Background: In Canadian healthcare, systemic racism subverts the commitment to universal coverage by building inequities into the system of governance, regulation, and clinical practice. While racial disparities have been documented, little attention has been paid to how institutional structures perpetuate these inequities. Objective: This paper critically examined the organizational aspects of racism in the Canadian healthcare system. It aims to identify structural obstacles faced by racialized patients and foreign-trained physicians, and to provide policy recommendations grounded in evidence. Methods: A narrative review framework is used for qualitative document analysis. Public inquiries (e.g., Truth and Reconciliation Commission, Viens Report), government audits (e.g., PHAC, CHRC), case files (e.g., Brian Sinclair, Joyce Echaquan, and Dr. Akinbiyi), and peer-reviewed publications between 2000 and 2024 were the sources of the data. Thematic coding occurred across four areas: (1) institutional discrimination, (2) licensing and workforce exclusion, (3) patient and cultural safety, and (4) accountability gaps. Results: The review found continuing institutional disregard for Indigenous and Black patients, and the disparities were most marked in emergency and maternal services. Internationally educated doctors are confronted with opaque and delayed credentialing procedures that can solidify workforce disparities. Case examples demonstrate how system failings, such as disregarding patient suffering, ignoring cultural requirements, and lacking effective oversight, cause harm. It is a recurring pattern that recommended action is not taken following a review, suggesting organizational resistance to change . Discussion: Canadian systemic racism in healthcare occurs through omissions (failure to act on reform) and commissions (institutional exclusion). To tackle this, it is to entrench antiracism in legislation, make cultural safety training a requirement, collect race-disaggregated data, and transform licensing routes. Conclusion: Universal healthcare is not equitable unless it eliminates systemic racism. Systemic changes that recalibrate healthcare governance according to the values of antiracism and equity are necessary to provide safe and inclusive care.
Adegoke et al. (Mon,) studied this question.