November 2022: Health and anti-Black racism the remix

“In some ways, Canada very much is a welcoming place. However, that can act as a barrier in understanding how racism manifests — it’s not just the racial slur. It’s not just the racist targeting. But it is in the very systems of continuing to practice race-based medicine. Even if we had more funding and even if we had more Black physicians and practitioners, if we do not address the very real reality of anti-Black racism — in structures and in practice — we will continue to see poor health outcomes from Black communities.”
Dr. OmiSoore Dryden, Associate Professor, Faculty of Medicine, Dalhousie University

Delia Douglas

This month’s blog continues Rady’s response to the Scarborough charter. We would first like to extend our gratitude to Dr. Onye Nnorom (University of Toronto) and Dr. Omisoore Dryden (Dalhousie University) for the October 19th workshop: #Blacklivesmatter in health care: historical roots and legacies of anti-Black racism in medicine and the October 20th grand rounds: addressing anti-Black racism in the clinical setting: a look at the social and physiological heath impacts of injustice.

Anti-Black racism – what is it and why does it matter?

Dr. Akua Benjamin, professor emeritus at Toronto Metropolitan University, conceived of the term anti-Black racism to underscore the distinct nature of systemic racism on Black people in Canada that is the result of the enduring legacies of enslavement and the colonization of people of African descent in this country. Anti-Black racism is manifest in policies and practices embedded in Canadian institutions such as, health care, education, and justice that reflect and sustain beliefs, attitudes, prejudice, stereotyping and/or discrimination towards people of African descent.

Consider that the first medical education program in Canada was established in 1824, a decade before the end of enslavement in Canada (1834), and while residential schools were operating.

In 1918 Queen’s University senate voted to ban Black students from enrolling in its medical school. At that time 15 Black men were enrolled in the university’s medical school, and while those students were not formally removed, the administration actively encouraged them to leave the program. Bolstered by the ban, white students put on a minstrel show; approximately half of the Black medical students left the program, while the other half remained. Several decades later, in 1965 Black students returned to register at Queen’s School of Medicine. The ban would not be repealed by senate until the fall of 2018 and an official apology was given in 2019.

In addition, the medical schools at McGill University, Dalhousie University, and the University of Toronto also excluded Black students, or placed restrictions on their admission, for varying periods of time.

Systemic anti-Black racism is evident in the ways people of African descent have long been used to “advance” medicine. For example, J. Marion Sims, the founder of gynecology, and the doctor credited with the creating the speculum was known for developing a surgical technique to repair vesico-vaginal fistula. His breakthroughs occurred at the expense of his subjects, namely enslaved Black women, who he operated on without use of anaesthesia. Henrietta Lacks’ cervical cancer cells were taken and used without her consent. Named after Lacks, the hela cell line represents one of the most important human cell lines in medical research; they have been instrumental in cancer studies and aids research, as well as in the creation of polio and Covid-19 vaccines.

Simply put, the past and present histories of enslavement and settler colonialism in Canada form the foundation of these institutionalized expressions of anti-Black racism in society in general, and in the field of medicine and medical education programs in particular.

Anti-Black racism(s) affect the health and well-being of Black communities in multiple ways. In addition to undermining trust in health care delivery systems and practitioners, it impacts the quality of care that Black people receive, resulting in poor physical and mental health outcomes.

It is therefore imperative that medical and health education professionals are taught about how anti-Black racism affects the social and structural determinants of health for Black people.

Marcia Anderson

In order disrupt the anti-Black racism patients experience, we have to disrupt the anti-Black racism that Black learners and health professionals’ experiences. These experiences are widespread, pervasive, and cause harm including decreased academic performance, burnout and high staff turnover. Disruption requires understanding how anti-Black racism was built into our systems.

The current special issues (volume 194, issues 41 and 42) of the Canadian Medical Association Journal (CMAJ) are an important intervention into this knowledge gap.