian Participants discussed the need for more organizations roundtable participants. celebrated by your patients. Canadian, African Canadian and Middle Eastern to develop multicultural education programs that descent as a way to better serve the practice’s could be leveraged locally by eyecare professionals. 5. Never assume. Assumptions can be dangerous PROFESSIONAL EDUCATION culturally diverse patient base. They also expressed interest in the creation of a and, when faulty, may even cause you to lose Participants agreed that the optical industry should play “central website” that could contain valuable eye a patient. Never assume levels of education or a larger role in providing cultural competency education CONSUMER EDUCATION health information relevant to different understanding, and never assume your patient and resources to both opticianry and optometry schools. While eyecare professionals can play a sizeable role in demographic groups. will not like – or can’t afford – premium eyewear They reinforced a need for industry associations and educating their patients about eye health, they rely on options. Treat all patients as individuals and organizations, as well as optical companies, to develop the industry to provide valuable in-office tools, and to Media Exposure with respect. new multicultural content that can be used within schools more effectively reach those who rarely – or have never To effectively reach specific demographics about or by individual eyecare practitioners as continuing – seen an eyecare professional. Roundtable participants their eye health needs, roundtable participants 6. Use bilingual and in-language materials. Even education opportunities. expressed a need for the following: stressed the importance of targeting local and national if language barriers don’t exist, offering bilingual media. Advertising on television and radio can and in-language resources can help to establish INCREASING DIVERSITY In-Office Resources help to increase awareness and drive consumers to a welcoming environment and show respect for Roundtable participants identified a need for increased Optical associations and corporations can get involved eyecare professionals. Transitions Optical, for example, different cultures. If language barriers become diversity among optical professionals. Increasing by offering complimentary patient education and point- is already reaching Chinese-speaking consumers a larger issue, you may also want to consider the number of minority eyecare professionals in the of-sale materials – including bilingual tools – that eyecare through Mandarin and Cantonese television professionals can use within their practices. advertising on OMNI TV.

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20 21 REFERENCES

1 Projections of the Diversity of the Canadian Population, 2006-2031. 36 The Inroads of Chronic Disease. Volume 3, Chapter 3. Indian and CONCLUSION Statistics Canada, March 9, 2010. Northern Affairs Canada. As the face of the nation continues to change, eyecare 2 Statistics Canada, 2001 and 2006 Census reports. 37 Global Cardiovascular Infobase. Accessed May 2010. professionals must also adapt their practices to better 3 Research Solutions, Inc. Survey of Household Spending, 2006. 38 First Nations Regional Longitudinal Health Survey (RHS). accommodate their culturally diverse patient base. 4 Canadian Ophthalmological Study, 2006. 39 American Academy of Ophthalmology, 2005. Transitions Optical views this roundtable as an initial 5 The Cost of Vision Loss in Canada. CNIB and the Canadian 40 Vision Loss in Canada: Q&A Document. The Cost of Blindness. step in supporting eyecare professionals’ efforts to Ophthalmological Society, 2009. Accessed May 2010. provide more culturally appropriate vision care to 6 Foundations for a Canadian Vision Health Strategy. Vision Health 41 Healthy Diverse Populations: Health and First Nations, Inuit and all patients. Canada, 2007. Métis Populations. Alberta Health Services. 7 Novartis Canada. 42 First Nations, Inuit and Aboriginal Health, Tuberculosis. Health Canada. Despite an urgent need for culturally appropriate vision 8 The Growing Burden of Heart Disease and Stroke in Canada. Heart care, roundtable participants agreed that “multicultural” and Stroke Foundation of Canada, 2003. 43 The Health of the Off-Reserve Aboriginal Population. Health Canada. has historically been a quiet topic in the optical industry. 9 Heart and Stroke Foundation of Ontario, May 2008. 44 TB Epidemic Among Canada’s Native People: Canadian Aboriginals Have Third World Levels of Tuberculosis. Public Health Agency of For this to change, eyecare professionals and the entire 10 Journal of Epidemiology and Community Health, June 2002. industry must first recognize that a need exists – and Canada. 11 The Canadian Encyclopedia, Tuberculosis. Accessed May 2010. then take the time to identify and apply strategies for 45 AIDS 2008 Summary Report. Public Health Agency of Canada. 12 The Chinese Community in Canada; The South Asian Community in providing better care to culturally diverse groups. 46 Public Health Agency of Canada. Canada. Statistics Canada, 2007. 47 Aboriginal Peoples of Canada. Statistics Canada, 2001. 13 Effects of Language Barriers on Patient Access and Care. Health By understanding and meeting the needs of diverse Canada, 2006. 48 Ethnologue: Languages of the World. Gordon, Raymond G. Jr., groups, eyecare professionals have the opportunity 2005. 14 The Chinese Community in Canada. Statistics Canada, 2007. to improve patient care, increase customer satisfaction 49 Nunavut’s Languages. Office of the Languages Commissioner of 15 The South Asian Community in Canada. Statistics Canada, 2007. and grow their practices through long-term patient Nunavut. 16 Understanding Cultural Diversity: Asian American Family Roots. relationships and referrals. 50 Statistics Canada, 2006 Census Profile of Federal Electoral Districts Chan, Sam. Developmental and Behavioral Pediatrics Online. (2003 Representation Order); Language, Mobility and Migration and 17 Vision Care Institute, 2006. Immigration and Citizenship Ottawa, 2007, pp. 2, 6,10. 18 Lack of Awareness of Heart Disease and Stroke Among Chinese 51 Aboriginal Mental Health and Substance Use. Here to Help. Canadians. Chow C, Chu J, Tu J, Moe G. 2008. Accessed May 2010. 19 Profiles of Ethnic Communities in Canada: The African Community in 52 Wikipedia: Aboriginal Peoples in Canada. Accessed May 2010. Canada. Statistics Canada, 2001. 53 Aboriginals Surprisingly Loyal to Christianity. The Vancouver Sun. 20 Economic Benefits of Treatment. Medec’s Ophthalmic Sector Douglas Todd. August 28, 2009. Committee. 54 Aboriginal Peoples Survey, 2006. Statistics Canada. 21 National Eye Institute. 55 HIV/AIDS Among Aboriginal Persons in Canada: A Continuing 22 Ophthalmic Disease in Blacks: Prospects for Eliminating Racial and Concern. Public Health Agency of Canada. Ethnic Disparities in Health in the Public Health Context. Livingston, 56 The Need for an Aboriginal Health Institute in Canada. Health Ivor Lensworth. Canada. 23 Insights from roundtable participant Michael Kaplan, O.D. 57 Statistics Canada, 2006. 24 Healthy Diverse Populations. Alberta Health Services. 58 Statistics Canada, 2001. 25 Canadian Diabetes Association, 2006. 59 A Decade of Northern Ophthalmology. Dr. Elizabeth Cass. Arctic 26 Heart and Stroke Foundation, 2002. Ophthalmology Symposium, 1973. 27 Health Canada, 2003. 60 Insights from roundtable participant Richard Winn. 28 Sarcoidosis of the Eye. Sarcoid Networking Association. 29 The African Community in Canada. Statistics Canada, 2007. 30 The Case for Black Marriage. Hylton, Tricia, 2005. 31 Wikipedia: Eye Contact, Cultural Differences. Accessed May 2010. 32 Strong Black Women. Health Association of African Canadians. 33 Black Canadians: History, Experiences, Social Conditions. Mensah, Joseph, 2002. 34 Ethnic Marketing: A Strategy for Marketing Programs to Diverse Audiences. 35 Aboriginal Peoples in Canada in 2006. Statistics Canada.

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22 23 This publication was produced as a professional education resource by Transitions Optical, Inc.