racematters – Page 3 – Race matters

May 2023: The past is the prologue

Delia Douglas and Marcia Anderson

May 25 marks 3 years since the murder of Mr. George Floyd.

In the aftermath, tens of thousands marched across the United States, in support of Black Lives Matter (BLM), and inspired global protests against police brutality, anti-Black racism, and racial injustice. Across Canada people organized and gathered to stand in solidarity with George Floyd’s family and the Black Lives Matter movement, drawing attention to racialized police violence, systemic racism, and inequality. In Winnipeg thousands attending the Justice 4 Black Lives rally called for justice for Black people and an end to state violence and racial injustice, the organizers of the demonstration at the Legislature carried out a series of protests for eight consecutive days beginning June 22 at the Winnipeg Law Courts, in recognition of the urgency and pervasiveness of racism and racial inequality in Winnipeg and across the country.

These protests took place at a time when large public gatherings had been banned to prevent transmission of the virus, massive crowds of Black, Indigenous, and racially diverse groups of people took to the streets, risking their lives. Truth be told their lives were already at risk – they were fighting two pandemics that inhibit our ability to breathe: racism and COVID-19. The protests were not a choice, but a necessity, a matter of life and death. stand against racial terror and a rejection of the status quo. For Black, Indigenous, and racialized minority folx, these demonstrations were an affirmation of our humanness, and a confirmation of our commitment to building a better future. One where race does not shape who lives and who dies. As physician Rhea Boyd explains, “protest is a vital public health intervention.” Notably, thousands of health care practitioners across Canada and the US penned an open letter, offering their full support for those who are working to demolish racist institutions, stating “white supremacy is a lethal public health issue that predates and contributes to COVID-19.”

Some regarded this massive mobilization as a racial reckoning, derived from widespread recognition of the brutality and lethalness of systemic racism.

Some wondered if this was simply a moment – an expression symbolic solidarity that would not result in substantive change: a moment that might be followed by no change at all.

3 years on – where are we at now?

Black learners, physicians and educators have provided leadership that would move systems beyond symbolic solidary to substantive change.

The Black Medical Students Association of Canada provided recommendations to Canadian medical schools and to the Association of Faculties of Medicine of Canada.

The Black Health Education Collaborative began working on competencies for learning and a Black Health Primer to support the transformation of medical and health professional education to improve the health Black communities across Canada. They also pushed the CMAJ to publish two special issues on anti-Black racism the its effect on health in Canada.

And yet: racism persists. Race continues to shape who lives and who dies: it remains a public health crisis. The lives of Black, Indigenous, and racialized minority folx remains at risk.

Real talk: How has the labour and leadership of Black folx been met with reciprocity and effort by your institution? What have you done personally to advance anti-Black racism, or anti-racism, ‘lately’? As in the past 3 years lately?

In August 2020 the Disruption of All Forms of Racism Policy was passed by the Rady Faculty Council. It is currently being revised and will be supported by a disclosures and reporting document. The policy was created in and against the backdrop of the histories and the enduring legacies of the racial violence and hostility that created the Canadian nation state some of which include dispossession, enslavement, genocide, the Indian Act, Residential Schools, and immigration laws.

The prioritization of racism is important because racism is entrenched in our day-to-day lives both in and outside of the university. Racism is (re)produced through silence, invisibility, and exclusion, as well as through covert, entrenched and cumulative actions that can be difficult to identify.

In this context, the creation of an anti-racism policy signals that manifestations of racism are a key concern of the RFHS, and evidence of its commitment to building a safe community, where all are valued equally and treated with dignity and respect.

It is also important to note this policy goes beyond consideration of individual behaviours or the notion that racism simply involves individual acts, to focus on structures, as one tool that is integral to achieve organizational cultural change.

While the passing of the policy was groundbreaking, there remain many barriers and challenges to actively advancing and sustaining the work of anti-racism. We continue to have much work to do at a system level and at individual levels to realize its aspirational goals.

Here are a few examples:

There is a significant knowledge gap regarding the meaning and significance of race and racism. The only reason we are talking about race, is because of the pervasive problem of racism – so we need to address it. The knowledge gap means that the work necessary to disrupt/eliminate the various barriers/social relations/attitudes/practices that promote and/or sustain racial inequality and the damage of racism have not been taken up. We need more individuals across our Faculty to commit time and effort to their own unlearning and learning. The Office of Anti-Racism provides a starting point to explore learning resources available.

The profound under representation of Black, Indigenous, and racialized minority people in Faculty and Senior Leadership positions sustains racial hierarchies and puts unmanageable burdens and responsibilities on the Black, Indigenous, and racialized minority folx who are present- this is one form of the minority tax. We need leaders to prioritize the relevant expertise that representation brings as they are considering job descriptions and hiring decisions to support the recruitment and retention of Black, Indigenous and racialized minority folx.

One of the consequences of inadequate representation is that decisions regarding the meaning and significance of race and racism are largely in the hands of those who are Not the targets. The absence of a critical mass of Black, Indigenous, and racialized minority learners, staff, and faculty also makes it difficult for the targets of repression to speak up for fear of reprisal. One of the resources we developed is a template to review committee Terms of Reference to support critical reflection on how all RFHS committees explicitly support our stated commitments to anti-racism. We need committee chairs and leaders to have open conversations with the Black, Indigenous and racialized minority folx in their departments about how to prioritize their participation in committees that most align with their own goals and career trajectories AND support high impact, anti-racist decision-making.

These are just a few actions that at the individual level can help support a continued movement away from symbolic statements and towards racial justice and equity.

Resources

Rhea Boyd, “You Realize It’s a Privilege to Worry That Protests Will Cause a Second Wave of Coronavirus, Right?” Cosmopolitan, 16 June 2020, https://www.cosmopolitan.com/politics/a32782471/protesting-saves-lives-even-during-coronavirus-pandemic/

^[1] Rhea Boyd, “You Realize It’s a Privilege,” para. 12.

April 2023: Part 1: Integrate this! Identifying grammars of resistance and refusal

“The oppressed struggle in language to recover ourselves, to reconcile, to reunite, to renew. Our words are not without meaning, they are an action, a resistance. Language is also a place of struggle.” bell hooks (1996, p. 146).
“There is no thing as a single-issue struggle, because we do not live single-issue lives.” Audre Lorde (1984, p. 138).

(This month’s blog is part 1 of a two part discussion on the politics of language).

Delia Douglas

Where we live now: Translation terms and racial realities

Language matters.

We have been in the long emergency with respect to acknowledging and addressing manifestations of systemic racism. The events of the past few years have laid bare the ordinariness of racism, underscoring that there is no place to stand outside of its reach. The parallel pandemics of systemic racism(s) and COVID-19 highlight how race shapes who lives and who dies. From the disproportionate impact of the virus on Indigenous, Black, and racialized minority communities, to the police violence directed against Indigenous and Black folx, to the racist targeting people of East Asian descent, and the rise in Islamophobia and anti-Semitism. These most recent examples emphasize the normalization of racism which is the very definition of systemic racism.

As long the impact of racism(s) continues to be homogenized/marginalized/ignored/denied interpersonal and social relations are compromised, talent will be lost, and people will continue suffer trauma and harm in a host of ways which will include death.

In order for us to disrupt and dismantle racism, we have to understand it. Racism is typically understood in simplistic and homogenous manner, however, there is no singular definition of racism. Rather, racism takes many forms, some of which include symbolic, embodied, psychological, institutional/systemic, every day, and interpersonal.

The violence is psychological, physical, and cultural. We are far more familiar (and indeed comfortable) with allegations of racism that involve white supremacist and extremist groups. There has been far less attention given to the ways in which our daily lives are crucial sites through which practices and beliefs regarding white racial superiority/power/domination are produced.

Racism is dynamic, and our language must adapt so that we are able to address our racial realities and avoid oversimplification/erasure/silence/lateral violence. We need language that is expansive, disruptive, and ultimately transformative.

As Audre Lorde reminds us, “We don’t lead single issue lives.” Consequently, if we are to understand the full effects of racism, we have to see how race intersects with other forms of difference such as gender identity and expression, sexuality, dis/ability, class, etc.

Dr. George Sefa Dei, a professor at the Ontario Institute for Studies in Education, uses the term “integrative anti-racism” to address the fact that people’s experiences of racism are shaped by the multiple elements of their identity such as gender, class, sexuality, and ableness. Talking about intersections is vital for us to be able to adequately understand and respond to the various ways in which racism(s) are manifest. However, while policies, strategies, and practices should address the integrative character of racism(s), he argued that we also need to be able to respond to the distinctiveness of anti-Black racism(s), anti-Indigenous racism(s), and Islamophobia in their myriad forms (e.g., engendered, dis/ability, sexuality).

Language is indeed a site of struggle. As a tool of resistance and refusal, it can help us to create spaces that recognize our humanity, diversity, and complexity, and in so doing offer possibilities for Black, Indigenous and racialized minority folx to find connections across our differences.

…to be continued.

Resources

Dei, George S. (1995). Integrative anti-racism: Intersection of race, class, and gender. Race, Gender & Class, 2(3), 11-30.

Essed, Philomena. (2002). Everyday racism. In D. T. Goldberg & J. Solomos (Eds.), A companion to racial and ethnic studies (pp. 202-216). London, UK: Blackwell Publishers Ltd.

hooks, bell. (1990). Yearning: Race, gender, and cultural politics. Toronto, ON: Between the Lines.

Lorde, Audre. (1984). Sister outsider. Freedom, CA: The Crossing Press.

March 2023: Racial matters: What is race? Who is ‘raced,’ and the role of disaggregated data in advancing health equity

“…any doctrine of racial superiority is scientifically false, morally condemnable, socially unjust and dangerous and must be rejected, together with theories that attempt to determine the existence of separate human races, …”
United Nations, 74th session, January 27, 2020.

Delia Douglas

Context – Racial Matters: What is race? Who is ‘raced’?

As a sociologist working in the health sciences, I am continually confronted by the separation that exists between the social sciences and health sciences – a division which is not unintentional, but part of the way in which white supremacy operates through the reproduction of race-based medicine and racist assessments of patients. However, in order to disrupt and dismantle the many forms of racism that exist, we must first understand it.

So, what is race?

Race is a social and historical construct, not a biological difference. Despite the failure of science to demonstrate that our physical differences represent racial superiority and racial inferiority, biological racism (scientific racism) persists. There remains a profound investment in the belief that our visible physical differences signal proof of one’s ability, potential, and capacity: our humanness.

Marcia Anderson

From the time I started medical school in 1998 through the H1N1 pandemic (and beyond) with the exception of some of my Black and Indigenous colleagues, if a physician taught, talked about, or researched racial gaps in health outcomes it was framed as a question of genetic difference (e.g. the thrifty gene theory or T-cell immunity differences). Framing racial health gaps as the result of racism was unpopular, to say the least.

As an early public health doctor however, one of my role models was Dr. Camara Phyllis Jones who is an anti-racism activist and academic and former President of the American Public Health Association. She defines racism as “a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call “race”), that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”

When I consider the differential impacts of COVID-19, HIV, and the new CMAJ guidance on the reporting of race and ethnicity in research articles, I see that this is where the social sciences and health sciences have to meet.

Delia and Marcia

The reason we need to talk about race is because of racism.

Similar to race, racism is about how we make sense of difference, it is based on the false assumption that physical differences such as skin colour, bodily features, and hair texture are related to intellectual, moral, or cultural superiority.

This enduring investment in innate difference is a matter of life and death – the belief is used to justify racial inequality, it informs policies, relationships, it influences how people are seen and treated. It denies the fact that racial meanings are dynamic and shaped by the social, historical, and political context in which they appear. The belief in race as a biological difference is an attempt to silence and suppress histories of genocide, dispossession, enslavement, heteropatriarchy, settler colonialism, and the attendant violence(s) of domination. In this context the role of science – of race as a biological difference – is employed to ensure that our differences are understood as inevitable/unchangeable/unalterable and thus don’t need further interrogation or intervention.

Who is ‘raced’?

Across North America, those typically identified as raced are those identified as Black, Indigenous, or a member of a racialized minority community. In other words, those identified as ‘non-white.’

This brings me to the matter of whiteness -whiteness is a location within the racial order and one of advantage, as highlighted by Dr. Jones. Whiteness is an element of identity and part of the system of racial categorization and while this also varies over time and place, it is shaped by the past and present of dispossession, genocide, enslavement, and settler colonialism. Usually unmarked, whiteness usually operates as the default category (e.g., the norm); whites are typically regarded and identify as ‘raceless,’ or simply human. Consider this –- to only regard Black, Indigenous, and members of racialized minority communities as racialized is an example of how a system of racial classification and hierarchy has been normalized. White people are “just human” while Black, Indigenous, and racialized minority folks are, well, regarded as something else: humans with caveats.

It is important to bring whiteness into this conversation because it is imperative that we acknowledge that we are all racialized, engendered, and sexualized (to name but a few components of our identities). Naming whiteness also signals how we are all located in relations of domination and subordination. Making whiteness visible allows space for us to understand how the marking of the so called ‘racial other’ simultaneously involves the making of the dominant…with respect to racism it means that we are able to not only recognize the harms and hardship of racism(s), but how it also benefits those who are not its targets.

Resources

Jude Mary Cenat. (2023). Who is Black? The urgency of accurately defining the Black population when conducting health research in Canada. CMAJ July 18, 2022, 194 (27) E948-E949; DOI: https://doi.org/10.1503/cmaj.220274.

Stuart Hall (1997). Race the floating signifier. Producer: Sut Jhally. Media Education Foundation.

Camara Phyllis Jones. (2018). Towards the Science and Practice of Anti-Racism: Launching a National Campaign Against Racism. Ethnicity and Disease August 9, 2018, 28 (Suppl 1) 231-234; DOI: https://doi.org/10.18865%2Fed.28.S1.231.

Matthew B. Stanbrook and Bukola Salami. (2023). CMAJ’s new guidance on the reporting of race and ethnicity in research articles. CMAJ February 13, 2023, 195(6) E236-238; DOI: https://doi.org/10.1503/cmaj.230144.

United Nations. (2020). A global call for concrete action for the elimination of racism, racial discrimination, xenophobia and related intolerance and the comprehensive implementation of and follow-up to the Durban Declaration and Programme of Action. Available at: https://documents-dds-ny.un.org/doc/UNDOC/GEN/N19/426/41/PDF/N1942641.pdf?OpenElement.

February 2023: Black History Month: Meeting grounds of radical resistance, bold solidarity, and social justice

Delia Douglas

“The true focus of revolutionary change is never merely the oppressive situations which we seek to escape, but that piece of the oppressor which is planted deep within each of us, and which knows only the oppressors’ tactics, the oppressors’ relationships.”
Audre Lorde (1984, p. 123)

Black History Month 2023 takes place in the shadows of the in-custody death of Nicous D’Andre Spring, a 21-year-old Black man who had been illegally detained in a Montreal jail in December 2022, and the January 2023 murder of Tyre Nichols, a young Black man who died in Memphis, TN following a “routine traffic stop” where he was beaten by 5 police officers, all of whom are Black. Mr. Nichols died of his injuries in hospital 3 days later.

We live in a present created by dispossession, genocide, enslavement, and ongoing settler colonial projects. We live these histories intimately, intensely, quietly, and at times grievously (lateral and internalized violence).

Their needless deaths remind me of the fact that we are all exposed to images, ideas, beliefs, and practices (e.g., white supremacy, heteropatriarchy, dis/ability, capitalism) which structure our institutions and shape our relationships to ourselves and each other. Simply put, we need not be racialized as white (for example) to reproduce settler colonialism and uphold anti-Blackness.

The fact that we are not encouraged and taught to see ourselves as equals and the fact that we are not encouraged and taught to see ourselves in each other are examples of the normalization of racism. That is the very definition of systemic racism.

I am thinking about Black life matters, Black liberation, and lateral violence – within and across diverse Black communities and beyond…I am thinking about radical resistance and bold solidarity…

In 2014 – 3 Black queer women – Alicia Garza, Opal Tometi, and Patrisse Cullors – established the contemporary #BlackLivesMatter (BLM) movement – a sociopolitical and ethical demand for action against state sanctioned anti-Black terror and anti-Black racism. Garza, Tometi, and Cullors advanced an expansive lens that sheds light on the experiences of those who have frequently been excluded as contributors to social justice movements and victims of anti-Black violence, namely Black women and girls, Black folks who are disabled, gender non-conforming and those who identify as LGBTQIA+.

Black freedom struggles are as multifaceted and diverse as are Black folx.

The events of the past few years have not only exacerbated existing inequities, they have also laid bare how racism is a public health crisis.

Racism lowers life chances. Racism kills.

The enduring legacies of residential schools are revealed in the uncovering of the bodies of the 215 children who died at the Kamloops Indian Residential School (and the thousands more graves identified since), the death of Joyce Echaquan, the murder of George Floyd, the rise in racism against people of East Asian descent, Islamophobia, and the death of Indigenous, Black, and racialized people in police involved shootings across Canada. These are not individual acts of racism, or the actions of a few bad apples – these are instances of systemic racism. These are acts that demonstrate how racism influences who lives and who dies.

This is not a zero-sum game – racism is not a competition to see who has endured the most harm – comparing ourselves to each other to construct hierarchy is itself is a form of violence. Lateral violence does just involve Black people, it occurs between members of different marginalized groups. Lateral violence also occurs when we don’t show up for each other – when we adopt the settler colonial strategy of divide and conquer…

Systemic racism requires a systemic response.

Solidarity requires courage. We cannot eradicate racial inequality and injustice unless we challenge the divisiveness of hierarchies of oppression and recognize the interconnectedness of systems of domination.
Bold solidarity is that which affirms and embraces the marginalized and excluded in our communities.

Movements such as Idle No More, #AmINext, #BLM, #Sayhername, #MeToo, and Dream Defenders make visible and affirm the lives of Indigenous and Black women and girls, 2SLGBTQQIA and those who live along the gender spectrum as targets of, and resistors to, oppression, creating space for the recognition of the humanity of all Indigenous and Black lives.

These are acts of radical resistance.

Our freedom struggles and futures intersect in complex and complicated ways owing to these histories of racial violence and their enduring legacies.

There is no time like the present to analyze our investments and allegiances and to commit ourselves to broadening our understanding of the diversity and complexity of Black identity and lived experience.

Consider this February/BHM as an opportunity to examine how anti-Blackness is manifest within ourselves and in within and across our various communities…

As political activist, scholar, and freedom fighter Angela Y. Davis asserts, “freedom is a constant struggle.”

…We…. can’t stop…We… won’t stop…

References

Cathy J. Cohen (1997). Punks, bulldaggers and welfare queens: The radical potential of queer politics. GLQ: A Journal of Lesbian and Gay Studies 3(4): 437-
465.

Angela Y. Davis. (2016). Freedom is a constant struggle: Ferguson, Palestine, and the foundations of a movement. Chicago, Il: Haymarket Books.

Alicia Garza (2014). A herstory of the #BlackLivesMatter movement.” The Feminist Wire. Available at: https://thefeministwire.com/2014/10/blacklivesmatter-2/.

Audre Lorde. (1984). Sister Outsider. Freedom, CA: The Crossing Press

Robyn Maynard. (2017). Policing Black lives. Winnipeg, MB: Fernwood Publishing.

January 2023: Where we live now: Ways forward, critical race theory and anti-racism

Delia Douglas

“If there’s shouting after you, keep going. Don’t ever stop. Keep going. If you want a taste of freedom, keep going”
Harriet Tubman, n.d.

A new year is often a time for reflection, and the making of resolutions. I begin with the words of renowned resistance fighter Harriet Tubman, who crossed the colonial boundaries of Canada and the United States in the service of Black liberation. Her words are an important reminder that anti-racism is a journey – not a destination. My use of the word journey here is deliberate…To quote the late James Baldwin, a Black American gay activist and writer across many genres, “A journey is called that because you cannot know what you will do with what you find, or what you find will do to you” (excerpt from Raoul Peck 2016 documentary, I am not your Negro).

We inherit the legacies of that which has come before.

We live in a present created by dispossession, genocide, enslavement, and ongoing white settler colonial projects and heteropatriarchy.

So, what has Critical Race Theory got to do with it?

Well, Critical Race Theory (CRT) emerged in the US in the late 70s early 1980s among a group of racialized legal scholars (e.g., Derrick Bell, Mari Matsuda, Kimberlè Crenshaw, and Richard Delgado), to examine the roles that race, and racism played in American legal structures in the post-Civil Rights context. Their work was political in nature, growing alongside movements for social justice and equality that recognized that history and context inform the character and structure of social life.

Rather than being one perspective or approach, CRT advances our understanding of the meaning and significance of race and racism. It is a collection of theoretical positions and disciplines that self-consciously views the construct of race through a critical lens, posing new questions on the persistence, if not the intensification, of race and the multicultural “colour line” where we live now. It has subsequently been taken up across a range of disciplines such as sociology, education, feminist studies, and more recently in health studies.

Some of CRT’s guiding principles are that race is a sociohistorical construct and that racism is pervasive and not an aberration. CRT recognizes that current inequalities and institutional arrangements and practices are tied to past and present systems of racial exclusion, hostility, and violence such as dispossession, genocide, enslavement, settler colonial projects, and immigration laws. It is a lens that sees link between racism and mass incarceration, housing, education, income, and health inequalities.

CRT is a purposeful intervention – one that explicit names race. This identification is important because it means that we can explicitly identify the existence of racism. The Disruption of All Forms of Racism Policy is aligned with CRT in a number of ways, beginning with acknowledgement of the continuing significance of race and the prevalence of racism in many systems in Canadian society, including health care. Crucially, the Policy also goes beyond a focus on individual behaviours but focuses on structures, as one tool as part of organizational cultural change.

With respect to health care, CRT offers a framework to disrupt the false binary that exists between the social sciences and health sciences, by enabling us to challenge claims that health care is race-neutral, objective, and “colourblind.” Consequently, CRT also enables us to think about how racism is a public health crisis that disproportionately impacts Indigenous, Black, and racialized communities.

In addition, the forthcoming revisions to to the Canadian Medical Education Directives for Specialists (CanMEDS) provide an opportunity to address the racism inherent in its existing framework. Similarly, this year the General Standards of Accreditation for Institutions with Residency Programs are scheduled to make changes to make them more inclusive of Indigenous and Black perspectives and address anti-Indigenous and anti-Black racism(s).

Anti-racism work involves the active process of acting to challenge not only one’s own biases and prejudices, this work also involves the dismantling of the policies/social relations/attitudes/practices that promote and/or sustain racial inequality and racial oppression.

Together Critical Race Theory and anti-racism work can be a meeting ground – a site of disruption and of possibility – a combination that has the potential to create community, solidarity, and advance movements for health equity and related movements for social justice.

A new path forward towards racial justice is challenging, but possible if we commit to new learning, building relationships, cultural shifts, and structural change.

The process/journey of working in solidarity involves unlearning and building relationships that are based in transparency, consistency, and accountability.

Our futures are linked; the potential from strategic solidarity would be transformative.

References

Delia Douglas, Sume Ndumbe-Eyoh, Kannin Osei-Tutu, Barbara-Ann Hamilton-Hinch, Gaynor Watson-Creed, Onye Nnorom, and OmiSoore H. Dryden; on behalf of the Black Health Education Collaborative. (2022). Black Health Education Collaborative: the important role of Critical Race Theory in disrupting anti-Black racism in medical practice and education. Canadian Medical Association Journal (CMAJ), 194 (41) E1422-E1424; DOI: https://doi.org/10.1503/cmaj.221503.

Mari J. Matsuda, Charles R. Lawrence III, Richard Delgado, and Kimberlè W. Crenshaw. (1993). Words that wound: Critical race theory, assaultive speech, and the First Amendment. Westview Press, Boulder, CO.

Kannin Osei-Tutu, Whitney Ereyi-Osas, Priatharsini Sivananthajothy, and Doreen Rabi (2022). Antiracism as a foundational competency: reimagining CanMEDS through an antiracist lens. CMAJ. 194 (49) E1691-E1693; DOI: https://doi.org/10.1503/cmaj.220521.

Rahel Zewude and Malika Sharma. (2021). Critical race theory in medicine. CMAJ, 193 (20) E739-E741; DOI: https://doi.org/10.1503/cmaj.210178.

December 2022: Accountability: The relationship between data collection and disrupting systemic racism in health care

Delia Douglas

The measurement, classification, surveillance, and analysis of Black, Indigenous, and racialized minority communities in the service of white supremacy has a long history. While data collection involves achieving a balance between managing need and risk, it is clear that we are operating at a data deficit. The absence of data is a manifestation of systemic racism. In the absence of data, Black and racialized communities will be spoken for, our voices silenced, and racial inequities protected and sustained.

Marcia Anderson

My 2006-2007 masters of public health capstone project focused on developing a proposal to implement the collection of Racial/ ethnic/Indigenous identifiers in Canada because of a deeply held belief that without this we will never be able to close the gaps in health care quality and outcomes that occur by race and/ or Indigeneity. In its absence we create a health care space where we can pretend that color-blindness is good, that we serve everyone equally, and that none of us contribute to systemic racism in Canada. In reality, this further fuels racism because then we don’t examine the system design and actions that create unequal outcomes, and instead blame the people who experience them.

Marcia and Delia

Data collection provides invaluable information that can reveal patterns and guide solutions through resource allocation, quality improvement, and data-driven policy decisions, and participatory program planning. While this is not a new topic, the calls for data collection have certainly intensified over the past two years, as we witnessed the spread and disproportionate impact of COVID-19 on Black, Indigenous, and racialized minority communities in Winnipeg, across Canada, and around the world.

Building on the data collection and governance in place to monitor and provide supports for First Nations, in May Manitoba 2020 became the first province to track the racial identities of Black, and racialized minority persons who tested positive for the virus. This data revealed how COVID-19 exacerbated existing inequities and provided invaluable information about the impact of the virus on members of Black, Indigenous, and racialized minority communities, demonstrating the profound inequities in terms of the social determinants of health, highlighting their vulnerabilities, and the urgent need for a targeted response.

In 2016 the UN Working Group of Experts on People of African Descent visited Canada. Their report examined the history and legacy of systemic anti-Black racism. They identified that the lack of race-based data and research on the experiences of people of African descent, noting the need for disaggregated data to adequately address the diversity and complexity of Black identity and lived experience.

While there is no one approach that can be applied to all, creating race data collection standards and good data governance guidelines should be driven by researchers, social scientists, clinicians, and members from Black, Indigenous, and racialized minority communities and/or representative organizations. This approach will help address this systemic barrier that contributes to the economic inequality and health inequities that members of Black and racialized minority communities face across the country.

We invite readers to review the Key Considerations: Race, Ethnicity and Indigenous Identity Data Collection and Use (https://umanitoba.ca/health-sciences/sites/health-sciences/files/2022-11/Key%20considerations.pdf) as a starting point for considering your organizational/ team readiness to move forward with this work.

References

Black Health Equity Working Group. (2021). Engagement, governance, access, and protection (EGAP): A data governance framework for health data collected from Black communities. https://blackhealthequity.ca/wp-content/uploads/2021/03/Report_EGAP_framework.pdf

UN Report of the Working Group of Experts on People of African Descent on its mission to Canada. Available at: https://digitallibrary.un.org/record/1304262.

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.

Resources

Visit the CMAJ website to view the two special issues on Black health and anti-Black racism in health care:

https://www.cmaj.ca/content/194/41?current-issue=y

https://www.cmaj.ca/content/194/42

Black health education collaborative: The important role of critical race theory in disrupting anti-Black racism in medical practice and education:

https://www.cmaj.ca/content/194/41/e1422

Canadian medical journal acknowledges its role in perpetuating anti-Black racism in health care

https://www.cbc.ca/news/health/cmaj-anti-racism-1.6627312

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2625534/

https://www.cmajopen.ca/content/10/4/E937

https://rnao.ca/sites/default/files/2022-02/Black_Nurses_Task_Force_report_.pdf

https://jamanetwork.com/journals/jamasurgery/fullarticle/2777800

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000324/

October 2022: Racism is a public health crisis

This first blog is an introduction and a conversation – a collaboration between our anti-racism and social justice work.

Visit the Canadian Public Health Association website for a statement on racism and public health.

Marcia Anderson

As a physician, I have seen unequal access and treatment of Indigenous, Black and racialized people in learning and work environment, and read countless journal articles documenting the same.

While we are trained as medical experts and scholars, what we know hasn’t been sufficient to disrupt or address racism in ways that have been shown to close these gaps in unequal care by race.

Delia Douglas

As a sociologist, I am attentive to the continuing significance of the legacies of enslavement, imperialism, and settler colonialism in the present.

I have examined racism’s impact in post-secondary institutions, the law and sport – and now I am working in the realm of health care.

That said, there are certainly many points of connection across different systems, organizations and institutions – the pervasiveness and persistence of racisms… I use the plural because racism is not one thing.

The events of the past two years – COVID -19 and the denial of bodily autonomy (the right to health and wellness, freedom from police violence, autonomy over gender and sexuality and the right to look after our children and families in safe and sustained communities) certainly exacerbated existing inequities and they have also produced new forms of violence.

The enduring legacies of residential schools as evidenced in the uncovering of the bodies of the 215 children who died at the Kamloops Indian Residential School (and the thousands more graves identified since), the death of Joyce Echaquan, the murder of George Floyd, and the reckoning with anti-Black racism, the rise in racism against people of East Asian descent, Islamophobia, and the death of Indigenous, Black, and racialized people in police involved shootings across the country.

These are not individual acts of racism, or the actions of a few bad apples, these are instances of systemic racism. These are acts that demonstrate how race influences who lives and who dies. Racism lowers life chances – racism kills.

I am reminded of the insights of the late Audre Lorde, a Black lesbian feminist writer poet and activist (1984). In her words, “We have the power those who came before us have given us, to move beyond the place where they were standing” (Sister outsider, p. 144).

I interpret Lorde’s remarks as both a responsibility and opportunity- our lives are shaped by all that has come before…

There is no quick fix, or toolkit, which can solve racism – if it were easy, we would be in a very different place. A new path forward towards racial justice is challenging, but possible if we commit to new learning, building relationships, cultural shifts, and structural change.

We have commitments – in our Faculty’s Disruption of all forms of racism policy, the Truth and reconciliation action plan, and Equity, diversity, and inclusion policy, and in the University’s commitment to the Scarborough Charter.

We have educational tools available (e.g., Learning module on disruption of all forms of racism policy and Manitoba Indigenous cultural safety training) and in development (e.g., Disrupting dialogues anti-racism speaker series, enhancing our racial literacy activities, and learning module on how to receive a disclosure of racism).

We all have a role to play.

What we need from our Faculty community is humility, accountability, courage, and open engagement with new learning, the application of new knowledge, and full participation in the organizational and structural changes required to create a more racially just environment.

If not now, then when?

Resources

Visit the Canadian Public Health Association website for a statement on racism and public health

Audre Lorde (1984): Sister Outsider.
Freedom, CA: The Crossing Press Feminist Series.

Disruption of all forms of racism policy