health equity – Race matters

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.

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.