Covid-19 – 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.

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.

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