Black Canadians’ Experiences of Structural Racism in Ontario’s Healthcare System

Background: Despite Canada’s universal healthcare system, Black Canadians continue to experience inequitable access to services. While much of the literature has examined urban centres such as Toronto and Montreal, little is known about experiences in mid-sized cities where healthcare systems are less resourced and culturally diverse. This study explores how structural racism and intersecting barriers shape healthcare access for Black Canadians in Kingston and London, Ontario. Methods: We conducted a qualitative secondary analysis of 25 semi-structured interviews with Black parents and caregivers (2023–2024) from a mixed-methods study on early learning and childcare. Although the parent study focused on childcare, participants frequently described healthcare challenges, which prompted a re-analysis of these narratives. Using a hybrid inductive and deductive thematic analysis, transcripts were coded through the lens of Critical Race Theory (CRT) and Structural Violence Theory (SVT), emphasizing both systemic inequities and community-based strategies of resilience. Results: Five overarching themes emerged: (1) Institutional Racism and Cultural Incompetence, where participants reported dismissal, disbelief, and lack of culturally responsive care; (2) Structural Violence and Delayed Access, where immigration-linked exclusions, long wait times, and economic barriers limited access; (3) Intersectionality, where race, gender, immigration, and socioeconomic status compounded disadvantage, with Black women describing gendered racism in maternal care; (4) Informational and Communication Barriers, where newcomers relied on informal networks and Google due to weak institutional guidance; and (5) Community-Based Resilience, where churches, diaspora networks, and midwifery care provided culturally safe alternatives to formal systems. Conclusion: Findings demonstrate that healthcare inequities for Black Canadians in smaller cities are not incidental but structurally embedded. CRT and SVT reveal how systemic racism and bureaucratic inaction reproduce harm while communities develop parallel infrastructures of care. Addressing these inequities requires race-conscious health policies, investment in culturally safe services outside metropolitan centres, and intentional inclusion of Black voices in healthcare planning.