June 6 | Words by Harit Sohal and Nadia Ladak, Graphics by Sissi Chen
The unjust murder of George Floyd has caused a recent surge in public awareness and activism regarding the inherent racism within the police, judicial, and prison systems in the United States. This is a result of centuries of racism deeply-rooted in systems and institutions within and outside the United States, and contributes to the oppression of Black people.
Racism permeates every single institution in our society, including the healthcare system. While racism in healthcare is a complex issue and our blog cannot be exhaustive, the purpose of this post is to provide an opportunity for reflection by highlighting a few examples of racial disparities in healthcare.
Canada is often seen as a country that prides itself on values of multiculturalism and acceptance. However, these values are not always reflected in our healthcare systems, particularly for Black and Indigenous peoples. A core issue is the lack of race-based health data collection, meaning that although racism in the healthcare system exists, it may not be adequately detected. For example, the disproportionate effect of COVID-19 in Black communities is clear in the US. However, with a lack of data in Canada, the severity of the impact on Black communities in Canada is lost. Because of this very problem, many of the statistics mentioned below are based on US data.
In the shift to dismantling racism in healthcare systems, the focus needs to be extended beyond research and into practice as well. Currently, 5.7% of US Physicians are Black, even though they represent 13% of the overall population. This forces Black people to have sensitive conversations with medical professionals who may not understand their lived experiences and unique needs. Furthermore, it has been argued that having similar racial and cultural backgrounds with one’s doctor promotes communication and trust, leading to more effective treatment. While we are not stating that Black patients must be treated by Black doctors, we are simply expressing that shared experiences establish a stronger sense of empathy and understanding of a patient.
Physicians, like every other individual in society, are exposed to several negative narratives regarding racial minorities, especially with the Black community. This exposure has the ability to lead to implicit and explicit biases about Black individuals. In fact, a study from the US National Institute of Health showed that many White doctors perceive Black patients to be less sensitive to pain than their White counterparts. Before slavery was abolished, this pain myth was used by slave owners to dehumanize their slaves without guilt. Although it is no longer a predominant thought, this myth continues to seep into the perception of Black individuals’ pain today. For example, Black patients are currently 22% less likely than White patients to receive pain medication in the emergency department.
According to the Canadian Health Association, social determinants of health include but are not limited to, income, education, unemployment, social exclusion, early childhood development, food insecurity, and housing. Although Black individuals represent 3% of the Canadian population, they represent 18% of Canadians living in poverty, resulting in disparities across several social determinants of health. Healthcare is universal in Canada yet there are many examples in which those with lower income levels have higher barriers to leading a healthy life. For instance, living in poverty makes it next to impossible to afford high quality nutrition and groceries that are recommended to optimize health. This can lead to a vicious cycle of poor nutrition, increased chances of falling ill, expensive medical bills that may not be covered by universal health care, and overall worse health outcomes.
This article is not an exhaustive document, but a contribution to the awareness of racial healthcare disparities. We acknowledge that we have only begun to scratch the surface of a deeply rooted and widely-interconnected issue. We don’t use this as an excuse to stop here, rather we accept the challenge to further educate ourselves and to raise health standards for everyone. We have listed a number of resources below that will be helpful in starting your educational journey regarding this topic. We encourage you to join us in following organizations such as Black Health Matters and Black Health Alliance that are making a difference in this space.
36 Resources To Learn About Racism & Health
By Janice A. Sabin | AAMC (Jan 6, 2020)
By Linda Villarosa | NY Times (Aug 14, 2019)
By Erika Stallings | The Oprah Magazine (Aug 1, 2018)
By Black Heath Alliance
By Danyelle Solomon | Centre of America Progress (April 18, 2018)
By Meghan Collie | Global News (Nov 13, 2019)
By Hamza Shaban | The Atlantic (Aug 29, 2014)
By Heidi Ledford | Nature (Oct 24,2019)
By David R. Williams
By Heather C. McGhee
By Mary Bassett
By Dorothy Roberts
By T. Morgan Dixon and Vanessa Garrison
By Miriam Zoila Perez
By Keolu Fox
By Brittney Cooper
John Hopkins Medicine (April 18, 2017)
PBS NewsHour (April 5, 2016)
Al Jazeera (Nov 23, 2015)
ABC News (May 21, 2020)
The Gilder Lehrman Center for the Study of Slavery, Resistance, and Abolition (May 4, 2020)
How Racism Impacts Our Mental Health | Therapy for Black Girls
How the Bad Blood Started |1619
Reproducing Racism | Reveal
So Why Is the Pandemic Killing So Many Black Americans | The Daily
Episode 76: From the Archives: Dr. Kenneth Clark on Racism and Child Well-Being | Into The Fold
The Intersection of Racism and Health Amid the Coronavirus | The World
How Racism Harms Pregnant Women - And What Can Help with Miriam Zoila Perez | Ted Health
Ep 6: Racism Is A Public Health Issue | Coloring Health Policy
Bleeding | Bodies
Racism, Colonialism & Hope. The Realities of Indigenous Health, with Dr. Michael Kirlew | Solving Healthcare
The Black Women's Health Book: Speaking for Ourselves | By Evelyn C. White
Medical Apartheid | By Harriet A Washington
Just Medicine: A Cure for Racial Inequality in American Health Care | By Dayna Bowen Matthew
Science as Social Knowledge: Values and Objectivity in Scientific Inquiry | By Helen Longino
Breathing Race Into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics | By Lundy Braun