Knock down anti-Black racism in medicine, two powerhouse advocates tell health-care sector in new CMAJ article

More on process-type recommendations to identify approaches to address issues, many of which reflect social determinants of health:

When rapper John River went to a hospital emergency room in 2017 with shortness of breath and severe headaches, he was treated like he was faking his symptoms to get drugs. When he turned to social media for help, well-wishers told him how he and his family acted and dressed at the hospital would impact the kind of care he would receive. No hoodies, for instance. His mother tried to button a dress shirt on to him as he lay unconscious on a stretcher. He was eventually diagnosed with a spontaneous cerebrospinal fluid leak from a prior procedure.

For years, Black people have shared, with data scientists, governments, academics, journalists and each other, terrifying stories of not being believed in hospitals, of receiving substandard care, of feeling like they were left to die.

In this COVID-era, race-aggregated data showing Black people disproportionately impacted by the virus has rightly raised awareness and alarm over the impact of racism across systems leading to that outcome.

“The field of medicine can no longer deny or overlook the existence of systemic anti-Black racism in Canada and how it affects the health of Black people and communities,” write OmiSoore Dryden of Dalhousie University and Onye Nnorom from the University of Toronto. 

In a Canadian Medical Association Journal article released Monday, the two powerhouse experts in the field of anti-Black racism in medicine say the health-care system needs to focus on — and redress — not only the reasons that send Black Canadians to hospitals but how they’re treated when they get there. 

Despite protests against anti-Black racism this summer, despite the UN expressing concern in 2017 of the plight of Black Canadians, “the impression that we got is that many Canadian physicians did not think that anti-Black racism is a problem in Canada,” Nnorom told the Star. And that “most physicians do not have an understanding of how racism operates as a system such that some groups are disproportionately disadvantaged.” 

With this article, Dryden said, the authors aimed to “tell practitioners and clinicians that your patients are not just bodies in front of you. They come with experiences. One of the experiences your Black patients come with is anti-Black racism.” 

Dryden is the James R. Johnston (JRJ) Chair in Black Canadian Studies at Dalhousie University’s faculty of medicine. Nnorom is trained as a public health physician and a family physician and has published several articles in medicine.

About a year ago, they set up Canada’s Black Health Education Collaborative by bringing together a group of scholars of Critical Race Theory from across Canada and working on creating curriculum around how anti-Black racism affects health outcomes in medical schools.

The many manifestations of racism in society — being passed over for a job or a promotion, being treated with suspicion in public spaces, being denied homes to rent, being unduly disciplined in school — all boil down to one unspoken assumption: that the person in question is not credible because they are not innocent. An assumption we like to give the innocuous label of “implicit” bias, even though its consequences can be tragically explicit. 

“This article and the conversations many of us have been having is identifying that racism is not an anomaly, it’s an everyday experience,” Dryden said. 

When Black people go to the hospital in pain, they are profiled as drug seeking, she said. Or the assumption is they don’t feel pain at the same level. Or if they are given medication that they’re not compliant and won’t follow guidelines. 

In her many public talks to health and medical professionals, Dryden tells them, “If you have a patient that doesn’t return, instead of thinking they’re not compliant, you might want to start with, ‘Did something racist happen and how do I find out?’

Although modern science conclusively busts the myth that race has biological origins, medical stereotypes rely on the belief that Black people are a different genetic species of humans. 

“Yes, the human genome has been mapped,” Nnorom said. “Yes, we know a person’s postal code has more impact on their health than their genetic code but it is difficult to completely remove that type of thinking. The history of medicine and these genetic biological associations with race dates back centuries.” 

The first program of medical education began in Montreal about 20 years before the end of slavery in Canada, Dryden said. “So it began at a time when Black and Indigenous are enslaved and that becomes the continuing flavour of education in Canada.”

If studies show how African-Americans have higher rates of diabetes or hypertension, the medical approach is there’s something wrong with their genetics or their culture or their practices that needs to be fixed. 

“The way we’ve been traditionally taught in medicine is to pathologize the marginalized group.” Nnorom said. “We’ve been taught to assume there is something wrong with the group that has been marginalized as opposed to thinking there was something wrong with society to create the conditions in which those communities find themselves.

“The process (of learning), you’d almost have consider it an unlearning.”

To address racism, the authors say health-care professionals should acknowledge its existence first. “We can do this by listening to the voices of Black Canadians, patients and health care professionals who have been grappling with anti-Black racism for generations, and by engaging with the many communities that have made recommendations for meaningful change to address the problem,” they write.

What would listening look like? 

“That’s a very good question,” said Nnorom, because while organizations might engage in consultations with focus groups in different communities, “what ends up coming out of that is not what the community has recommended. That is not true listening.”

Hospital leaders, administrators and academics would have to take up hard, uncomfortable work of “actually looking at recommendations by Black communities, to hold town halls start, to have Black community members at the board — and not just with one person because that would be tokenism.” 

Said Dryden: “There’s always an excuse for why something isn’t anti-Black racism as opposed to sitting with it for a moment (and thinking) ‘If this is racism what should I be doing differently?’ And nobody asks themselves that question. That’s the thing we want them to ask themselves.” 

This article is intended as a building block in that journey towards change, Nnorom said. 

“So that we can see a Black patient can come into a hospital and be treated with dignity, where their pain is recognized and they receive respect and empathy and not be treated worse because of the colour of their skin.”


About Andrew
Andrew blogs and tweets public policy issues, particularly the relationship between the political and bureaucratic levels, citizenship and multiculturalism. His latest book, Policy Arrogance or Innocent Bias, recounts his experience as a senior public servant in this area.

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