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Racism in Canada’s health-care system was a risk to BIPOC Canadians before COVID-19

COVID-19 has brought to light some of the glaring inequalities present in Canada when it comes to accessing health care. Disparities in social determinants of health like housing, food, education, and income levels stand in the way of achieving a truly equal health-care system, and racialized Canadians — especially those who are Black or Indigenous — are among the most affected by these inequities. 

But even when BIPOC Canadians are able to access the care they need, they face yet another hurdle: ingrained racism within the health-care system linked to a history of colonization that significantly impacts the diagnosis, treatment, and quality of care that they receive. 

For example, there was a series of incidents in British Columbia — first reported in June — in which doctors and nurses played a “game” to guess the blood alcohol level of Indigenous patients who visited the emergency room, prompting an investigation and condemnation from Indigenous groups. The game was referred to as “The Price is Right” among staff, with participants trying to guess the exact blood alcohol level of patients. 

Another example is the 2008 death of Brian Sinclair, an Indigenous man who arrived in a Winnipeg emergency room and was ignored by staff for 34 hours until he eventually died of a bladder infection. Staff at the hospital stated that they had assumed Sinclair was intoxicated and “sleeping it off” in the waiting room. In 2017, a group of doctors and academics released a report which concluded that the cause of Sinclair’s death was the racism he experienced as an Indigenous man. 

These are just two of the many instances of anti-Indigenous racism baked into our health system that prevent Indigenous people from accessing equitable health care. And because of this, some Indigenous patients may hesitate to enter medical spaces at all; a 2015 Wellesley Institute report found that racism in the health-care system “is so pervasive that people strategize around anticipated racism before visiting the emergency department or, in some cases, avoid care altogether.”

One way of addressing the issue of ingrained racism in health care is to increase the diversity of the medical profession itself, especially for Black and Indigenous doctors. Medical schools have been slow to prioritize diversity, but in 2019 Canada’s 17 medical schools implemented a plan to boost recruitment of Indigenous students in response to the Truth and Reconciliation Commission’s calls to action.

Black Canadians also report experiencing racism in the health-care system, and have historically not seen themselves reflected among the doctors who provide them with care. But there are signs of change: the University of Toronto reported that the highest number of Black students ever were admitted to the school’s Faculty of Medicine MD program for the school’s upcoming Fall 2020 semester. 

“It’s important to have more Black doctors because we’ve not been at the table in the same numbers. We’re not represented in health care or leadership in the same proportions as we’re represented in society, largely due to the complex social impacts of systemic anti-Black racism,” said Onye Nnorom, a family doctor and the Black Health Theme lead for the U of T Faculty of Medicine, in a recent interview. But more progress needs to be made: the number of Black doctors in Ontario would need to double to become proportionate to the province’s Black population, Nnorom said.

According to the Black Physicians of Canada, diversity in the medical profession also has the effect of better serving Black populations since “Black patients are more likely to feel comfortable with Black doctors and more likely to adhere to certain preventive measures delivered by Black doctors.” Black doctors are also more likely to work in Black communities, where rates of certain chronic diseases tend to be higher and barriers to care are greater. 

At the same time, Black and Indigenous doctors can face obstacles that other doctors do not, including bias and prejudice in the workplace, lack of mentorship opportunities, and barriers to advancement — all of which can make their path to practising medicine more difficult. 

Addressing the issue of racism within the health-care system will require a multi-pronged and comprehensive approach. Other solutions could include improving race-based data collection, allowing doctors with foreign medical training to gain licensing in Canada, and educating those working in medical fields about the complex history of colonization in Canada. For a truly equitable future even beyond the COVID-19 pandemic, Canada will need to embrace these changes and commit to anti-racism practices in health care at every level.