Wednesday, 06 July 2016 22:29

Canadian Pharma: Know Your Patient

Commentary by Rohit Phillips in Aurora, Ontario

The fast-growing multicultural consumer segment of Canada represents a potential opportunity for pharmaceutical companies, especially if they can improve patient outcomes on a national scale.

For a small or mid-tier drug company battling to make headway in the general market, capturing a large portion of the multicultural market may be the path to improved profitability and growth. 

Ethnic (or “Diversity”) Healthcare is all about the ‘culturally sensitive connection’ to effectively address ‘health and healthcare disparities’ that result from cultural differences. These differences influence the health and well-being of Canada’s growing visible ethnic minority population, which made up to 20 per cent of the total population in 2013 and is projected to grow to 32 per cent by 2031.  

Fifteen years from now, it’s projected that visible minorities will make up 63 per cent of Toronto, 59 per cent of Vancouver, 31 per cent of Montreal.  Together, these three areas will account for 70 per cent of Canadian GDP.

Genetic, Environmental and Cultural Factors 

The factors contributing to varied drug responses are complex and inter-related. Differences in drug response among racial and ethnic groups are determined by genetic, environmental, and cultural factors. These factors may operate independently of one another, or they may work together to influence outcomes.

Biological Factors: The genetic makeup of an individual may change the action of a drug in a number of ways as it moves through the body. Clinically, there may be an increase or decrease in the intensity and duration of the expected typical effect of the drug.

Environmental Factors: Diet, climate, smoking, alcohol, drugs, pollutants —may cause wide variations in drug response within an individual and even wider variations between groups of individuals.

Cultural Factors: Cultural or psycho-social factors, such as the attitudes and beliefs of an ethnic group, may affect the effectiveness of, or adherence to, a particular drug therapy.

Being Culturally Sensitive

Multicultural marketing isn’t just attaching a face to your campaign.

It has more to do with presenting information in a culturally relevant way and context. Isn’t all communication and marketing about better connecting with the audience?

So, what aspects of any ethnicity do marketers and advertisers need to understand to connect their brand messages well?

Here are a few important ones:  

1.       Language: It’s not just about translation from English. The message must be written for and from the perspective of the minority language audience. Health promotion communication should also take into account the visual and oral cultural cues, like pictures and music.

2.       Beliefs: Beliefs can be powerful forces that affect our health and capacity to heal. Whether personal or cultural, they influence us in one of two ways – they modify our behaviour or they stimulate physiological changes in our endocrine or immune systems. Many cultural beliefs have implications for healthcare, which may be direct or indirect.

As an example, many Asians believe that the number four is unlucky because when pronounced in Japanese or Chinese it sounds very similar to the word for “death”. Thus, items arranged in groups of four, such as pills or syringes, can symbolize bad luck for those people who believe in numerology.

3.       Behaviours: Culture has a bearing on the way a person acts in response to a particular situation. Buddhist teachings emphasize ‘’face’’ or dignity. An individual’s wrongdoing causes the immediate family to lose face. Such behaviours have a direct bearing on disease screening and diagnoses as patients may not admit or realize they have health problems, especially mental health problems, as this may bring shame upon their family.

4.       Communication style: Refers to ways of expressing oneself to others and can be very different for a Chinese-Canadian compared to an Indo-Canadian. Older Chinese patients tend to be polite and may smile and nod. Nodding does not necessarily indicate agreement or even understanding of medical facts. Understanding of verbal and non-verbal communication styles of these cultures is critically important during screening, diagnoses and outreach programs.

5.       Notions of modesty: Modesty is highly valued in South Asian culture. An example is an elderly woman who may be soft-spoken and not advocate for herself. Important decisions are made in this culture only after consulting with family members or close family friends. Involving the family and friends in intervention/prevention programs and long-term care for specific ailments like diabetes, cardiovascular disease and cancers can go a long way in increasing compliance, raising awareness and generating brand loyalty.

Despite the many differences among the cultures that make up our nation, we all have the same basic needs: to be able to convey the symptoms and concerns of an illness, to receive competent care, to be acknowledged and valued.

A few fundamentals

When conducting situation analysis and a SWOT analysis of your business plan, the following are important for success:

·         Explore implications of demographic changes (regional and national)

·         Segment patient population by ethnicity

·         Identify differences in disease incidence (determine if your product treats a condition in which a health disparity exists between the ethnic and general populations. For example, is mortality different among ethnic groups in your disease category?)

·         Examine the growth patterns of your customer base

·         Find out from physicians and managed care organizations what issues they encounter in an increasingly diverse population. Then identify challenges and opportunities your company can pursue

·         Find out what your competition is doing to serve the needs of the “emerging majority”

Rohit is a seasoned healthcare marketing and advertising professional with an entrepreneurial instinct and a degree in pharmacy. Rohit is currently employed with The Gibson Group, a healthcare communication agency in Canada.

Published in Health
Tuesday, 15 July 2014 16:22

Filipinos in Canada: Behind the Numbers

by Noel Tarrazona in Manila

The Canadian government forecasts that there will be one million Filipino immigrants in Canada by 2025, marking a 50 per cent increase from today. If immigration to Canada is a horse race between competing nations, China, India, the Philippines and Pakistan have the inside track, with Filipinos being the current “favourites.”

New Canadian Media decided to partner with the Asian Pacific Post (APP) - Filipino Post to go behind the numbers and see how newcomer Filipinos are doing. We also spoke to three academic researchers who study migration from the Philippines to understand this movement of people and what it means for Canada. Please click on the plus (+) signs to read comments by the researchers. Our main finding based on a few random interviews: While most Filipino immigrants have stayed and embraced Canada as their new home, some of them have gone back to practice their professions.

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[toggle_item title="Dr. Philip Kelly, York University" active="true"]The Philippines was the #1 source country for immigrants to Canada in 2010 and 2011, but by 2012 it had fallen back to second place behind China.

There are two reasons for the recent prominence of the Philippines. One is that the numbers arriving in the Live-In Caregiver category spiked quite dramatically around 2010 -- reflecting an expansion in demand for the program around 2007-2008 (caregivers have to spend two years as temporary foreign workers before they can apply for PR [Permanent Resident] status, hence the time lag).The other reason is that the Provincial Nominee Program has expanded hugely in recent years, mainly in Western Canada. This has been a major channel for new arrivals from the Philippines, especially to Manitoba, which has a very large Filipino community.

The other factor that might be added is that language and educational requirements have been increased, which would favour applicants from countries such as the Philippines, where English is widely spoken and tertiary education is geared towards the needs of the global labour market. That said, the expansion in Filipino migration hasn't been in the federal skilled worker category, where such factors are most important, so it's probably not the most significant explanation.  Dr. Philip Kelly, Director, York Centre for Asian Research (YCAR), Professor, Department of Geography, York University[/toggle_item]
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This reverse migration is no different from trends for other nationalities, reported by StatsCan as far back as 2006.

Few case studies

Philippine dentist Mike Muin was a university dentist in the southern Philippines when he applied for a family immigrant visa. His family landed in Ontario as immigrants in 2013, but Mike’s credentials as a dentist were not recognized in Ontario unless he took a Dental Challenge Exam. For a year, he never practised dentistry and so he decided to fly back to the Philippines with their youngest son. According to Mike, he is happy working as an associate dentist in a Philippine city.

Muin told NCM-APP that he is still in a quandary whether or not to return to Ontario, where his wife, Rose, and their eldest son still reside. Rose says that for her the Philippines is still an ideal place to raise her children because parents have more time to monitor their children as they grow up. “If I were to choose between Canada and Philippines, I would still choose the Philippines to raise my children where families can spend more time together,” Rose said.

In another case, an assistant professor from the Philippines, who requested anonymity, saw Canada as a potential place for a social sciences academic. He landed as an immigrant in Vancouver in October 2011 and submitted his credentials to the University of British Columbia, Douglas College, Vancouver Community College and Simon Fraser University. Not one of the schools recognized his credentials. He was advised to take bridging courses. The graduate school professor ended up as a labourer for two months in a logistics company on Annacis Island.

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[toggle_item title=Glenda Bonifacio, Ph.D., University of Lethbridge" active="true"]
Philippines is quite complex to compare with China and India. India has historical ties with Canada as a former  British colony. China is also different as it has historical roots with racialized labour prior to the institution of the points system. Philippines is a postwar (WWII) immigrant source nation for Canada, but has historical ties to US as a former colony. Restrictions faced by those initially planning to go to the US find immigration streams to Canada favourable at some point.

Chain migration is also a feature of Filipino permanent migration in Canada. As well, Filipinos are family-oriented and sponsor family members when they can to the country. By family, it means an extended family and sponsorship implicates many things -- direct sponsorship for parents and qualified siblings, or indirect sponsorship thru offering housing arrangements for relatives and fictive relations. When the path for those extended family members are clear, then another family chain of sponsorship begins. All source countries display similar patterns of chain migration.

Aside from this, Filipinos are highly educated and highly skilled that they most often comply with the independent skilled migration to Canada. They have higher adaptability of integration into Canada since English is the language of education and business in the Philippines, with no need for them to take language classes like other immigrants in Canada. In other words, Filipinos are ready workforce upon entry into Canada. As well, Filipinos are western-oriented into democracy and shared liberal values as coming from the 'showcase' country of U.S. imperialism. In short, Filipinos have higher adaptability to western lifestyle (including shared beliefs in western Christianity, women's empowerment) that enable them to maximize the opportunities in Canada. – Glenda Lynna Anne Tibe Bonifacio, Ph.D., Associate Professor, Department of Women and Gender Studies, Research Affiliate, Prentice Institute for Global Population and Economy, University of Lethbridge, and Collaborator, Pathways to Prosperity Partnership[/toggle_item]

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Feeling demoralized, he flew back to the Philippines and went back to the university he used to teach at. He wrote scholarly publications and his internationally published publications were cited by North American university journals like the University of Bridgeport in Connecticut and other best-selling books on security. Canada would have had that honour if the professor was absorbed by one of the schools he had applied to. 

When asked if he was willing to return to Canada, the graduate school lecturer said, “Probably, if most universities will start to recognize our credentials.”

Expert advice

Vancouver-based Filipino immigration analyst Manny Noel Abuel observed that Filipino immigrants return to the Philippines when they don’t find jobs similar to work they had before moving. “You must be willing to start a new life -- like a baby -- where you need to learn how to walk your way to success no matter how challenging the road is.

“When I came to Canada in 1988, I only have $1,000 (U.S.) in my pocket, with three children, but I had to face reality and was determined to succeed in this country,” Abuel said. She also head the media bureau of the Filipino Advent Believers in British Columbia and is a practising communications consultant.

The same advice was shared by Evelyn Yadao, an immigration consultant of Grand Migration Canada. She countered that skilled Filipino immigrants who have gone back to the Philippines should consider returning to Canada because in the long run they will appreciate what this country will do for them. Yadao is also the National Convenor of PLS (Progressive Learning Space) for Kids program, a Canada-based program helping educate displaced Filipino children caught in the war in the Southern Philippines.

Immigrants who stayed

While some Filipino immigrants returned to the Philippines, most Filipino immigrants have decided to stick it out. They have embraced Canada as their new home and have decided to pledge allegiance to Canada’s citizenship once they meet their residency requirements.

Working in the Middle East for years, Filipino Edwin Nodora landed in Canada with his family in 2011 and started working as a maintenance crew in a mall in Richmond. But three years later, he now works in a job where he can use his engineering background.  In his first year, he was tempted to return to the Middle East, but he resisted and eventually got the job he wanted.

Edilberto Javier landed the same year with his family and got employed as a cleaner at Lowe’s, a hardware store, but after three years, he was promoted to Product Service Associate.

[toggle_box]
[toggle_item title="Denise L. Spitzer, Ph.D., University of Ottawa" active="true"]Labour migration has been regarded as vital to the Philippine economy for decades, relieving pressure on un- and under-employment in the country and contributing to the economy through the receipt of remittances from overseas workers. The Philippine government has developed a highly sophisticated state apparatus whose aim is to facilitate labour migration. Among its activities, state agencies engage in ongoing surveillance of the global economy to determine emerging markets and to identify the types of skills that will be in demand in order to prepare Filipino labour migrants for overseas deployment.

Furthermore, the state regulates labour recruitment agencies who “sell” Philippine labour abroad and broker employment contracts across international borders. For their part, employers may express a preference for Filipino workers because of their facility in English and their generally high level of education.Denise L. Spitzer, Ph.D., Canada Research Chair in Gender, Migration and Health, Associate Professor, University of Ottawa, and Collaborator, Pathways to Prosperity Partnership[/toggle_item]

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Jeanette Co- Lim faced a tough challenge when she landed in Canada in the same year, because she could not find the job she wanted, but in her third year, she finally found the right job as an assistant accountant.

“The toughest challenge is  when employers here doubt your credentials, so we have to prove to them that we can do the job, and from there the employer will assign you the job that rightfully belongs to you,” Co-Lim said.

Top ranking

The Philippines became the largest source of immigrants in 2010 when Citizenship and Immigration Canada (CIC) figures show 36,000 Filipino immigrants came to Canada. The next two years have brought 35,000 and 33,000, respectively.

While young Filipino immigrants are helping to replace Canada’s ageing workforce, the Philippine economy in turn also gets over $2 billion (U.S.) in remittances every year.

Further, Tagalog is the fastest growing language in Canada and is the fifth most common non-official language spoken in Canadian households. Statistics show nearly 279,000 people reported speaking Tagalog most often in 2011, up from 170,000 five years earlier.

Canada has also remitted more than $20 million (U.S.) to help rebuild two major cities in the Philippines -- Tacloban and Zamboanga – after they were devastated by a super typhoon and attacked by rebel separatists in 2013.

Noel T. Tarrazona is a Filipino immigrant of Vancouver and is completing his Doctor of Pubic Administration in the Philippines. He can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it.

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Published in National

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