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In 2020 the murders of George Floyd, Breonna Taylor and Ahmaud Arbery were direct result of racist police brutality and systemic racism. Since, the Black Lives Matter movement, an ideological and political intervention first developed in 2013, has flooded America and the world. Here in Canada, we are learning and coming together in solidarity for our Black community.
In the context of health, racism is a public health crisis. The Canadian Nurses Association states that racism is an important determinant of health that has major implications for all aspects of a person's wellbeing. While most of the focus has been on the United States, if you are a Canadian reader, we invite you to turn your awareness to your own backyard. Canada is certainly no stranger to racism and discrimination.
The Impact of Race on Health & Well-Being
In Canada, systemic racism occurs as racialized differences in housing, education, employment opportunities, the justice system and even within the media (1). Your race can have a direct relationship on health, including the quality of health care you receive, health outcomes, and even life expectancy.
Racism may subvert the health of populations in many different ways. Within the Canadian health care system, racial discrimination is often indirect and systemic. Often times healthcare is provided as "one size fits all" with little regard for cultural, religious and linguistic differences. This has been cited as the "colour-blind" approach (2). Research has found that health care providers may have both conscious or unconscious bias towards members of racialized groups that can affect the care they provide. This includes unawareness of specific assessment and treatment strategies. To make matters worse, racialized groups are under-represented within health professions. This means there are fewer persons of colour (POCs) working at an institutional level to advocate for change, such as cultural competence training or more inclusive assessment and treatment approaches.
Historically, systemic racism has resulted in primarily "white" control of and access to work and labour, material resources, and other symbolic resources within society. This means that several communities that comprise Canada's population, including Black, Indigenous, and racialized immigrants, face unjust discrimination on the basis of their skin colour. The outcomes of centuries of oppression against POCs have resulted in some staggering and disturbing statistics (3)
Black people are twenty times more likely to be killed or injured by police in Toronto
The 2016 Census of Canada showed that 20.8% of people of colour are low-income compared to 12.2% of non-racialized people
Racialized women earned 58 cents, and racialized men earned 76 cents, for every dollar a white man earned in Ontario in 2015
Black students were 12% of the Toronto District School Board student population but represented 48% of all expulsions; Indigenous students were 0.3% of the student population and 1% of all expulsions; Eastern, Mediterranean and Southwest Asian students were 4% of the population but 8% of all expulsions
In 2011-2012, almost 11 million Canadian households experienced food insecurity; the percentage was higher among recent immigrants -19.6%, versus 12.4% among Canadian born
A national study reported that individuals with an Indigenous identity were more than twice as likely (18%) to have experienced hidden homelessness as their non-Indigenous counterparts (8%)
The 2016 Census data shows a 45% income gap between Indigenous women and non-Indigenous men, while the average income gap between all Indigenous and non-Indigenous people was 33%
Yes, Canada Does Have An Anti-Black Racism Problem
It is a common misconception that because Canada played a lesser role in Black slavery compared to the USA, we are immune to the anti-Black racism that plagues America. Unfortunately, this could not be further from the truth. To date, the vast majority of health and race research in Canada focuses on immigrant and indigenous health. While there is plenty of international research, the Canadian data on racism and the associated health disparities in Black populations are extremely limited. One reason for this is that race and ethnicity statistics are not regularly recorded in health care registry data. Veenstra & Patterson suggests that a "lack of attention to racial health inequalities in Canada may reflect a national rhetoric of multiculturalism and tolerance that prevents a specific focus on ‘race’ in favor of issues associated with acculturation and immigration"(4). In other words, because Canadians have a perception that Canada is "multicultural" and tolerant of diversity, we are ignorant of the racism impacting Black communities. Discrimination affects all POCs in Canada, where we have a significant history of cultural genocide against our own Indigenous people and approximately 21.9% of our population are reported immigrants (5).
Colour-Coded Health Care : Where Racism is Least Expected But Most Detrimental
"Colour-coded health care", a term coined by Sheryl Nestel in her review of the impact of race on health, describes the bias, discrimination, and stereotyping that exists in health care delivery. To the middle-class white Canadian, our healthcare system might appear to provide considerable accessibility with equal health care services. However, the available health research speaks volumes, and that is that if you are a POC, our healthcare system is failing you.
Systemic racism has lead to poorer health outcomes for all minorities living in Canada. Since racialized groups experience higher rates of poverty and poorer living and working conditions, it is theorized that the result is the onset of chronic diseases like hypertension and other cardiovascular illnesses, obesity, asthma, excess alcohol consumption, substance abuse, diabetes, depression and prolonged stress due to the experience of racism (6,7).
According to research, Black individuals are less likely to receive inexpensive effective treatments for heart conditions compared to other individuals.(8) African Americans aged 18-49 are twice as likely to die from heart disease than whites.(9) Other studies have found that POCs are less likely to receive preventative screening such as mammograms, pap tests and prostate exams compared to white people (10). In the USA, evidence shows that maternal mortality rate is 3-4 times higher in Black women than White women. In Canada, Black communities have been disproportionately affected by the COVID-19 pandemic, where there is a strong positive association between neighborhoods with a higher number of Black people and the number of coronavirus cases (11).
Further, patients of minority groups are more likely to feel that their health providers are not listening, do not show respect and do not explain medical information clearly (12). Unfortunately, there seems to be a lack of understanding of these issues among health care providers. In one study, nearly half of family doctors believed that race raised no tensions within their practice, and many physicians perceived racial differences as having no social importance. This evidence suggests that there may be a denial of the role racism has in health care delivery.
The lack of scientific data focusing on health and racialized groups is extremely concerning, as the outcome means that we do not have the understanding of how to assess and manage specific health conditions within these communities. This is really only the tip of the iceberg when it comes to health, race and racism. Communities, health care providers and the government have a long way to go in delivering culturally sensitive care, improving access to basic necessities of living such as quality food, housing and healthcare, and beginning to develop race-based data collection in order to create healthier futures for racialized people in Canada.
Where Do We Go From Here?
Many of us are in special positions to advocate for change, whether we work for the government, community, or health care system. Public health professionals can work with faith and community organizations, education, , transportation, and housing, to create social and economic conditions that promote health starting in childhood. Healthcare providers should work with local organizations to eliminate cultural barriers to care & promote a trusting relationship by encouraging patients to ask questions and seeking out education to eliminate racism in their own practice. The federal government can begin to collect data and trend health conditions that affect overall health, and support actions to create healthy food environments and increase physical activity in underserved communities. Finally, everyone can always listen and engage, educate others and act in a fashion that promotes awareness in their communities and addresses racism head-on in their social circle, homes, institutions, and workplaces. While we are not experts in this area, we have listed some impactful resources, as well as organizations we encourage you to check out that are advocating for change now.
Resources For Further Education or Donation:
500 Women Scientists
Black Lives Matter
# SayHerName
Black Women In Motion:
Women's Health in Women's Hands Community Health Centre
References
Ontario Human Rights Commission. (2004). Racial inequality in access to health care services. http://www.ohrc.on.ca/en/race-policy-dialogue-papers/racial-inequality-access-health-care-services
Vargas, N. (2014). Off white: Colour-blind ideology at the margins of whiteness. Ethnic and Racial Studies, 37(13), 2281-2302
Ontario Council of Agencies Serving Immigrants. (2019) New Fact Sheets Show Growing Racial Disparities in Canada.https://ocasi.org/new-fact-sheets-show-growing-racial-disparities-canada
Veenstra, G., & Patterson, A. C. (2016). Black–white health inequalities in Canada. Journal of immigrant and minority health, 18(1), 51-57.
The Government of Canada, Statistics Canada. (2016). Immigration and ethnocultural diversity: Key results from the 2016 Census https://www150.statcan.gc.ca/n1/daily-quotidien/171025/dq171025b-eng.htm?indid=14428-1&indgeo=0
Ontario Human Rights Commission. (2004). Racial inequality in access to health care services. http://www.ohrc.on.ca/en/race-policy-dialogue-papers/racial-inequality-access-health-care-services
Toronto Public Health. (2013). Racialization and Health Inequities in Toronto http://www.multiculturalmentalhealth.ca/wp-content/uploads/2014/01/Racialisation-Toronto-2013-62904.pdf
Hargreaves, S. (2000). Inequalities in clinical decision making for low-cost treatments. The Lancet, 356(9229), 569.
Centers For Disease Control and Prevention.(2017). African American Health: Creating equal opportunities for health. https://www.cdc.gov/vitalsigns/aahealth/index.html).
Quan, H., Fong, A., De Coster, C., Wang, J., Musto, R., Noseworthy, T. W., & Ghali, W. A. (2006). Variation in health services utilization among ethnic populations. Cmaj, 174(6), 787-791.
City of Toronto. (2020) Neighbourhood Profiles..https://open.toronto.ca/dataset/neighbourhood-profiles/)
Feagin, J., & Bennefield, Z. (2014). Systemic racism and US health care. Social science & medicine, 103, 7-14
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