Health equity – Page 2

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.

“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.