Race doesn’t affect health outcomes — racism does
As medical professionals, we see this reflected in COVID-19 stats
Why are people of colour, particularly Black Canadians, suffering from COVID-19 at a disproportionate rate? As doctors in the medical field, we see that racism is the virus’s risk factor.
There is a long history of racism and prejudice that has siphoned away the health of racialized people in Canada. The latest COVID-19 data — with racialized people making up 83 per cent of Toronto’s cases — is just another stark reminder.
In the 19th century, the Canadian government viewed Indigenous peoples as “a dying race, destined to vanish.” Conditions of rampant illness, malnutrition, poverty, tuberculosis and staggering disease rates presented an existential threat for Indigenous peoples culminating in one of the largest depopulations in human history.
Two centuries later, this inequitable distribution of disease continues to have a strong hold in our society. Whether chronic conditions, like diabetes or cardiovascular disease, cancer, or premature and preventable death, racialized and low-income patients bear the brunt.
When we look at the alarming and persistent health status gaps in Canada, it is tempting to say that race is the critical factor, but it’s not. Race does not determine health outcomes — racism does. Structures of racism shape life opportunities, and are insidious, prevalent and so deeply interwoven into our societal fabric that they influence every aspect of our lives.
Just this week, a new report from the Ontario Human Rights Commission underscored the punishing reach of structural racism in law enforcement. Black people in Toronto are over-policed, over-charged, and over-harmed by our systems of law enforcement.
At less than a 10th of the population, Black people make up one third to one half of all people shot, pepper sprayed, Tasered, struck or grounded by police, and almost 60 per cent of incidents involving police dogs.
Like the stats on police brutality, we know that there are structural forces that are far more impactful than access to health care alone.
These social determinants of health — capturing everything from employment, income and wealth to education, housing and so on — are what ultimately determine who survives or how long we live.
In many ways, the single most important protective factor in this pandemic was having the privilege to stay at home. But that’s if you had a home and a job that would allow you to work remotely and take paid leave if sick or unwell.
This is why the lockdown only seemed to work in white affluent neighbourhoods in reducing COVID-19 infections. The intersection of race and poverty left many exposed, as low-paying jobs that kept life moving became “essential work.”
The shift we now need is to understand that the onus isn’t all on individuals, but that we are all interconnected in a system — rife with its own racism, prejudice and ineptitude. We cannot shirk this shift in our own health-care system either.
Health-care providers operate in environments with deeply rooted bias, and as a result, study after study has shown Indigenous and Black individuals being harmed, mistreated and ultimately killed by racism.
Whether it is poor care in the emergency department, or being charged without cause by the police, the effects of racism are damning on either side of our hospital walls.
It has forced us to reflect upon the societal fault lines along which wealth, health and well-being divide. We simply cannot “cure” COVID-19 without tackling the health and social inequities that have plagued too many lives. We finally need policy-makers to commit and act on the recommendations in reports that are now collecting dust.
Yet lasting change will also require greater diversity and representation at the tables where such decisions are made.
This will have to happen within health care as well, with more practitioners reflecting the communities they serve and upending our profession’s own history of discrimination and prejudice.
And no app or technology will provide the protection our populations deserve — it is a societal commitment to health equity that is more important than ever.
We can no longer feign shock or surprise at racism’s devastating toll. COVID-19 has brought it out into the open, and a failure to act will only deepen this damning divide.
Dr. Suzanne Shoush is a family physician and Indigenous health co-lead at the department of family and community medicine at the University of Toronto.
Semir Bulle is a medical student and co-president of the Black Medical Student Association at the University of Toronto.
Dr. Andrew Boozary is a family physician and executive director of population health and social medicine at the University Health Network.