Understanding anti-Black racism in the health-care system

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VCH physicians and medical staff were given two opportunities during Black History Month to hear from the president of Black Physicians of Canada, Dr. Modupe Tunde-Byass. She spoke to members about the impact of race in health care as well as inclusion in health care. Physicians attending her second talk were able to earn CME credits.

Dr. Tunde-Byass defined racism as the belief that a certain race is inherently superior. “It is prejudice or discrimination based on race,” she said. This is overt racism, whereas her talks focused on systemic racism, where structures and systems are designed to be advantageous to the majority of people. “Systemic racism exists with or without you,” she emphasized. “By just letting it be, we are responsible for what it produces.”

Anti-racism is defined as acknowledging the pervasive existence of systemic racism and actively confronting and dismantling unequal power dynamics between groups and the structures that sustain them. Anti-Black racism is prejudice, attitudes, beliefs, stereotypes, and discrimination directed at people of African descent. It is rooted in the unique history and experience of enslavement and its legacy.

“Racism is everywhere in health care,” said Dr. Tunde-Byass, “and it’s a health crisis that affects us all.”

Herself an obstetrician and gynecologist, Dr. Tunde-Byass pointed out some of the racial disparities in obstetrics. Black women in the UK are still four times more likely than white women to die in pregnancy or six weeks after childbirth. New data from California demonstrate that childbirth is deadlier for Black families than White ones, even when the Black families are rich.

Canada does not collect medical race data, making it more difficult to enact change. However, we know that risk factors and conditions of infant death include low maternal education, inadequate housing, poverty, a lack of access to health care, food insecurity, and unemployment—areas where our Black citizens are over-represented.

The legacies of slavery have built a mistrust of the health-care system and gynecology. Black people were subjected to multiple experiments without anesthesia because it was believed they did not feel pain. Black people were viewed as animals and their consent was not required. Enslaved women were exploited by doctors performing surgeries such as Vaginovaginal fistula repair. There was forced sterilization. Black midwives were abolished in the US.

A scoping review of cancers in Black Canadians found no data related to Black people for the top 20 most common cancers. Data on incidence and stage revealed racial disparities that affect the quality of health received by Black people. Members of Black communities are less likely to voluntarily get screened for cancers. This means an increase in late diagnoses and an increase in mortality.

Dr. Tunde-Byass referred to a 1932 to 1972 US Public Health Service syphilis study that has created great mistrust of the health-care system among Black Americans. She referred to the Flexner Report in the early 20th century that forced all but two Black US medical schools to close. This study is believed to be responsible for the disproportionately low number of Black physicians working today. Oppression in medical education, says Dr. Tunde-Byass, exists at the individual, interpersonal, institutional, and structural levels.

Addressing racism and bias in medicine requires action and education. It is vital that we acknowledge that racism and structural inequities exist. We must make a commitment to disrupt and dismantle racism. We need to collect race-base data and see increasing representation of Black people in medical schools. We must commit to EDI and demand accountability within the system.

“We need to change how we deliver health care,” said Dr. Tunde-Byass. “The system has to prove itself to be equitable. We need to collect and share data. And we need to have constant messaging and reassure the Black population that the health-care system is safe for them.”

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