The challenges Black Canadians face in accessing equitable education, work, and health care have featured prominently in media coverage in recent years.
But when Onye Nnorom began to develop the country’s first dedicated curriculum on anti-Black racism in health care with the University of Toronto, she found available educational resources did not communicate how everyday racism, the legacy of slavery, and previous experiences of discrimination impacted Black patients accessing health.
With her colleague Sume Ndumbe-Eyoh; OmiSoore Dryden at Dalhousie University; as well as a network of scholars from across the country called the Black Health Education Collaborative (BHEC), Nnorom created the Black Health Primer — the first comprehensive resource focused on understanding the complexities of Black health in Canada.
TVO Today speaks with Nnorom about the formation of this program and the challenges Black Canadians face in accessing care.
TVO Today: How did this course come to be?
Onye Nnorom: In 2016 I took on a new role at the University of Toronto, where I’m an assistant professor. I became the first Black team-lead in the country. My task was creating a curriculum on Black health for medical students, but there were no textbooks and standardized resources on Black health.
As I developed this curriculum at UofT, I realized there needed to be something like this that could be a resource across the country. I contacted OmiSoore Dryden in 2019. She’d just started her role as the James R Johnson chair in the faculty of medicine at Dalhousie. We agreed that there needed to be a resource that talked about Black communities and anti-Black racism that could be used to teach medical students across Canada.
We were able to bring together scholars from around the country and get some funding. In 2021, we officially established the Black Health Education Collaborative. Somewhere in the middle there we had a pandemic. Not only did that have an impact on our lives, but at the same time, there was a greater understanding of anti-Black racism in Canada.
That’s what expanded our scope beyond medical schools to thinking about practicing physicians, public health practitioners, nurses, and the whole health-care system being aware of Black communities, Black health, and anti-Black racism.
TVO Today: What does the course cover?
Nnorom: Broadly speaking, it’s information that medical and health-care folks need to know about Black communities, about Black Canadian history — including slavery in this country — and the health impacts of everyday anti-Black racism.
There have been studies showing that Black people in Canada experience everyday forms of racism and indignity, from being denied job opportunities and housing to being mistreated in the educational system. All of these things create stress and circumstances that impact health, and health practitioners need to understand that.
Then, when Black people who experience these health outcomes go to seek care, there’s the added experience of racism within health care. There have been studies looking at this that show Black people are often ignored, experience dehumanization, and receive a lower quality of care. Many students never come across these, so the course aims to make that real for them.
The most important section covers how we can do better: how to provide better quality care and equitable care for Black patients. How everyday racism impacts health, the harms of racism in health care, and finally how they can address anti-Black racism as individuals in a health-care system.
TVO Today: What role does education like this play in addressing anti-Black racism in health-care?
Nnorom: Education is necessary, but it’s not sufficient for change. Luckily, we are part of an ecosystem of practitioners advocating for anti-racist health care. Alongside education you would ideally have policy change as well. Policies that can ensure, for example, that Black patients get timely service, that their pain is not ignored, that there’s collection of race-based data to be able to monitor if care is equitable.
That said, it’s true that education comes first. If you have policies and people don’t understand why those are in place, it becomes very difficult for people to follow — and for there to be accountability and positive outcomes.
TVO Today: What should the public should know about anti-Black racism in medicine?
Nnorom: The extent to which so many Black patients are actually frightened when they have to access care might surprise people. I can talk about the studies that show that, for racialized groups in Canada, they experience dehumanization, delays in care, a feeling of being discriminated against. Right? But let me just give you an example.
Picture a Black woman. We know that in Canada, according to StatCan, she is 1.5 times more likely to be overqualified for her job. That means she’s working harder for less money. So, she’s experiencing a greater level of stress because of the colour of her skin. She might also be coming from a family where people around her are also experiencing anti-Black racism and maybe she’s stressed about that as well — whether it’s because of barriers they are facing with regards to housing, or anti-Black racism in the educational system or the workforce. All of these things are very unique to the Black experience, because of the kinds of stereotypes that came out of slavery: that we’re less intelligent, subhuman, and not to be trusted. These all have implications in our everyday lives.
Now, say she is pregnant. She wants to seek health care. She has already heard from many community members what we know to be true: that there is anti-Black racism in health care. She knows that in this system, she might not be believed, she might experience delays, or there might be stereotypes about her when she accesses care. On top of that, she might be aware of the data that shows that a Black woman is more likely to go into pre-term labour than a white woman in Canada. All of this is not because of genetics or mutations, it’s our lived situation.
If she doesn’t have a doctor who understands all of that: how everyday anti-Black racism can affect your health, how racism in the system can affect your health — then you don’t get the same quality of care.
This is the type of patient most likely to track me down to ask: do you know a Black obstetrician or gynecologist? Do you know any Black doctors? And the reason she’s asking is because she is terrified that she’s going to experience racism in the system.
I think a lot of people don’t realize that a lot of Black patients feel this way. They’re scared or suspicious or on edge or feel like they need to come with their families and remain hyper-vigilant to the harm they can experience in care. That’s what I hope this course helps medical students and professionals understand.
TVO Today: What happens when a doctor doesn’t understand this?
Nnorom: If this patient walks into a doctor’s office, and if she’s say 25-years-old, a doctor may think she’s average risk — but in fact she’s at a higher risk of being a complex patient because the complexities around her experience predispose her to worse outcomes.
It’s common for people to think that, when a Black patient asks for a Black doctor, or an Indigenous patient asks for an Indigenous doctor, they are being racist. No. It’s that they are trying to find a way to get equitable care that is non-racist. That is safe. And, of course, Indigenous and Black doctors are underrepresented in the system. Yes, part of the answer is to have greater representation in medicine, but the other piece is to make sure that all doctors and health-care providers have that cultural dexterity so that they can work with different groups and understand these issues.
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