The diversity of diversity: Canadian-American differences and their implications for clinical training and APA accreditation [American Psychological Assn]

Abstract

When Canadian clinical training programs seek APA accreditation, they face a problem in communicating the unique features of Canadian society relevant to their programs and to the APA criterion relating to "diversity." This is frequently a basis of misunderstandings that emerge in informal comments and final reports. This article reviews the differences between Canada and the United States in terms of well-being, social policy, and the nature of diversity within each nation. It outlines the relevance of these factors to Canadian clinical programs. The review can assist Canadian programs preparing APA accreditation.

The American Psychological Association (APA) has accredited 18 university programs(f.1) and 18 internships in clinical and school psychology in Canada, using a joint process with APA and the Canadian Psychological Association. The evaluation of a program may reveal problems that are eventually reconciled, but one theme that has been a source of difficulty relates to Domain D of the criteria (American Psychological Association, 1996), concerning "cultural and individual differences and diversity." Problems with Domain D have also occurred in U.S. programs, generating criticism of the way programs have been increasingly sanctioned for failure to satisfy these criteria. Critics there have argued that often the criteria of diversity that are emphasized concern a narrow list, essentially race, disability, and sexual orientation (Rickard & Clements, 1993). In fact, race normally dominates APA documentation about minorities, surveys routinely seek program information about diversity defined racially, and APA pressures its committees to incorporate this racially defined minority representation (Thorn, 2000).

Domain D problems also occur when APA site team members from the U.S. examine Canadian programs. Informal evidence from directors of these programs suggests that U.S. examiners are looking for race-based evidence that people of African origin are present and are featured in training materials and settings. Canadian directors have been asked by American examiners, "Where are your blacks?," and have been told "you all look pretty white to me." (Hard data are difficult to get as colleagues advise me these and other events are not for attribution for fear of endangering their accreditation.) Finding little evidence of the expected representation of African (or Hispanic) visibility in students and faculty, U.S. examiners describe the program as having limited diversity. The problem continues at the Committee on Accreditation, where diversity criticisms have led to requests for "supplemental information," "further clarification," and to final reports referring to the Canadian programs' insufficient efforts to address the cultural diversity domain.

These examples suggest a narrow construal of diversity in APA criteria, arising from U.S. attempts to ameliorate social problems related to their important racial minorities. In contrast, as this review will show, the diversities upon which Canadian clinical training programs in psychology ought to focus are significantly different, and largely are not correlated with race or social problems.

To understand the "diversity of diversity" in the two nations, I will first review U.S. and Canadian societies across indicators of well-being relevant to psychological practise, documenting significant differences. I will then review the different nature of minorities in Canada, and examine how these relate to Canadian clinical programs and accreditation. Finally, I will propose a way of approaching diversity in our multicultural country that avoids stereotyping while advancing cultural richness.

Psychosocial Differences Between Canada and the United States

Our two nations are similar in many ways, deriving from common roots in the United Kingdom. Similarities include a commitment to democracy, universal education, universal adult franchise, the rule of law, and freedoms of religion, speech, and association. Both countries are affluent and developed. In addition, however, they have significant psychosocial differences that affect clinical practise, and Canadian programs will have features that validly differ from the APA template. In reviewing these differences, numerical data are taken from the official census and statistical tables of each nation for 1996 or the year indicated (accessible from the Internet at http://www.statcan.ca for Statistics Canada, and http://www.census.gov for the U.S. Census).

Population. Canada is slightly larger than the United States but has a vastly smaller population, with 1/9 the density. Urban life in Canadian cities is characterized by a higher quality than found in U.S. cities (Barber, 1995). Although Canadian cities have districts of social dysfunction, they do not have large dense regions of inner city decay that concentrate people into homogeneous impoverished areas defined primarily by race. Table 1 shows some comparisons

Income. Average family income is higher in the United States by about US$2,200 (MacKinnon, 1998) although Canadians' median after-tax income is marginally higher (Wolfson & Murphy, 1998). Canadian income inequalities are less for all family types (Blackburn & Bloom, 1993), and this relates to minority well-being; health and mortality are not associated with income in Canada although they are in the U.S. (Ross et al., 2000). Some comparisons are in Table 2.

The U.S. has a smaller and shrinking middle class (Burkhauser, Cutts, Daly, & Jenkins, 1999), while Canada has a larger and stable middle class (Atkinson, Rainwater, & Smeeding, 1995; Drohan, 1994; Wolfson, 1997). Income is more dispersed among the lower quintiles in Canada (Picot & Myles, 1995; Statistics Canada, 1996b) because of government transfer payments that yield increases in family income greater for the poorest (Statistics Canada, 1997), a pattern opposite to that seen in the U.S. There is a substantially larger proportion of poor people in the U.S., whether the criteria used are of absolute (Atkinson et al., 1995) or relative poverty (Blank & Hanratty, 1993).

Social spending policy and well-being. Canada spends 2-3 times as much of its tax income on transfer payments (e.g., pensions, unemployment insurance, and social welfare) to individuals, and this provides higher income and transfers to a larger portion of the poor (Blank & Hanratty, 1993), reducing income disparities to a much greater extent than happens in the U.S. Canadian programs are typically universal rather than meanstested as in the U.S., yielding administrative efficiencies. Canada's social spending reflects widespread consensus; there is greater participation in the democratic process with national voter participation rates of 69%, compared to 49% in the U.S. (United Nations, 1998).

Canada's use of taxes accounts for nearly all the national differences in the poverty rates of vulnerable groups and contributes to greater Canadian well-being. The United Nations Human Development Program reports annually on a Human Development Index in 160 nations based on quality of life indicators including life expectancy, education, and income. Canada ranked first on this Index for the past five years and never lower than second since the evaluations began (United Nations, 1998). The United States has ranked at an average of 4.5, ranging down to 8th.

Education. Both Canada and the United States have extensive post-secondary education systems. The proportion of young adults who have completed upper secondary education across three generations has now increased to similar levels of 80-90% (OECD, 1998). Nevertheless, there are differences reflecting the greater socio-economic homogeneity in Canada. Among youth whose parents have completed high school, Americans score 2-3 years lower on international literacy tests than Canadians (Willms, 1999). Table 3 shows this and other comparisons.

More striking differences concern universities. In Canada, virtually all universities are publicly funded; tuition costs thus play a more limited role in student costs. All college and university entry is by academic competition; in the U.S., 60% of colleges admit nearly all who apply (Kane, 1998) and land-grant state universities provide automatic entry for high-school graduates. Canadian entry and drop-out rates are lower.

Health. The two countries have health services that include high levels of technology. There are, however, significant differences in health, in access to treatment, and in satisfaction with health services. Across virtually all the major indicators of health, Canadians are considerably better off; as well, mortality is not correlated with income inequalities as it is in the U.S. (Wolfson, 1999).

Canadians have better physical and mental health than Americans (Kessler et al., 1997; Starfield, 1991); poor Canadians have better health than poor Americans (Ross et al., 2000). In a 1997 international comparison by The Economist Intelligence Unit, Canada ranked 4th in general health among 27 developed countries, compared to 13th for the U.S. Canada has lower death rates, maternal mortality rates (Euromonitor International, 1997; Health Canada, 1999; Turner, 1998), longer life expectancy (World Bank, 1999), a greater proportion surviving to age 60 (United Nations, 1998), broader child immunization for polio and measles (Euromonitor International, 1997; Federal Interagency Forum on Child and Family Statistics, 1999), more years free of disability, and half the obesity rate (OECD data cited in Gilmore, 1999). Even in its poorest neighbourhoods, Canada has better infant mortality rates (Wilkins & Houle, 1999).

In terms of disease, Canadians have 1/39 as many AIDS cases (at a rate that is 75% less than that in the U.S.), lower incidence and better five-year survival rates for cancer (Gorey et al., 1997), and lower mortality rates for heart disease (Jee & Or, 1999). Cancer survival rates are correlated with income in the U.S. but not in Canada (Gorey et al., 1997). Canada has less use of illicit drugs (Single, MacLennan, & MacNeil, 1994) and a lower prevalence of psychiatric disorders (Kessler et al., 1997).

The better health of Canadians relates to a significant national difference: The use of taxes for universal health care, which has been in effect since 1970. Health care is rationed by medical judgments and system funding. Poor Canadians increased their use of health services after universality (McDonald, McDonald, Salter, & Enterline, 1974) and now use physician services more than rich Canadians (Johansen & Millar, 1999). In the U.S., health care is a commodity rationed by individual income. More than 16% of the 1997 population (about 43.3 million; 40% of poor families) have no health insurance (Angell, 1999).

The costs of the two health care systems also differ significantly. Canadian costs are relatively stable at about 9% of GDP. U.S. costs are about 50% higher and represent more than 14% of GDP. Health care costs have risen faster in the U.S. over 30 years (Passell, 1993). The editor of the most prestigious American medical journal concluded, "The American health care system is at once the most expensive and the most inadequate system in the developed world..." (Angell, 1999, p. 48).

In the past, Canadians have reported more satisfaction with their health care. Compared to 10 developed countries, Canada had an index score of 7.6 (where the Netherlands was highest/best at 9.0), and the U.S. index was 0.2 (Starfield, 1991).

Families. There are significant differences in families in the two countries, with more intact Canadian families. In Canada, 14% of families are headed by single-parents (compared to 27% in the U.S.), and traditional married couples comprise 87% of Canadian families compared to 54% of American. The Canadian divorce rate per 1,000 population is 2.2 (about half the U.S. rate of 4.3). Canada has less than one-half the U.S. rate of teenage pregnancies (22.1 per 1000 births vs. 52.9 in the U.S.).

Crime and corrections. The two nations differ on virtually every major index of crime and social unrest. Crime is more prevalent and violent in the U.S. and incarceration is a more significant element in life (Table 5). Capital punishment ("judicial homicide" in U.S. data) has not been used in Canada for several decades, and was abolished in 1976. Across 133 years of history less than 100 citizens have died in political strife in Canada (Saul, 2000).

Incarcerated offenders with major mental disorders are treated differently in Canada and the U.S. In Canada, these types of offenders are sent to hospitals within the corrections system. In the U.S., the care of mentally ill offenders varies widely across states and municipalities and is subject to local budget allocations.

SUMMARY OF NATIONAL DIFFERENCES IN WELL-BEING

When considered separately, none of the national differences in population density, income distribution, education, health, family life, or crime appear to speak to a need for a different national model for clinical training in diversity. They provide, however, a necessary overview of well-being in the two populations as a context for understanding the different situation of minorities in each country.

Cultural Diversity: Minorities in Canada and the United States

Canadians and Americans differ in cultural diversity and in the nature of minorities. Diversity is examined by creating smaller homogeneous clusters of individuals using criteria of inclusion/exclusion. Individual differences that are biological and visible (e.g., race, sex, physical abilities, and age) provide one basis for groupings. Another method is to cluster nonvisible but significant cultural groupings (e.g., based on language and ethnicity).

VISIBLE RACIAL DIFFERENCES AS A GROUPING VARIABLE FOR DIVERSITY

Although there is ongoing dispute as to the usefulness of the concept of race, (Helms & Talleyrand, 1997), visible differences associated with geographic ancestry provide a way of grouping minorities. In the U.S., this race-based system is the most prominent way of grouping people, with Blacks, Hispanics, Asians, and Natives representing the minorities of most interest to the Census and to APA. (U.S. Census reports use the term "Blacks" in their tables. The Canadian Census used that term for the first time in 1996. It will be used here, as well, for individuals with African ancestors.) Canada is very different in grouping by race.

"Race" in Canada. From 1901 to 1996, the Canadian Census did not collect data on race comparable to those collected in the U.S. Questions related to race were considered to be inherently discriminatory and thus illegal. This restriction prevented problems inherent in racial categorization that occur in the U.S., where race, language, and ethnic origins are illogically mixed together. (The U.S. Census perpetually has to footnote "Hispanic" in its racial tables to explain that Hispanics may be of any race.) Further, from Canada's earliest history onward, there has been significant mixing across traditional racial categories, starting with the First Nations people who hunted for, and married, the fur traders. This pattern did not develop in the U.S. for either Aboriginal people or Black slaves.

In Canada before 1996, language and birthplace were combined to create a proxy variable for "visible minority" (VM) groups (Kelly, 1992). In 1996, VM groups were directly counted for the first time, defined differently from U.S. categories. Canadians were asked to indicate if they came from one or several visible minority origins from a list of 10 geographical categories. Recent newspaper articles report that the 2000 U.S. Census will offer a list of six plus the Canadian-style option of checking all that apply, yielding 63 different "racial" categories, up from four in 1990 (Holmes, 2000).

The recent change in census practise has not led to any extension of racial tagging of individuals in Canadian social institutions. Universities continue to treat any question about the race of an applicant as inherently discriminatory and illegal. This prevents Canadian programs from knowing and, thus, reporting race of applicants to APA.

All visible minorities represent a portion of the American population that is 55% larger than that in Canada. In the U.S., visible minorities comprise 17.2% of the population compared to 11.2% in Canada. Canadians do "look whiter." The racial composition of Canadian and American populations is also very different (Table 5).

In Canada, there is substantial overlap between the categories of "immigrant" and "visible minority." Almost 80% of Canada's visible minorities are foreign-born, while 63% of immigrants are visible minorities. Asians comprise 63% of all visible minority immigrants to Canada (Kelly, 1992), while the largest VM group in the U.S. is Black. About the same number of Canadians are Black, as Americans are Lithuanian-born.

CULTURAL ORIGINS OF VISIBLE MINORITIES

In addition to the profoundly different racial proportions in the two countries, there are major differences in the cultural characteristics of the visible minorities. In Canada, 62% of visible minorities have a mother tongue that is neither French nor English, and 9.4% do not know French or English (Statistics Canada, 1996a). Most American visible minorities speak English and are not foreign-born.

Canadians and Americans of African origin. In the U.S., most Africans came from a narrow band of West African cultures. They arrived forcibly through slavery and have been present for many generations. During this period they have struggled for full citizenship and better living conditions. As a group they display American culture and have English as a mother tongue.

There are vastly fewer Canadians of African origin, and they are far more culturally heterogeneous. All have come through voluntary migration from diverse origins; most have come in recent years. The earliest were individuals who fled to Nova Scotia as escaped U.S. slaves during the Civil War. Acquisition of slaves was outlawed in Canada in 1793; ownership was outlawed in 1833 throughout the British Empire. More recently (1960-1990) they include U.S. men fleeing the Vietnam draft, Caribbean migrants (Jamaican to Toronto, Haitian to Montreal), and Somali migrants of mixed African, West-Asian, and Caucasian origins to Toronto. Each group represents a distinct historical, cultural, linguistic, religious, and racial mixture, and they are not a culturally homogeneous "Black" group.

Canadians and Americans of Asian origin. There are differences between the U.S. and Canadian Asian migrant populations. In Canada, Asian migrants represent 63% of all Canadian immigrants (Statistics Canada, 1996a). They have migrated, mostly in recent years, from a wide array of cultures and languages ranging across East Asia (mainland China, Hong Kong, Singapore, Vietnam, and Japan), South-East Asia (the Philippines), South Asia (Pakistan, India, and Sri Lanka), and West Asia (Turkey and Lebanon). Asian migrants to the United States have come from a narrower range of nations, mostly from East/South-East Asia (the Philippines, Korea, Vietnam, and Hong Kong). More Asian migrants than not have been members of American society for more than one generation and speak English as their first language.

Canadians and Americans of First Nations/Aboriginal origin. The two nations have very different histories in terms of relations between early European migrants and Aboriginals. From the earliest days of French-Canada, Aboriginals worked with, and married, the French and Scottish fur traders; policies were developed to avoid conflict and enhance this work. Agricultural settlement by Europeans was small-scale and occurred slowly. This rate of settlement allowed for the development of treaties in advance of migration and led to peaceful coexistence. These treaties provided mutual advantages to both parties and, thus, were largely honoured by both Aboriginals and Europeans. In the U.S., agricultural settlement was large-scale and rapid. Agricultural development resulted in massive, forcible displacement of Aboriginals from eastern treaty regions ever westward, decades of Plains Indian wars undertaken by the U.S. Army, and large-scale thefts of lands that had been assigned to Indians by treaty. Across the plains of Canada, there were very few open conflicts, no military or police units created to fight Indians, and no Indian wars. Thus, Canadian Aboriginals survived at higher rates, rising from 220,000 at European arrival (McInnis, 1959) to 799,000 today. Estimates place the number of Aboriginals in the U.S. at first contact at one million falling to 200,000 by 1890 (Hofstadter, Miller & Aaron, 1959), and rising to 2.28 million now.

IMPLICATIONS OF VISIBLE MINORITIES FOR PUBLIC POLICY

Visible minorities in Canada and the United States represent different cultural features. The high proportion of VMs within the U.S. has led to much social policy directed toward those groups, especially toward Blacks whose visibility is correlated with disadvantage. In Canada, the largest VM group (recently migrated Asians) represents a minority that does not suffer disadvantage and, indeed, is advantaged on key indicators. In Canada, most VMs are also non-English-speaking immigrants, whereas in the U.S., the largest VM (Black) is native and English-speaking. These differences demonstrate the inappropriateness of using racial visibility as if it were a culturally homogeneous and psychologically meaningful minority index within Canada.

Even more significant differences exist in terms of other minority groupings based on cultural criteria. In Canada, mother tongue and foreign-birth minorities are numerically and culturally far more important than are racial groups.

LANGUAGE AS A GROUPING VARIABLE FOR DIVERSITY

The two countries differ significantly in terms of the role of language in their national cultures. With respect to diversity in Canada, linguistic minorities represent a vastly more important issue. The largest Canadian minority group (linguistic, French mother tongue, 22%) is a much larger group in the Canadian population than is the largest minority group in the U.S. (racial, Black, 12.6%). Canadians whose mother tongue is neither French, nor English represent a larger minority group within Canada than Blacks represent in the U.S.

A far greater proportion of Americans speak English at home (86% vs. 67% in Canada; U.S. Census Bureau, 1998). In Canada, more people speak French at home than those who speak all non-English languages in the U.S. (22% vs. 14%, respectively). A further 10% in Canada do not speak either official language at home.

Mother tongue data are even more extreme because of the greater proportion of Canadians who are first-generation immigrants. Forty percent (40%) of Canadians do not speak English as a first language; of this group, French-speakers account for 24% with the remaining 16% speaking neither English nor French as a first language. Individuals who speak neither English nor French as their first language represent a culturally powerful group in Canadian life. Sixty-three percent (63%) of visible minorities are immigrants whose mother tongue is neither French nor English, and 10% of visible minorities do not know either French or English (Statistics Canada, 1996a). The impact of mother tongue is striking in Canada's cities. Toronto offers telephone translation in 148 languages for citizens needing to deal with the city, as nearly 40% speak neither English nor French (Purvis, 1999). In Richmond, British Columbia, which adjoins Vancouver, 45% of the students have neither English nor French as their mother tongue; their first language is mostly Chinese. Vancouver sends property tax assessment cautions in 10 languages, 6 of which do not use the Roman alphabet.

FOREIGN BIRTH AS A GROUPING VARIABLE FOR DIVERSITY

Although the United States is widely seen as an immigrant-rich country, foreign-born migrants represent a far higher proportion of the Canadian population. Canada has almost twice as many new immigrants per capita as does the U.S. (17.4% vs. 9.6%, respectively). Canada is the least culturally homogeneous of all Western nations, with 25% homogeneity compared to 50% in the U.S. (Kurian, 1991).

The origins of immigrants are also significantly different. The largest group of Canadian immigrants comes from Asia (57%) with the next largest group coming from the United Kingdom (13%). The largest group of immigrants to the U.S. comes from Central and South America (36%), with a much smaller group coming from Asia (17%).

In both countries, immigrants are highly urban in their settlement preferences. In Canada, 93% of all adult migrants settle in urban areas (Kelly, 1992), with nearly 75% settling in Toronto, Vancouver, and Montreal (Siemiatycki & Isin, 1997). The substantially higher rates of immigrants in Canada become an even higher percentage in cities. These immigrant settlement rates differ significantly from those in U.S. areas. In 1996, Toronto (48%) and Vancouver (35%) had the highest rates of foreign-born immigrants; in comparison, Miami (34%), Los Angeles (27%), San Francisco (20%), and New York (20%) had the highest rates in the U.S. (Siemiatycki & Isin, 1997).

In Canada, mother tongue and foreign birth define the most prevalent and culturally powerful minorities. In terms of diversity, these groupings require attention in clinical training programs, rather than the race-based groupings used by APA.

MINORITY STATUS AND WELL-BEING

The relationship between minority group status and well-being is not the same in both nations. Income is a greater determinant of well-being in the U.S. than in Canada. In the U.S., minority status is correlated with income disadvantage; thus, minority groups there tend to do poorly across most indicators of well-being.

Minorities and income. Canada's two significant minorities (French-speaking and foreign-born) represent groups of similar or better economic condition when compared to the majority (Blank & Hanratty, 1993; Green, 1999); Lian and Matthews (1999) state that, "...at most educational levels, Canadians of French ethnicity now earn significantly more than those of British ethnicity when other variables are controlled."

There is an almost complete disappearance of any relation between foreign birth and occupational status in Canada, which is better than that of the native-born; the opposite pattern appears in the U.S. (Boyd et al., 1981). Income of Canadian immigrants varies significantly by migration recency. Their income is 5.7% higher than native-borns' (Statistics Canada, 1998c); in the U.S., migrants' incomes are 16.9% lower. Independent migrants to Canada have better occupational mobility, earnings, and occupational status than Canadianborn. These rates are somewhat lower for immigrants not speaking French or English (Green, 1999). Among the 78% of visible minorities who are foreign-born, income is determined by migration recency, age, and part/full-time work (Drolet & Morissette, 1999). Among Canadian-born visible minorities, income is 4% below that of other Canadians when age and part/full-time status are controlled (Statistics Canada, 1998c).

Across all visible minorities in Canada income is 15% below the national mean (Statistics Canada, 1998c), while mean household income of the main minorities in the U.S. is 25.2% below the national mean (U.S. Census Bureau, 1998). Differential incomes found among selected smaller groups within Canada are essentially accounted for by educational achievement (e.g., Aboriginals; De Silva, 1999.) Although visible minority status in the U.S. is more independent of the migration and linguistic complications found in Canada, U.S. poverty still correlates more highly with VM status (Blank & Hanratty, 1993).

The main Canadian minorities have better social conditions and benefit from a different pattern of government transfers to the poor. Consequently, there has been less impetus to develop social policy that promotes selective income improvements for minority groups. Smaller minority groups (foreign-born and racial) experience the most disadvantage in the early years after migration.

Minorities and health. Income is not a major determinant of health in Canada because of the universality of health care. The two main minority groups do not differ from the majority on any of the main measures of health. The foreign-born/visible minorities have better health (Chen, Ng, & Wilkins, 1996), live longer, and have more disability-free years than Canadian-born (Chen, Wilkins, & Ng, 1999). U.S. minorities are characterized by disadvantage on all major health indicators. They have worse rates of infant and maternal mortality, life expectancy, death from murder, and disease-related death rates; these rates reflect a difference in access to health care based on differences in income (Plepys & Klein, 1995). Race probably functions as a proxy variable for income (which provides a disadvantage in the fee-based system); income inequality is correlated with morbidity in the U.S. (Lynch, Smith, Kaplan, & House, 2000).

Minorities and education. There are only minor variations in education in the main Canadian minority groups. There are no differences in the proportion of university-degree holders in predominantly English-speaking Ontario and French-speaking Quebec, which represent Canada's two largest provinces. The proportion of university-degree holders has risen dramatically in Quebec in the last three decades (Statistics Canada, 1998b). The second-largest Canadian minority (foreign-born) has a mean level of education higher than that of Canadian-born; 35% of the foreign-born aged 25-44 vs. 19% of Canadian-born have university degrees (Statistics Canada, 1998a). University degrees are possessed by 18% of VM Canadians (ranging from 9% to 36% by origin) (Kelly, 1992), compared to 11% of non-VM Canadians over 15 years of age.

University education for the small minority (2%) of Canada's earliest migrants, the visible First Nations, has special support features. For decades, all Indian and Inuit university students have been fully supported by a program funded by the federal Department of Indian Affairs and Northern Development and administered by native bands. This support includes full tuition, living expenses, travel costs home, daily transportation, and daycare. Those who do well can receive additional awards and scholarships. As a group, First Nations people are 10 years younger than the Canadian mean, more live in remote regions, and complete secondary school at lower rates. These factors affect proportions attending university more than does income. Many Canadian universities offer additional help to Aboriginal applicants through special admissions, programs, and scholarships.

Racial minority status in the U.S. is associated with significant differences in educational achievement. In the U.S., 83% of Whites and 84% of Asians over 25 years of age have completed high school compared to 74% of Blacks and 55% of Hispanics (U.S. Census Bureau, 1999). U.S. minority educational disparities correlate with economic factors reflecting family composition, for example, female-headed households, and community stability, and also, for example, crime rate and percentage of rental units (Jaggia & Kelly-Hawke, 1999). In terms of gender and education, the 1997 United Nations Human Development Index ranking of educational and economic achievements for women placed Canada leading the world. The U.S. ranked 6[Symbol Not Transcribed]th (United Nations, 1998). U.S. minority status is correlated with crime, incarceration, and judicial homicide; these relationships are not found among Canada's main minority groups.

In sum, the main minorities in the U.S. represent significant socioeconomic disadvantage in comparison with the majority. In Canada, the main minorities, (linguistic and foreign-born) represent the most important kinds of diversity, and do not represent significant socioeconomic disadvantage in comparison to the majority.

DIVERSITY POLICY: ASSIMILATION OR SEPARATION

There are also important national differences in policies about assimilation/integration, or separation/segregation of minorities. In the U.S., Black and Hispanic minorities have fought for assimilation. Separateness is construed as ghettoization, as reflected in the historic U.S. Supreme Court conclusion that separation of minorities is inherently unfair in the school system (Brown v. Board of Education of Topeka, 1954). The U.S. does not have federal legislation to foster minority group separation. In recent years, however, it has begun to reconsider the assimilation model as it tries to accommodate minority requests in ways that resemble those that have long been practised within Canada. Assimilation has been actively resisted within Canada by its main minority, French-speaking Quebecers, and by Aboriginals. Both groups use political pressure, and debate with the majority, to achieve enhanced separation.

These contrasting policies derive from different national histories. There is a long history of Canadian policy encouraging cultural diversity and asserting the preservation of cultural minority groups as a common good. Quebec's unique culture has been preserved through policies starting with the Quebec Act of 1774, and subsequent British guarantees to maintain the French language, religion, civil law, and property ownership system. In 1969, the Official Languages Act established French and English as official national languages. Section 23 of the 1982 Charter of Rights and Freedoms provided protection for group-specific French and English language rights in school instruction. In 1988, the Multiculturalism Act established federal funding to support cultural diversity. Canada's "cultural mosaic" model of preserving minority cultures has long been contrasted with the American "melting-pot" policy of assimilation.

DIVERSITY SUMMARY: CANADA IS SIGNIFICANTLY DIFFERENT FROM THE UNITED STATES

The two nations differ profoundly in terms of minority groups. French-speaking Canadians and foreign-born immigrants represent the largest and most culturally significant minority groups in Canada. Visible groups consisting of African-Americans and Hispanics represent the largest and most significant minorities in the U.S. Further, Canada's largest minority represents a far larger portion (24%) of the population than does the Black minority group (13%) in the U.S. There are substantial differences in the disadvantages associated with minority membership status in the two nations. Economic and social disadvantage does not overlap with minority status in Canada the way it does in the U.S. These national differences are reflected in both nations' legislative policies, including directly contradictory approaches to assimilation or separation.

Implications of National Differences for Clinical Psychology Training

These national differences have implications for clinical training because APA policy is intended to remedy U.S. minority disadvantage. Canadian programs must understand this in order to articulate the different Canadian conditions. The valid ways in which Canadian programs deal with the APA diversity criterion will differ significantly from the ways used in American programs.

From the outset there is a logical problem in APA/CPA policy concerning minorities. Under the APA and CPA codes of ethics, psychologists are required to respect the dignity and worth of each individual, contradicting a competing value mandating group-defined inclusiveness. In addition to managing this conundrum, Canadian programs have to ensure that faculty and students know Canada's psychosocial features, rather than passively accepting APA's construction of diversity from U.S. concerns. Canadians are a minority within APA. Students must be educated about Canada's distinctive economic, social, health, criminal, linguistic, racial, and policy features. Accreditation self-studies must articulate these differences to identify which APA assumptions about diversity are inappropriate in Canadian recruitment, clinical teaching, and training with clients. These topics will be very briefly considered, using only English-language materials.

IMPLICATIONS OF CANADIAN DIVERSITY FOR RECRUITMENT

Membership in Canada's two main minority groups does not indicate economic or social disadvantage that requires targeted advancement, as is the case in the U.S. Canadian programs, nonetheless, know that inclusion of members with diverse backgrounds enriches those programs. The racial minority focus of APA is inappropriate in Canada. Other group-defined inclusion goals are complex and raise the problem of stereotypes. Minority representation benefits are not guaranteed by selecting individuals as exemplars of groups unless these individuals also wish to represent group-typed qualities. Individuals may not exemplify their group's values or may resist being categorized in this objectifying manner. Recruitment for cultural richness cannot be guaranteed by group-targeted recruitment.

There are additional diversity-recruitment problems in Canada. All Canadian programs have inclusion restraints set by the language of instruction and by student language competence. The language of Canada's most important minority limits the recruitment of Quebec undergraduates into English-language programs. French-language Quebec programs have limited capacity to include mother-tongue-English non-Quebec students. In Quebec, English-language programs, by definition, serve their local minorities. Outside Quebec there is no way to ensure that English-language programs can have a full proportion of students from Canada's French minority population for both practical and political reasons.

In practical terms, out-of-province recruitment of Quebec students is constrained by the small pool of Quebec applicants with graduate-level English. Only one small and two large universities in Quebec provide English undergraduate instruction. There are also political problems with recruiting Quebec students. The Quebec government prefers to enhance the French education of its talented students and would object if English-language universities in other provinces aggressively recruited them. In the U.S., there are no political considerations concerning cross-state minority recruitment. Finally, Canada's most important minority group is not disadvantaged nor in need of outside help. It represents a thriving culture.

Language skills are crucial in graduate studies and remain relevant in recruiting students from Canada's second minority (foreign-born migrants). A significant proportion of migrants are without English. Their skills vary with the recency of their migration to Canada. Applications for graduate study from undergraduate students who are foreign-born and whose mother tongue is not English are likely to be lower than the ratio these minority groups represent in the Canadian population. Programs can accommodate linguistic minorities in a progressive way by nonrote evaluation of the GRE Verbal score, where lower scores may reflect only recency of English. McGill's clinical program asserts a diminished weight for English-loaded criteria in its descriptive materials when evaluating non-English speaking applicants. This may serve as a model policy for other Canadian programs even though it will affect the statistics that the APA uses.

The small number of urban areas in Canada is paralleled by a small number of universities. Both of these facts constrain recruitment for diversity. There are 53 universities with four-year degree programs in English-Canada; only 18 of these offer clinical programs. Three provinces have only one clinical program; four provinces (Alberta, Saskatchewan, Manitoba, and Nova Scotia) have only one APA/CPA accredited program; and three have none (New Brunswick, Prince Edward Island, and Newfoundland). Although about the same rate of doctoral clinical programs are accredited in Canada and the U.S. (17 in Canada, 179 in the U.S.), the smaller Canadian numbers constrain student recruitment. Programs have to decide if they will select students in relation to local, regional, or national minority patterns. National recruitment makes sense in view of the unequal distribution of graduate training. Most programs welcome applicants from distant underserved regions. Geography also constrains recruitment of local minority students in another way. Many Canadian programs do not accept their own undergraduates. This "three-degree rule" prevents students from completing all degrees within one university in order to enhance diversity in their education. If there is only one university in the region, then the opportunity to recruit minority students will be further restricted. All of these factors affect student selection, which may not result in a student population that reflects local diversities.

In terms of faculty recruitment both countries have federal laws that prohibit discrimination against individuals on the basis of sex, race, religion, and other group characteristics. Both countries constrain hiring in terms of citizenship. There are significant differences, however, in legislation about group-targeting and in the interpretation of anti-discrimination policy that affect the ways by which Canadian programs can recruit faculty and students. In the U.S., racial questions are always considered appropriate despite the changing and sometimes contradictory nature of state-specific affirmative action laws. Both recruiters and applicants are expected to use race as a variable in making discriminative judgments. The legal view in Canada is that even if race is known it should not be the basis of selection decisions. It is illegal to ask applicants questions about their race because the questions open the possibility of discrimination. Racial data, thus, cannot be collected about applicants to Canadian programs until after they have been hired or admitted into a program. Only in those cases where an applicant reaches a short list on a culture-blind appraisal of credentials and is invited for a visit, will the race and other cultural qualities of a restricted set of applicants be known. Canada's different political and legal history impedes compliance with routine APA requests for data on minority applicants by race; at times CPA surveys have unthinkingly mimicked APA practise. While racial counts are possible after admissions and hiring decisions are completed, race-based data sets are tangential to the minority issues in Canada and are seen as alien.

In sum, the barriers to minority student participation in Canadian graduate programs are not related to visible qualities or minority-determined socioeconomic disadvantage. Participation is related more narrowly to the language of graduate-level competence. In terms of APA standards, Canadian programs have to decide which, if any, types of diversity (local or national rates of: age, sex, language, foreign birth, disability, ethnicity, or other psycho-social qualities) represent salient features for student or faculty recruitment. These will look different from diversity representations in U.S. programs because it is almost impossible for them to be racially based. The different Canadian look, however, may well represent Canada's kinds of diversity.

IMPLICATIONS FOR TRAINING WITH MINORITY PATIENTS

National differences in health care affect patient characteristics that will be seen by students in training settings. Patients in Canadian hospitals and mental health (MH) settings are representative of all minorities because of the universality of health care. Patients seen in U.S., health settings represent groups sorted by affluence, which is correlated with minority status; this restricts the exposure of clinical students to minority patients. In Canada, while a smaller percentage (8%) receive MH services, this group consists of those whose needs are significant and are directly met. In the U.S., more (13.3%) receive MH services but this group has less severe illness (Kessler et al., 1997), reflecting lack of access for the poor. Kessler concluded that there was a better match between psychiatric needs and services in Canada. Students in Canadian settings will thus see more minority and more severely ill patients than will students in many U.S. settings.

The higher prevalence of violent crime in the U.S. affects population mental health, the number and proportion of clinical forensic training settings, and minority representation. There is greater provision of psychiatric facilities for mentally ill offenders in Canada; students in forensic settings are less likely to see an offender whose illness is not being treated. Canada's significantly lower homicide rate means that death is more likely to come at natural times; bereavement through homicide is rare. There are lower rates of MH problems arising from victimization. Fewer families experience problems from incarceration. These variables are not correlated with Canada's significant minorities.

IMPLICATIONS OF CANADIAN DIVERSITY FOR TRAINING IN ASSESSMENT

Canadian students have to be taught how national differences affect psychological assessments. In intelligence testing, they have to be taught that Canadian raw score means are higher on the Wechsler tests and that these scores are re-normed down for Canadianized IQ scores (Saklofske & Hildebrand, 1999). Canadian students have to be taught the circumstances under which Canadian or U.S. norm transformations are appropriate. Students need to be taught that there is no good standardized individual English- or French-language IQ test with norms for Canadian minorities, although Jackson's Multidimensional Aptitude Battery is a Canadian-based group test with English /French norms (Jackson, 1984/98). English-Canadian students have to be taught that Quebec psychologists use French versions of the Wechsler tests, for which there are no Canadian norms.

In assessing emotional condition and personality, students need to learn that none of the major U.S. standardized clinical tests used in clinical programs include norms for Canadians or for any major minority groups. Canadian Douglas Jackson, however, has almost single-handedly created a series of such tests using some Canadians. His tests include those for the description of normal personality (Jackson, 1976, 1997), for assessment of psychopathology (Jackson, 1988, 1997), for identifying dimensions of personality disorders (Jackson & Livesley, 1999), and for assessing vocational interests in general (Jackson, 1977, 1999), and in handicapped populations (Jackson, 1997). Despite this sophisticated, vigorous work and the inclusion of some French versions and norms, these tests are less frequently used in Canadian clinical work or reported in research than are related American instruments. Students need to know that, within Quebec, psychologists use French translations of the major American personality tests for which no contemporary standardization has been done.

At the same time, students need to learn that there is little evidence that cognitive abilities, emotional condition, or personality is structured differently in cultural groups, according to international validation studies of the major U.S. instruments. The need for Canadian tests is thus an open empirical question, although the intelligence data show Canadian norms may well differ.

The most significant cultural differences in psychological function lie in the domain of values, which are infrequently assessed in clinical situations. It is improbable that these constructs are of major significance in understanding major mental disorders, but U.S. studies with American minorities provide little relevant to Canada's minorities. Assessment of individual differences in cultural values might be clinically useful in less severe disorders, and some dimensions that could be investigated are discussed in the Summary.

IMPLICATIONS OF CANADIAN DIVERSITY FOR TRAINING IN TREATMENT

There are no texts about psychological treatment that attend to Canadian diversity with any depth of empirical content. Texts about diversity issues in treatment are nearly all U.S. publications discussing U.S. minorities, often including a high ratio of rhetoric to empirical data. Cultural variations even within the Canadian visible minorities do not correspond to those in the U.S., thus issues raised in U.S. texts about minority-linked psychosocial problems do not speak to the Canadian situation. Even within the U.S., the study of minority-specific treatments is fragmented and of poor quality. A recent review of empirically validated treatments with minorities found few studies with data specific to U.S. minority groups. Importantly, these results were at times contradictory in supporting a group-differences, or a universalistic model of treatment (Doyle, 1998). Specialized treatment approaches that are sometimes proposed for tiny Canadian minorities such as Aboriginals in a particular region, are typically based on impressionistic anecdotes published in obscure journals.

Cultural groups vary in their "psychological-mindedness" (Bond, 1996); thus, the use of MH treatment should vary across Canadian regions, depending on the cultural mix. The recency of arrival and assimilation of a migrant will be the most important minority variable in Canada. Because recency and assimilation change with time, it is unlikely that any major literature will develop for group-specific valid treatments for Canadian minorities.

Canadians have not produced any significant empirically based clinical psychology textbooks relevant to Canadian groups. The prospects for their creation are limited because of the small numbers of Canadian clinical scholars and students, their linguistic divide, and the exceptionally differentiated and continually changing nature of Canada's minorities.

Summary

Significant national differences in diversity affect the ways in which ideas from the U.S. must be considered in Canadian training programs that wish APA accreditation. Important aspects of each country's diversities remain unique. American conceptions cannot be validly applied to Canada for recruitment, or for training in assessment or therapy. Awareness of differences is essential to ensure that inappropriate American cultural models are not inadvertently used when site visitors undertake evaluations of Canadian programs. Canadian programs have to educate accreditors about the different diversities in the two nations and about their implications for Canadian training. At times, Canadian practises must be altered to meet APA requirements that are culture-bound, and at times, expectations of APA examiners must be altered to ensure valid evaluation of Canadian programs. Education about Canadian culture has to be assertive to ensure students are exposed to Canadian facts and to how these differ from American data. Education about Canadian culture has to be creative in considering clinical implications.

Against this background of national differences, there is a ready model in psychology for Canadian programs to use in ensuring attention to Canadian uniqueness: the model of individual differences. Understanding individual differences in psychological functioning is the core feature of all good clinical work. We train students in assessing and remedying problems arising from individual differences in cognition, personality, and emotional condition. We can extend this model to include individual differences in values that might be correlated with group membership. "Modernity" represents an important values-cluster in cultural assessment (Mingo, Herman, & Jasperse, 2000). A valuable beginning in identifying important modernity values has been made (Yang, 1988). Values dimensions to consider might include valuing individualism/collectivism, elders/youth, tradition/change, education/custom, empirical/spiritual explanations, expectations of entitlement/disenfranchisement, parental authority/independence from, life-course open/caste-gender-determined. Such values dimensions could provide a framework for identifying cultural factors affecting individuals seeking clinical help in a multicultural society. Such a framework would not depend on group-clustered stereotyping, rather it would use individual values constructs.

Identifying key cultural values as psychological dimensions is more relevant to responding to diversities in Canadian clinical practise, than is attending to the rough racial groupings of APA. Creating clinical tools to work with important, differing cultural values relevant to mental health would also be an exciting research enterprise.

Send correspondence to Marilyn Laura Bowman Ph.D., Department of Psychology, Simon Fraser University, Burnaby, British Columbia Canada V5A 1S6 (E-mail: bowman@sfu.ca).

(f.1) Dalhouse University, Concordia University, McGill University, Universite Laval, Universite de Montreal, University of Ottawa, Queen's University, University of Waterloo, University of Western Ontario, University of Windsor, York University, University of Manitoba, University of Saskatchewan, University of Calgary, University of British Columbia, Simon Fraser University, University of Victoria.

Resume

Lorsque que les programmes canadiens de formation clinique cherchent a etre accredites par l'APA, ils sont confrontes a un probleme de communication decoulant des caracteristiques uniques de la societe canadienne pertinentes a leurs programmes et au critere de l'APA traitant de la [Symbol Not Transcribed]diversite[Symbol Not Transcribed]. Il s'agit souvent d'un terrain de mesentente qui ressort des commentaires informels et des rapports finaux. Cet article passe en revue les differences entre le Canada et les Etats-Unis en ce qui a trait au bien-etre, aux politiques sociales et a la nature de la diversite au sein de chaque pays. Il presente la pertinence de ces facteurs pour les programmes cliniques canadiens. L'examen realise peut aider les programmes canadiens a se preparer a l'accreditation par l'APA.

References

American Psychological Association. (1996). Guidelines and principles for accreditation of programs in professional psychology. Washington, DC: Author.

Angell, M. (1999). The American health care system revised -- a new series. New England Journal of Medicine, 340(1), 48.

Atkinson, A.B., Rainwater, L., & Smeeding, T.M. (Eds.). (1995). Income distribution in OECD countries: Evidence from the Luxembourg Income Study. Paris: Organization for Economic Co-operation and Development.

Barber, J. (1995, September 9). Mending our lovely metros. The Globe and Mail, pp. D1-D5.

Blackburn, M.L., & Bloom, D.E. (1993). The distribution of family income: Measuring and explaining changes in the 1980s for Canada and the United States. In D. Card & R.B. Freeman (Eds.), Small differences that matter: Labor markets and income maintenance in Canada and the United States (pp. 233-265). Chicago, IL: The University of Chicago Press.

Blank, R.M., & Hanratty, M.J. (1993). Responding to need: A comparison of social safety nets in Canada and the United States. In D. Card & R.B. Freeman (Eds.), Small differences that matter: Labor markets and income maintenance in Canada and the United States (pp. 191-231). Chicago, IL: The University of Chicago Press.

Bond, M.H. (Ed.). (1996). The handbook of Chinese psychology. Hong Kong: Oxford University Press.

Boyd, M., Goyden, J., Jones, F., McRoberts, H., Pineo, P., & Porter, J. (1981). Status attainment in Canada: Findings of the Canadian mobility study. Canadian Review of Sociology and Anthropology, 18(5), 657-673.

Brown v. Board of Education of Topeka. (1954). 347 U.S. 483, 74 S.Ct. 686.

Burkhauser, R.V., Cutts, A.C., Daly, M., & Jenkins, S.P. (1999). Testing the significance of income distribution changes over the 1980s business cycle: A cross-national comparison. Journal of Applied Economics, 14, 253-272.

Chen, J., Ng, E., & Wilkins, R. (1996). The health of Canada's immigrants in 1994-95. Health Reports, 7(4), 33-45.

Chen, J., Wilkins, R., & Ng, E. (1999). Health expectancy by immigrant status, 1986 and 1991. Health Reports, 8(3), 29-38.

De Silva, A. (1999). Wage discrimination against Natives. Canadian Public Policy, XXV(1), 79-82.

Doyle, A.B. (1998). Are empirically validated treatments valid with culturally diverse populations? In K.S. Dobson & K.D. Craig (Eds.), Best practice: Developing and promoting empirically validated interventions (pp. 93-103). Newbury Park, CA: Sage.

Drohan, M. (1994, December 17). The rich get richer, the poor get pummelled. The Globe and Mail, pp. B2.

Drolet, M., & Morissette, R. (1999). To what extent are Canadians exposed to low income? (75F0002MIE) Ottawa, ON: Statistics Canada, Income Statistics Division.

Euromonitor International. (1997). International marketing data and statistics 1997. (21 ed.). Chicago, IL: Author.

Federal Interagency Forum on Child and Family Statistics. (1999). America's children: Key national indicators of well-being. Washington, DC: U.S. Government Printing Office.

Gilmore, J. (1999). Body mass index and health. Health Reports, 11(1), 31-43.

Gorey, K.M., Holowary, E.J., Fehringer, G., Laukkanen, E., Moskowitz, A., Webster, D.J., & Richter, N.L. (1997). An international comparison of cancer survival: Toronto, Ontario, and Detroit, Michigan, metropolitan areas. American Journal of Public Health, 87(7), 1156-1163.

Green, D.A. (1999). Immigrant occupational attainment: Assimilation and mobility over time. Journal of Labor Economics, 17(1), 49-80.

Health Canada. (1999). Measuring Up: Infant Mortality <http://www.hs-sc.gc.ca/hpb/lcdc/brch/measuring/mu_c_e.html> (1999, June 16).

Helms, J.E., & Talleyrand, R.M. (1997). Race is not ethnicity. American Psychologist, 52(11), 1246-1247.

Hofstadter, R., Miller, W., & Aaron, D. (1959). The United States: The history of a republic. Englewood Cliffs, NJ: Prentice-Hall.

Holmes, S.A. (2000, March 19). The politics of race and the census. New York Times, pp. 3.

Jackson, D.N. (1976/97). Jackson Personality Inventory-Revised. London, ON: Research Psychologists Press, Inc.

Jackson, D.N. (1977/99). Jackson Vocational Interest Survey. London, ON: Research Psychologists Press, Inc.

Jackson, D.N. (1984/98). Multidimensional Aptitude Battery-II. London, ON: Research Psychologists Press, Inc.

Jackson, D.N. (1988/97). Basic Personality Inventory. London, ON: Research Psychologists Press, Inc.

Jackson, D.N. (1997). Ashland Interest Assessment. London, ON: Research Psychologists Press, Inc.

Jackson, D.N., & Livesley, W.J. (1999). Dimensional Assessment of Personality Pathology. London, ON: Research Psychologists Press, Inc.

Jaggia, S., & Kelly-Hawke, A. (1999). An analysis of the factors that influence student performance: A fresh approach to an old debate. Contemporary Economic Policy, 17(2), 189-198.

Jee, M., & Or, Z. (1999). Health outcomes in OECD countries. OECD Working Papers, VII(3).

Johansen, H., & Millar, W.J. (1999). Health care services: recent trends. Health Reports, 11(3), 91-109.

Kane, T.J. (1998). Do test scores matter? Racial and ethnic preferences in College Admissions. In C. Jencks & M. Phillips (Eds.), The black-white test score gap (pp. 431-456). Washington, DC: Brookings Institution Press.

Kelly, K. (1992). Visible Minorities: A diverse group [Online] <http://www.statcan.ca/english/ads/11-008-XPE/vismin.html> Ottawa, ON: Statistics Canada.

Kessler, R.C., Frank, R.G., Edlund, M., Katz, S.J., Lin, E., & Leaf, P. (1997). Differences in the use of psychiatric outpatient services between the United States and Ontario. New England Journal of Medicine, 336(8), 551-557.

Kurian, G.T. (1991). The new book of world rankings (3rd ed.). New York: Facts on File.

Lian, J.Z., & Matthews, D.R. (1999). Does the vertical mosaic still exist? Ethnicity and income in Canada, 1991. Canadian Review of Sociology and Anthropology, 35(4), 461-481.

Lynch, J.W., Smith, G.D., Kaplan, G.A., & House, J.S. (2000). Income inequality and morality: Importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320, 1200-1202.

MacKinnon, M. (1998, December 21). The myth of the rich American. The Globe and Mail, pp. B1, B7.

McDonald, A.D., McDonald, J.C., Salter, V., & Enterline, P.E. (1974). Effects of Quebec medicare on physician consultation for selected symptoms. New England Journal of Medicine, 291(13), 649-652.

McInnis, E. (1959). Canada: A political and social history. Toronto, ON: Rinehart & Company.

Mingo, C., Herman, C.J., & Jasperse, M. (2000). Women's stories: ethnic variations in women's attitudes and experiences of menopause, hysterectomy, and hormone replacement therapy. Journal of Women's Health & Gender-Based Medicine, 9(Supp 2), S27-38.

Organization for Economic Co-operation and Development. (1998). Education at a glance <http://www.oecd.org/els/stats/els_stat.htm> Paris: OECD.

Passell, P. (1993, May 16). Health care's fever: Not so high to some. New York Times, pp. E3.

Picot, G., & Myles, J. (1995). Social transfers, changing family structure, and low income among children (Research Paper Series, Analytical Studies Branch 82). Ottawa, ON: Statistics Canada.

Plepys, C., & Klein, R. (1995). Health status indicators: Differentials by race and Hispanic origin. Centers for Disease Control and Prevention: Statistical Notes, 10 (September), 1-8.

Purvis, A. (1999, May 31). The changing tapestry. Time, 153, 33-44.

Rickard, H.C., & Clements, C.B. (1993). Critique of APA accreditation criterion II: Cultural and individual differences. Professional Psychology: Research and Practice, 24(2), 123-126.

Ross, N.A., Wolfson, M.C., Dunn, J.R., Berthelot, J.-M., Kaplan, G.A., & Lynch, J.W. (2000). Relation between income inequality and mortality in Canada and in the United States: Cross sectional assessment using census data and vital statistics. British Journal of Medicine, 320, 898-902.

Saklofske, D.H., & Hildebrand, D.K. (1999). The Wechsler Adult Intelligence Scale-Third Edition: The Canadian Standardization Study. Canadian Clinical Psychologist, 9(2), 11-12.

Saul, J.R. (2000). How we will make Canada ours again, The Globe and Mail, pp. A14-A15.

Siemiatycki, M., & Isin, E. (1997). Immigration, diversity and urban citizenship in Toronto. Canadian Journal of Regional Science, XX(1,2), 73-102.

Single, E., MacLennan, A., & MacNeil, P. (1994). Horizons 1994: Alcohol and other drug use in Canada. Ottawa, ON: Health Canada, Health Promotion Directorate.

Starfield, B. (1991). Primary care and health: A cross-national comparison. Journal of the American Medical Association, 266, 2268-2271.

Statistics Canada. (1996a). Ethnocultural and social characteristics of the Canadian population (CD-ROM 94F0004XCB, (ethno.1.ivt)). Ottawa, ON: Statistics Canada.

Statistics Canada. (1996b). Upper limits of income quintiles of households and percentage distribution of total income by quintiles for selected years, Table 5 (13-218-XPB). Ottawa, ON: Statistics Canada.

Statistics Canada. (1997). Income distributions by size in Canada (13-207-XPB). Ottawa, ON: Statistics Canada.

Statistics Canada. (1998a). 1996 census: Education, mobility and migration. Ottawa, ON: Statistics Canada.

Statistics Canada. (1998b). Portrait of official language communities. Ottawa, ON: Statistics Canada.

Statistics Canada. (1998c). Sources of income, earnings and total income, and family income. Ottawa, ON: Statistics Canada.

Thorn, B. (2000). Commission on education & training leading to licensure. CUDCP@LSV.UKY.EDU.

Turner, L. (1998). Report on maternal mortality in Canada <http://www.hc-sc.gc.ca/hpb/lcdc/brch/reprod/matmorte.html> Ottawa, ON: Health Canada, Health Protection Branch, Laboratory Centre for Disease Control.

U.S. Census Bureau. (1998). March Population Survey: Money income in the United States: 1997. United States Department of Commerce.

U.S. Census Bureau. (1998). Language spoken at home. Washington, DC: Bureau of the Census.

U.S. Census Bureau. (1999). Educational attainment, by Race, and Hispanic origin (Table 260 P20 series). Washington, DC: US Census of Population.

United Nations. (1998). Human development report (Vol. 9). New York: Oxford University Press.

Wilkins, R., & Houle, C. (1999). Health status of children. Health Reports, 11(3), 25-34.

Willms, J.D. (1999). The level of literacy in a society is a key social and economic indicator (Downloadable publication (89F0116XIE). Ottawa, ON: Statistics Canada.

Wolfson, M. (1999). Income inequality and mortality among working-age people in Canada and the US. Health Reports, 11(3), 77-82.

Wolfson, M.C. (1997). Divergent inequalities - Theory and empirical results (Research Paper Series: Analytical Studies Branch 66). Ottawa, ON: Statistics Canada.

Wolfson, M.C., & Murphy, B.B. (1998). New views on inequality trends in Canada and the United States (Analytic paper, 11F0019MPE NO. 124 ISSN: 1200-5223). Ottawa, ON: Statistics Canada.

World Bank. (1999). World development report for 1998/99. New York: Oxford University Press.

Yang, K.S. (1988). Will societal modernization eventually eliminate cross-cultural psychological differences? In M.H. Bond (Ed.), The cross-cultural challenge to social psychology. Newbury Park, CA: Sage.