Health equity – Race matters

September 2024: Working towards more just futures

“It is certain, in any case, that ignorance, allied with power, is the most ferocious enemy justice can have”
(James Baldwin, 1972, p. 149). No name in the street. New York: The Dial Press.

Marcia

Welcome to the 2024-2025 academic year. I’m really proud of the work across Indigenous health, social justice and anti-racism, and the ongoing efforts to contribute to more culturally safe and racially just outcomes. Dr. Douglas continues to provide leadership in developing new educational initiatives to enhance the racial literacy of the Rady community.

Working with the Offices of Equity, Access and Participation, and Community Engagement and Social Accountability, the new dialogue series will align with the Faculty strategic priority of reciprocal community engagement and build from passive receipt of knowledge to active dialogue. These offices provide excellent educational resources to our community, but it is up to each of us to apply that knowledge in our work and learning environments.

This year I encourage you to reflect regularly on how you can take the new things you learn, and apply this new knowledge in meaningful ways that result in more culturally safe and anti-racist environments for our increasingly diverse community. It is through your individual and collective actions that positive change will happen.

Delia

September greetings! A new academic year is upon us and as part of our commitment in working towards more just futures we will be launching a number of initiatives that we want to tell you about.

Here Come the Modules:

Foundations of Race, Racism, and Anti-Racism

This online module is one mechanism that builds on the Disruption of All Forms of Racism Policy by providing people with a resource to cultivate their racial literacy.

I understand that people come to this material from different vantage points. This module is an opportunity to expand our understanding of the meaning and significance of race and the persistence of racism because to combat racism in its various forms, we must first understand it.

You cannot get to anti-racism without reckoning with racism, so this course is an opportunity for folx to enhance their racial literacy by providing them with a vocabulary for identifying and speaking to each other across our differences in the service of social justice.

Some of the topics covered include:

Why race matters
What is race?
White matters: The social construction of whiteness
Racisms and their impact
What is racism?
Impacts of racism
Continuing your journey: Next steps

The Black Health Primer

The Black Health Primer officially launched on March 21, 2024, the International Day for the Elimination of Racial Discrimination. The Primer is an 8 module online, self-paced, and asynchronous course, comprised of quizzes, case studies, reflections, and multimedia. Designed for learners from across health disciplines, professions, organizations and communities, the Primer was created in response to gaps in education and training on Black health and anti-Black racism in medicine and public health in Canada.

The Primer describes the historical context of racial oppression, explains how anti-Black racism influences the social determinants of health, and acts as a barrier to health equity. Participants will gain knowledge about anti-Black racism and Black health and this knowledge will improve the racial literacy of health care practitioners. This will enrich the health of Black communities, as well as the health of all patients. Enhanced racial literacy is imperative, as it is integral to the delivery of anti-racist care.

Dialogues of Disruption

The third initiative is a collaborative effort by all the offices that fall under the portfolio of Dr. Marcia Anderson, Vice Dean of Indigenous Health, Social Justice and Anti-Racism. This includes the Offices of Anti-Racism, Equity, Access and Participation, and Community Engagement and Social Accountability.

In the upcoming academic year, we will be hosting a series of events in the upcoming academic year under the title: Dialogues of disruption: An invitation to work towards more just futures.

These monthly events will address a variety of themes that correspond to our areas of work, some of which include disability justice; connections, coalitions and false equivalencies: the indivisible connections between racial, gender, and lgbtqia+ justice; and anti-racism and engagement with newcomer, refugee and immigrant communities.

We wanted to draw attention to under-served and under-represented communities, along with local organizations, exploring areas of silence, marginalization, and invisibility by providing a meeting ground to collaborate in our work towards more just futures. In this spirit we will be inviting members from some of these communities to provide their indispensable input about the needs and priorities in their communities so that we may engage with them in ways that are appropriate and meaningful. It is our hope that disrupting dialogues will offer guidance in the journey of un-learning and learning, while encouraging and inspiring change and possibility.

The first event will be an introduction to each of the Offices mentioned above and an opportunity to speak to our distinct and shared work with a Q & A at the end.

Dialogues of Disruption: Upcoming Event

This event will be held on September 24, 12 to 1:00 pm. It will be a hybrid event taking place in Basic Medical Sciences Theatre-B and online. For more information or to register, visit our event page.

We all have a role to play. We look forward to working towards more just futures with you.

Resources

Black Health Education Collaborative: bhec.ca

Knowledge One Interview Foundations of race, racism, and anti-racism: https://knowledgeone.ca/interview-foundations-of-race-racism-and-anti-racism-online-course/

May 2024: Sport matters: Black female athletes: Sistas are doin’ it for themselves

Marcia

It is fascinating to see how women- and in particular the majority Black players of the WNBA- are using their power to collectively advocate for health equity and racial justice. There has been lots of discussion and studies about how greater inclusion of women in medicine resulted in significant culture shift. I wonder how the leadership from Black Women in sport will shift professional sporting culture and equally be part of the work in health care to interrupt all forms of racism.

Delia

Never Surrender, the Unapologetic Lives of Black Female Athletes

I want to begin by giving a SHOUT OUT to the South Carolina Gamecocks and Head coach Dawn Staley for winning the Women’s National Collegiate Basketball Championship, capping off their undefeated season (38-0)!!

Sport matters.
An important cultural site of interracial competition, cooperation and antagonism, sport has played a profound role in civil rights and social justice struggles in North America and across the globe. For Black folx throughout the diaspora, as a visible source of entertainment and possibility, sport has provided them with opportunities to gain recognition through physical struggle, not just for their athletic achievements, but it has also been a place to pursue their dreams, secure their corporeal integrity, and declare their humanness and citizenship. While Colin Kaepernick has undeniably been a driving force for the current generation of activist athletes, the visibility of his public protest is matched by the invisibility of his Black female counterparts. Change agents in their own right, diverse Black women have always been integral to Black liberation struggles.

Celebrating its 28th year, the WNBA was built out of the labour, fierceness, and love of Black women: 76% of the players and 19% of the owners are Black.

In 2016 in the wake of the killings of Philando Castile and Alton Sterling members of the Minnesota Lynx held a pregame press conference to talk about police killings. In subsequent games they along with players from other WNBA teams wore plain black T-shirts. Five days later the league fined the New York Liberty, Phoenix Mercury and Indiana Fever 5000 dollars and their players 500 dollars ostensibly for violating the league’s uniform policy, a policy that requires players to exclusively wear official league uniforms during and before all games and practices and not alter the uniforms in any way (this fine was more than the 200 the standard uniform violation fine).

To give you some context, in 2014 the WNBA initiated an LGBTQQIA+ Pride campaign during Pride month in June, the first professional sports league to do so. The league’s selective consciousness refers to the fact that when WNBA players wore t-shirts with a rainbow heart displaying the words Orlando united, after the Orlando nightclub shooting, players were not penalized. Notably, the National Basketball Association did not fine its members when they wore t-shirts stating, “I can’t breathe,” following Eric Garner’s death.”

Several days later the league rescinded the fines.

In 2020 the WNBA Social Justice Council was formed. It is an activist committee run by the WNBA and the players union. With support from advisers including Black Lives Matter co-founder Alicia Garza, they raised awareness about issues of race, voting rights, LGBTQQIA+ advocacy, and gun control.

This year the league is focusing on women’s health reproductive rights and civic engagement (with a focus on how voting impacts reproductive health within racialized minority communities in the U.S.). They have partnered with Opill which is an over-the-counter daily birth control pill that is available in the U.S.

“Everyone watches women’s sports”
The t-shirt ain’t lying: 18. 9 watched the women’s national basketball final between South Carolina and Iowa, peaking at 24 million (FYI: 14.8 million watched the men’s final).

Former WTA superstar Serena Williams and retired track and field icon Allyson Felix have drawn attention to Black maternal health following their life-threatening experiences during childbirth. Initially doctors did not believe Williams whose knowledge of her own body and medical history, namely her previous experiences with blood clots, led to her challenging the skepticism of her doctors, and ultimately saving her own life.

According to U.S. data the maternal mortality rate for Black women is 2.6 times the rate for white women. In May 2023 former U.S. track and field athlete, Torie Bowie died due to complications related to her pregnancy. The autopsy revealed respiratory distress, high blood pressure and eclampsia. Towie’s teammate, Allyson Felix, developed preeclampsia (as did Beyoncé) during her first pregnancy resulting in an emergency C-section at 32 weeks. All three of the gold medalists on the 4 x 100 metre relay team at the Rio Olympics, three Black women, had serious complications during their pregnancy. Felix’s relay teammate, Tianna Madison disclosed that went she went into labour at 26 weeks, she went to the hospital with her will and healthcare directive. Both she and Felix continue advocating for better Black maternal care.

With respect to reproductive health Black women in Canada are three times more likely to have fibroids than white women, are more prone to endometriosis (and less often diagnosed) and are screened less often for cervical cancer. In addition, the lack of accurate data regarding maternal mortality in this country is highly problematic. What we do know is that racism and racial inequality play a part in maternal mortality across North America (see Martis 2020).

World champion gymnast Simone Biles and WTA star player Naomi Osaka are advocates for prioritizing mental health and are working to reduce the stigma associated with mental illness.

I wanted to draw attention to diverse Black female athletes’ resistance and activism because their labour, love, and commitment are an important step towards acknowledgement of the complexity and the interconnection of Black liberation struggles. Their experiences and insights provide an opportunity for us to begin to recognize places of common or related oppression and struggle, which could subsequently offer a foundation for coalition work in support of justice and recognition of the value of all Black Lives (Cohen 452).

This is an Olympic year, so more there will be more sport talk coming.
Stay tuned.

Resources

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

Felix, Allyson. (15 June, 2023). Allyson Felix: Tori Bowie can’t die in vain. Time.com. https://time.com/6287392/tori-bowie-allyson-felix-black-maternal-health/.

Giroday, Gabrielle. (15 November, 2019). Lack of health data hurting Black Canadian women u of t researchers find. U of T News. https://www.utoronto.ca/news/lack-health-data-hurting-black-canadian-women-u-t-researchers-find.

Martis, Eternity. (4 June 2020). Why Black women fear for their lives in the delivery room. Huffpost.com. https://www.huffpost.com/archive/ca/entry/black-maternal-health-canada_ca_5ed90ae3c5b685164f2eab93.

Parris, Amanda. (1 February, 2024). I made a documentary about the Black maternal health crisis. Then I experienced it. CBC. https://www.cbc.ca/documentaries/i-made-a-documentary-about-the-black-maternal-health-crisis-then-i-experienced-it-1.7101607.
(see her documentary Standard of Care).

Reuters. (15 June 2023). Allyson Felix demands better maternity care. Reuters.com. https://www.reuters.com/sports/athletics/felix-demands-better-maternity-care-black-women-following-bowies-death-2023-06-15/.

von Stackelberg, Marina. (24 April 2024). Canada’s cancer screening guidelines are out of date. CBC. https://www.cbc.ca/news/politics/cancer-screening-canada-guidelines-1.7180878.

WNBA. (9 April, 2024). Opill and WNBA team up for ground breaking partnership. WNBA.com
https://www.wnba.com/news/opill-and-wnba-team-up-2024.

n.d. Every breast counts. Women’s College Hospital Healthcare. https://www.womenscollegehospital.ca/care-programs/peter-gilgan-centre-for-womens-cancers/every-breast-counts/.

March 2024: Integrate this! Grammars of recognition, survival, and resistance

Marcia

As Dr. Douglas notes below, March contains both International Women’s Day and the International Day for the Elimination of Racial Discrimination. Maybe we need an International Day for Intersectionality to recognize the fullness and wholeness of our identities and how that intersects with our experiences of social systems that structure access to power, money and resources- including the resource of health care.

From the time I was a junior faculty member, I would often use the predictors of referral for cardiac catheterization (table 5 from Schulman et al. – linked below) to highlight how it’s not enough to just say women receive inequitable treatment for heart disease, we have to look more closely at how different women are treated.[1] This isn’t a standalone study. Other research demonstrates Black Women have a higher risk of heart disease, hyperlipidemia, high blood pressure and diabetes but are significantly less likely to receive appropriate preventive care.[2] From maternal health outcomes to gender pay gaps, when we look more closely we see the interaction of race and gender- reminding us that both our analysis and our action needs to be more complex than trying to reduce our experiences of difference to a single variable.

[1] Table from Schulman et al. The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization. NEJM (1999). https://www.nejm.org/doi/full/10.1056/nejm199902253400806.

[2] Jha et al. Differences in Medical Care and Disease Outcomes Among Black and White Women with Heart Disease. Circulation (2003). https://www.ahajournals.org/doi/10.1161/01.cir.0000085994.38132.e5

Delia

Following a landmark ruling by Canada’s highest court of appeal in October 1929, some women were legally recognized as “persons.” Notably, this ruling did not apply to Black, Indigenous, or racialized minority women.

March is Women’s History Month.
March 8 is International Women’s Day.
March 21^st is International Day for the Elimination of Racial Discrimination.

While that ruling was passed nearly a century ago, the question of personhood, of humanness, remains a site of struggle.

I have been thinking about ongoing efforts to discipline and punish those on the margins.

Who is often excluded in language that homogenizes…which women are we referring to when we say women?

I have been thinking about women, 2SLGBTQQIA+, folx, and disabled folx – where and when (if at all) does race enter these conversations?

To put it another way, disability, gender identity, and expression, and sexuality are always racialized. Race is always present whether or not it is named. What I mean is this – there is a tendency to address race as if it is only relevant to those perceived to be raced subjects – Black, Indigenous, and racialized minority folx. Excluding whiteness from the racial order fails to identify the racialization processes assigned to people of European ancestry.

Racism occurs in 2SLGBTQQIA+ spaces. Racism occurs in disability politics. Racism occurs between and among diverse women…there is no place to stand outside of racism.

All our lives are shaped by multiple axes of power.

I have been thinking about recognition, survival, and resistance.

How might we begin to make sense of the complex ways in which race, gender, sexuality, and disability operate independently and simultaneously to shape our diverse lived experiences?

Diverse women are differently vulnerable in a society organized around heteropatriarchy, white supremacy, capitalism, and ableism. Not all women experience these violences, harms, and wounds in the same way.

We must acknowledge and prioritize complexity.

Disrupting and dismantling racial-sexual-gender-ableist hierarchies requires nuance and a rejection of either/or thinking.

The rejection and denial of difference, the rejection and denial of complexity, and the rejection and denial of personhood are part of past and present settler colonial projects.

If we can’t recognize the specific identities and experiences of people, then we won’t be able to adequately respond to their needs.

Kimberlé Crenshaw’s framing of intersectionality discourages us from attempting to determine one form of inequality as separate from other forms of inequality. For example, it does not see race as more or less important than gender, rather it acknowledges and responds to people’s experiences as simultaneously shaped by the intersections of the various elements of identity, including race, gender identity, and expression, sexual orientation and ability. Intersectionality is a lens that does not position forms of inequality against each other to determine who has endured harm, resulting in a hierarchy of oppression which is itself another form of harm.

So, I am thinking about the need for a racial literacy that is expansive in its capacity to identify and challenge multiple systems of oppressions at once. It is a racial literacy that considers disability and its integration with anti-racist, feminist, and queer practices in its conceptualization of social justice struggles.

Resources

Lindsey, Treva, B. (2015). “Post-Ferguson: A “Herstorical” Approach to Black Violability.” Feminist Studies, 41(1), 232-237.

Simms, Sy, Nicolazzo, Z., & Jones, Alden. (2023). Don’t say sorry, do better: Trans students of color, disidentification, and internet futures. Diversity in Higher Eduation,16(3), 297-308.

December 2023: Creating anti-racism pathways: Being the change

Delia

In August 2020, the Rady Faculty of Health Sciences Faculty Executive Council approved The Disruption of All Forms of Racism Policy (DAFR), the first anti-racism policy to be passed by any Faculty or post secondary institution in Canada. In November 2023 the Rady Faculty of Health Sciences Faculty Executive Council approved revisions to the DAFR Policy.

The DAFR Policy constitutes a formal recognition of racial harassment, racial discrimination, racial vilification, and racism. It is an affirmation of a) the histories of dispossession, enslavement, genocide, and their legacies; b) ongoing settler colonial projects; and c) the humanity, rights, dignity, and safety of Black, Indigenous, and racialized minority learners, staff, and faculty.

However, while the Policy is an important structural intervention, it represents a point of departure and not an end point.

In conversations about anti-racism, I often hear “I don’t know what to do/what should I do”?

This very question can place an added weight of expectations, responsibilities, and burdens associated with addressing issues related to racial (in)equity, racism, and racial justice on Black, Indigenous, and racialized minoritized persons. I mention this, because this question can be an expression of defensiveness/resistance, which can result in inaction.

You may be familiar with the phrase: the “only way out” is through… Some of the next steps associated with disrupting and dismantling racism(s) involve the active process of challenging one’s own biases and prejudices, as well as actively engaging in the work of disrupting systemic racism by dismantling the policies/social relations/attitudes/practices that promote and/or sustain racial inequality.

In response we have drafted a number of documents to guide and support you in your efforts to enhance your racial literacy and efforts to disrupt/challenge/eliminate the structural arrangements/policies/social relations/attitudes/practices that promote and/or sustain racial inequality and perpetuate racism.

Marcia

I spend a lot of time thinking about how anti-racist and social justice change will happen in our faculty and in the health care system. We have done a lot of work to offer educational opportunities and resources, and there are many more options to enhance your racial literacy online, at conferences and in the arts. However, as we know from every single behavioral health intervention ever, education alone is not enough. Like many aspects of organizational culture, racism is deeply embedded not just in policies, procedures and practices but also in the more invisible aspects like the stories that get told, the coded language that gets used, and the disapproval and even backlash people face when they try to speak up.

These parts of the invisible organizational culture are not things we can change from the Dean’s Office or the Office of Anti-Racism. These require us all to show commitment and leadership in meaningful action. The tools attached are meant to guide your work at the Unit, Department or College level as you seek to build your anti-racism strategies, hire more diverse candidates with anti-racism expertise, and build your own and your team’s racial literacy.

In November I launched a group coaching program to support Faculty Leaders in their anti-racism and social justice work. In 2024 the Office of Anti-Racism will be launching a council or community of practice to support you as you take action across Rady’s Units, Departments and Colleges. If we are going to have a New Year’s Resolution, let it be this: that we all develop a further understanding of our individual and collective anti-racism and social justice responsibilities, and begin (or for some continue) taking visible and meaningful action.

Resources

In November 2023, Dr. Marcia Anderson (Vice-Dean, Indigenous Health, Social Justice and Anti-Racism) launched a group coaching program to support Faculty leaders in their social justice and anti-racism work.

In 2024 the Office of Anti-Racism will launch an Anti-Racism Community of Practice- stay tuned for a formal announcement, name and dates.

This work requires all of us to understand and act on our responsibilities as members of the RFHS community.

We hope that the attached tools will help you on the next steps in your Units, Departments and Colleges. The toolkit contains the following resources:

Anti-Racism Strategy Template
Anti-Racism Resource List
Rady Equity, Access and Participation Strategy
Anti-Racism and Social Justice Terms of Reference Review
Anti-Racism and Social Justice Syllabus Statement
Guide for the Implementation of Anti-Racism and Social Justice Syllabus Statement
Suggested Anti-Racism Competencies for Job Descriptions
Rady Performance Conversation Review with Anti-Racism and Equity
Guideline to Anti-Racism and Equity on Performance Conversation Review

These materials can be found on the Office of anti-racism website.

November 2023: Raceing gender engendering race: Collective struggles and the “fierce urgency of now”

“Encounters between dominant and subordinate groups cannot be ‘managed’ simply as pedagogical moments requiring cultural, racial, or gender sensitivity. Without an understanding of how responses to subordinate groups are socially organized to sustain existing power arrangements, we cannot hope either to communicate across social hierarchies or to work to eliminate them.”
Sherene H. Razack (1998, p. 8). Looking white people in the eye: Gender, race, and culture in courtrooms and classrooms. University of Toronto Press.

Marcia

Last year I read the United Nations Human Development Report with concern as it documents a decline in the global Human Development Index for the second year. Trends in increasing and intensifying polarization that I thought maybe I was just seeing in the work I do were reported as part of a global phenomenon in increasing uncertainty. Democratic backsliding was identified, which raises concerns about the erosion of human rights for structurally oppressed populations. As described below we’ve seen this evidence very close to home – and in my role I always have to question how this will impact members of our Faculty community and the communities we serve? As the quote below says – this is a time for vigorous and positive action.

Delia

August 28, 1963. At the March on Washington, Dr. Martin Luther King Jr. stated that “we are confronted with the fierce urgency of now,” adding “[t]his is no time for apathy or complacency. This is a time for vigorous and positive action.”

November 2023. 60 years on…Dr. King’s statements remain true.

This past May some residents in the Southern Central Region of Manitoba attempted to defund the library and have sexual education books designed for children removed from their library system.

In June a 24-year-old former University of Waterloo student entered a gender studies class stabbing two students and an instructor. According to police this was a planned and targeted hate motivated attack linked to gender identity and expression. The accused also damaged a pride flag.

In June and August provincial governments in New Brunswick and Saskatchewan have moved to require parental consent before students under 16 can have schools use their preferred pronouns and name. In October the Premier of Saskatchewan invoked the notwithstanding clause to ensure that his policy, Bill 137 passed. Parental consent is now required before a child under the age of 16 can use a different gender related name or pronoun at school.

Here in Winnipeg, in June protests occurred during the Louis Riel School Division’s school trustee meeting where antagonistic behaviour, along with homophobic, transphobic, and racist remarks were directed towards staff and families. The police were called in and the meeting ended early. In response the Louis Riel School division moved its September Board meeting online due to ongoing tensions and hostility regarding members of the 2SLGBTQIA+ community.

This past September (20^th and 24^th) was followed by two protests and counter protests that took place at the Manitoba Legislature regarding the teaching of sexual and gender diversity and related policies in public schools.

While safety is a varying condition, at school and in the workplace, using the name a person wants to be called is not only respectful, it is an affirmation of that individual’s personhood. It is an affirmation of their humanity.

Furthermore, affirming the gender identity of queer, non-binary, and trans folx is linked to lower rates of suicide attempts.

“This is no time for apathy or complacency.”

Gender Diversity

In April 2022 Statistics Canada began disseminating census data on the gender diversity of the population. Here are some of the findings:

One in 300 people in Canada aged 15 and older are transgender or non-binary.
In May 2021, there were 59,460 people in Canada aged 15 and older living in a private household who were transgender (0.19%) and 41,355 who were non-binary (0.14%).
Close to two-thirds (62.0%) of the 100,815 individuals who were transgender or non-binary were younger than 35.

Beyond the Binary

Sexuality, gender diversity, gender identity, and expression. What’s race got to do with it?

While the Stats Can information on gender diversity begins to address a notable data gap, it does not tell us about their racial and/or ethnic identity. Queer, transgender, and non-binary folx are not a homogenous group. Our multiple identities influence our access to different levels of power. There are those who have a measure of protection or more privilege within marginalized groups.

To put it simply – we are not equally vulnerable – our vulnerabilities, and consequently our harms, are not the same. It is therefore imperative that we make visible and acknowledge those who are “the margins of marginalization” (Lindsey, 2015, p. 237).

Racism(s) and white supremacy expose Black, Indigenous, and racialized minority 2SLGBTQQIA+ peoples to more danger and greater risk of discrimination.

Representation matters. This has implications for how we respond to and organize for social justice.

It is imperative that we make visible and affirm the experiences, interests, and needs of Black, Indigenous, and racialized minority 2SLGBTQQIA+ folx.

Racism, white supremacy, heteropatriarchy, and settler colonialism are local/regional inter/national problems. We cannot eradicate inequality and injustice unless we recognize the interconnectedness of systems of domination and challenge the divisiveness of hierarchies of oppression.

We are undeniably living in challenging times as local and intern/national policies and practices become more ruthless, intensifying existing inequalities.

We must broaden, complicate, and connect our discussions and activism regarding gender, race, and sexuality so that we are better able to respond to the varied interpersonal and systemic violences that shape where we live now.

“This is a time for vigorous and positive action.”

Resources

Cacho, Lisa. M. (2012). Social death: Racialized rightlessness and the criminalization of the unprotected. New York, NY: New York University Press.

Lindsey, Treva B. (2015). Post-Ferguson: A “herstorical” approach to Black violability. Feminist Studies, 41(1), 232-237.

Statistics Canada. (April 2022). Filling the gaps: Information on gender in the 2021 census. Available at: https://www12.statcan.gc.ca/census-recensement/2021/ref/98-20-0001/982000012021001-eng.cfm.

Travers. (2019). The trans generation: How trans kids (and their parents) are creating a gender revolution. New York, NY: New York University Press.

United Nations Development Program. (2022). Uncertain times, unsettled lives. Available at: https://hdr.undp.org/content/human-development-report-2021-22.

September 2023: Racial equity matters

“How excellent can a department/faculty/university be if its curriculum disseminates to students only a very minuscule, highly-selected, self-perpetuating, gender [in addition to race, sexuality, and disability]-biased representation of our collective knowledge about human beings and the world in which we live?”
(Sheinin, 1998, 103)

Marcia

I’d been following the US Supreme Court case on race-conscious admissions in colleges and universities because of concern about potential impacts here, and in particular on the universities that have specific pathways under development or in place for Indigenous and Black learners. These pathways seek to mitigate the impacts of colonization and racism that have created inequitable access to the opportunity to enter health professional education, that is, to lessen disadvantage. Thankfully there have been more people who support the further refinement and advancement of these pathways than those who don’t, but there are those who question it, who get together and write op-eds about how diversity is weakening medical education.

So when the Supreme Courts said the use of race-conscious admission practices was unconstitutional and had to end, I was concerned that this might give strength to those who oppose these equity-focused pathways. However, the American Medical Association made a strong statement around how the ruling has the potential to undermine important progress towards equity in admissions and ultimately equitable health care:

“Recently established AMA policy reinforces our stance that medical schools must continue to make progress toward enrolling talented and highly qualified medical students in racial and ethnic groups that have been traditionally underrepresented in medicine. Eliminating health inequity requires more commitment to, investment in and support for Black, Latinx and Native American and Indigenous communities, and LGBTQ+ people. Yet, today’s ruling undermines policy that was producing positive results and improving the health of our patients, as well as making all physicians better practitioners. This ruling is bad for health care, bad for medicine, and undermines the health of our nation.”

This is one situation where we need to continue the path we are on, recognizing the evidence base that supports this as necessary for eliminating racial health inequities.

Delia

The recent US Supreme Court ruling on Affirmative Action and race informed admissions offers an important point of entry for a conversation about equity in Canadian universities…

On the matter of equity – what’s race got to do with it?
In a word…. Everything…

We have over 30 years of evidence of the limited impact of federally legislated employment equity policies in Canadian post-secondary institutions. Out of the 4 groups identified by the government – Indigenous peoples, persons with disabilities, racialized minorities, and women – the greatest change occurred in the area of gender equity, with white abled women benefitting the most, resulting in the diversification of white folx, with little substantive structural change….

In addition, while Canadian universities make public statements and policies asserting their commitment to “equity, diversity, and inclusion,” they are governed by a leadership that remains predominantly white at all levels of administration, including deans, university chairs, and executive leadership.[1]

[1]https://www.thediversitygapcanada.com/diversity-gap-in-university-leadership.html

The gap between the academy and the community is increasing as the homogeneity of faculty stands in stark contrast to the ever-increasing diversity of the student bodies at these institutions and the changing composition of Canadian society.

Indigenous and racialized minorities constitute the youngest and fastest growing members of the population – they will soon comprise the racial majority in several of Canada’s major cities in the coming years. Yet, these young people will rarely, if ever, encounter faculty who are not white. Rather, they will continue to encounter universities across the nation that reproduce, rather than interrupt and transform, the exclusionary cultures of whiteness and racism that shape their experiences in so many ways.

Amid the nation’s increasing diversity, the predominance of whites in the academy simultaneously confirms white supremacy by reinforcing the belief that those who are there are effectively the top candidates for the job. Consequently, whites are readily understood as authorities, and they unquestionably believe themselves to be best suited for their respective professions. These patterned exclusions are significant precisely because it is white scholars and administrators who continue to make decisions about the relevance of race and the (in)significance of racism. As Queen’s university distinguished professor Dr. Audrey Kobayashi (2007) summarizes, the culture of whiteness is reflected in “the overwhelming power of white academicians which keeps the status quo in place in terms of the content and the standards of the university, in terms of research, in terms of who has access to positions.”

The underrepresentation of Indigenous, Black, and racialized minority faculty in Canadian universities has also placed an added weight of expectations, responsibilities, and burdens associated with addressing issues related to racial diversity and racial inequality. These forms of identity taxation, or racialized equity labour work, have become more onerous and more urgent owing to the perilous conditions borne of the pandemics of COVID 19 and systemic racism both in and outside of the academy.

Real talk: race consciousness has always a part of the organizational culture, institutional arrangements, and practices of Canadian universities…and beyond…

Predominantly white environments are racially structured environments – the assumption that race consciousness only enters the conversation when talking about Black, Indigenous, and racialized minority folx is one that renders whiteness the unmarked norm, the default category. We are all racialized – to only speak of so called ‘non-White’ people as raced ensures that racial hierarchies remain intact…

Nothing can be changed unless it is acknowledged…

We live in a present shaped by dispossession, genocide, enslavement, and settler colonialism…

Race is present whether or not it is named…

Achieving racial equity involves more than increasing racial diversity for appearances around the table, or in the pictures. Just as the fact of a racially diverse country does not signal the absence of racism, the presence of one or two Indigenous, Black, and/or racialized minority faculty or senior leaders does not signal racial equity, since it tells us nothing about Who we actually are, or how things are really being done.

Racial equity is about shifting the landscape and narrowing the gap between the community and the university. It is about disrupting and dismantling the university’s practice of white exclusivity and racial segregation that continues in plain sight, hidden behind the ostensibly objective criteria of “excellence,” “competence,” “best fit,” and “best qualified.” Racial equity is about shifting a pattern aptly identified by Dr. Malinda S. Smith, political scientist and the University of Calgary’s inaugural Vice Provost of Equity, Diversity, and Inclusion, as “the social injustice of sameness.”

And for those who are thinking that employing racial equity will result in the university being full of unqualified faculty who come from racially underrepresented groups, the facts say otherwise. PhDs who are Indigenous, Black, or racialized minorities continue to have high unemployment rates in general. The data demonstrates that they have the qualifications, but they are un(der)employed.

…Racial equity matters…

Curricula reflect departmental cultures through allocation of teaching and research assistantships, the selection of courses. Curricula also socializes students to dominant social norms, values and ways of thinking and being. Consider that claims about “neutral” and “evidence-based health or medicine” do not take in to account how different skin disorders will present differently owing to an individual’s skin tone. A singular approach to health and well-being not only excludes, it enacts harm, sometimes with fatal consequences. Consequently, the absence of some subjects denies the existence of certain groups and/or gives the impression that one’s experience and history is not worthy of study.

The predominance of white faculty also means that there are few opportunities to provide Indigenous, Black, and racialized minority students with mentors, role models, and advisors.

What’s more, when these students do not see themselves reflected – and respected – in the curriculum they study or the professors they encounter, these exclusions reinforce notions of the inherent superiority of whites and the attendant inferiority of Indigenous, Black, and racialized minorities folx in ways that have psychological, embodied, symbolic, and material ramifications. Simply stated, the cultural identities of white students are affirmed at the same time as the cultural identities of Indigenous, Black and racialized minority students are marginalized, distorted, or rendered invisible.

I am mindful that the link between embodiment and knowledge production is neither simple or straightforward, but the lack of urgency over three decades demands that we consider the meaning and significance of the absence of certain bodies and the related absence of certain bodies of knowledge, since it is principally white scholars and administrators who make decisions about whether race matters, how it matters, and, in turn, if it matters at all.

Excellence flourishes in an environment that embraces the broadest range of people and reflects local communities. If we want racial equity, we must address racism.

As Archbishop Desmond Tutu stated: “If you are neutral in situations of

injustice, you have chosen the side of the oppressor.”

I leave you with the question: Whose side are you on?

Resources:

Ahmed, Sara. (2012). On being included: Racism and diversity in institutional life. Durham, NC: Duke University Press.

Bowden, Olivia. (2020 September 10). CBC. Canadian university students use Instagram to reveal racism on campuses. Available at https://www.cbc.ca/news/canada/canada-universities-racism-instagram-1.5716603.

Bray, Nancy. (2016). The diversity gap in university leadership. Academic Women’s Association, University of Alberta. Available at https://uofaawa.wordpress.com/awa-diversity-gap-campaign/the-diversity-gap-in-university-leadership/.

Canadian Association of University Teachers. (CAUT). (2018, April). Underrepresented and underpaid: Diversity & equity among Canada’s post-secondary education teachers. Ottawa, ON: CAUT. Available at https://www.caut.ca/sites/default/files/caut_equity_report_2018-04final.pdf.

Douglas, D. D. (2021). Access denied: Safe/guarding the university as white property. In S. Thobani (Ed.), Racial (In)Justice in the academy. Toronto, ON: Toronto University Press.

Gutiérrez y Muhs, G., Flores Niemann, Yolanda, González, Carmen G., & Harris, Angela P. (2012). Presumed incompetent: The intersections of race and class for women in academia. Logan, UT: Utah State University Press.

Hyslop, Katie. (2021, March 26). Canadian universities have a racism problem. The Tyee. Available at https://thetyee.ca/News/2021/03/26/Canadian-Universities-Racism-Problem/.

Khosla, Risha. (2021, October 1). The entrenched racism in Canadian universities. Spheres of Influence. Available at https://spheresofinfluence.ca/the-entrenched-racism-in-canadian-universities/.

Kobayashi, Audrey. (2007). “Making the visible count: Difference and embodied knowledge in the academy.” Paper presented at the annual meeting for the Canadian Federation for the Humanities and Social Sciences, Saskatoon, Saskatchewan, May 26-June 2.

Seatter, Erin. (2016, December 13). Canadian universities failing at diversity: Study. Ricochetmedia.com. Available at https://ricochet.media/en/1588/canadian-universities-failing-at-diversity-study.

Tomlinson, Asha, Mayor, Lisa, & Baksh, Nazim. (2021, February 24). Being Black on campus: Why students, staff and faculty say universities are failing them. CBC. Available at https://www.cbc.ca/news/canada/anti-black-racism-campus-university-1.5924548.

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.

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.