Anti-Black racism addressed in new course for health-care providers

A family doctor who helped create an anti-Black racism course forhealth professionals says she hopes participants will "unlearn" long-standing discriminatory practices that contribute to inequitable care for a vulnerable group.

Dr. Onye Nnorom, co-founder of the Black Health Education Collaborative based at the University of Toronto and Halifax's Dalhousie University, said the online course, launched Thursday, addresses gaps in medical education by exploring how everyday systemic biases affect the health of a diverse community.

"Most of the time, it's not going to be a physician who actually says something directly racist, or a slur or something like that. It's simply a subtle lack of empathy, perhaps not going out of their way to provide resources. Or sometimes assumptions are made about a person or their level of education," said Nnorom, an assistantprofessor at the University of Toronto's Dalla Lana School of Public Health and Temerty Faculty of Medicine.

Nnoromsaid families are often "hyper vigilant" about any neglect or discrimination their lovedones may face while in hospital.

"One of the things that is difficult about racism in health care is that you're not always sure if the way you're treated, or your family is being treated, because it's so subtle, is due to racism."

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Nnorom said she spent a lot of time by her father's bedside in 2015 when he had surgery for a hemorrhagic stroke related todementia because she wanted to protect him from harm if necessary.

The six-hour, self-paced, online course was developed by the collaborative with partial funding from the Canadian Institutes of Health Research. It includes eight modules that cover topics including criminal justice, child welfare and the legacy of slavery.

Available on the collaborative's website, the voluntary course costs between $275 and $350, depending on the number of registrants, and results in a certificate.

Nnorom said the collaborative is now working with the Medical Council of Canada to include questions about Black health on future exams. All medical students must pass the exam before they can work as doctors.

"Students will have to learn about Black health for the first time," she said of the plan, adding that anti-Black racism is notpart of all medical school curriculums.

It could also be a resource for medical schools, which set their own curriculums to address racism against other groups and be used as part of a continuing education component for administrators, nurses, doctorsand public health officials, she said.

Harmful anti-Black misconceptions and social structures affect health in ways that could include high blood pressure and chronic diseases at an earlier age, she said.

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"It's the stress that's put on us that is impacting our health and not our faulty genes. We know that for high blood pressure, we see higher numbers for Black people, Indigenous people, South Asian people. Are you telling me that we all have the same mutation? Or are we experiencing similar situations? If it's a situation, that's injustice, and we can do something about it," she said.

"We want health-care providers to understand it's the situation that we're living in everyday. And when we come to the hospital, it's that much worse. We are put into another situation of racism."

Discrimination entrenched

A Public Health Agency of Canada report released four years ago said discrimination against Black communities is deeply entrenchedin the country's institutions, policies and practices due to European colonization in Africa and the legacy of slavery, which was legal in Canada until 1834.

Race-based data is not collected in Canada to help show the predominance of various conditions on certain groups that may be dueto social determinants of health.

A study published in the Canadian Medical Association Journal in 2016 found that nearly nine per cent of babies born to Black women were preterm between 2004 and 2006, compared to nearly six per cent for white women.

Nnorom said that type of data could help doctors more closely monitor the health of pregnant Black women who are also at greater risk of unemployment and housing inequity.

OmiSoore Dryden, an expert in Black studies at Dalhousie University's faculty of medicine and a contributor to the course, said she saw several specialists for pain several years ago but some assumed she had sickle cell disease because it is more common among Black people.

However, she was eventually diagnosed with Crohn's disease.

"It was the idea that because I wasn't white or Jewish that meant it couldn't be Crohn's, it had to be something else. This is where we see an over-reliance on race biology, or the idea that certain races, or certain people have specific types of illnesses."

Dryden said she has lived in cities including Victoria, Vancouver, Toronto and Halifax, and has heard of negative experiences that other Black people have also faced there in the health-care system.

"I think all of us could come up with a number of experiences, whether it was delayed diagnoses, inappropriate levels of pain management or being denied care."

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