Commentary: Addressing racism and public health in Canada

The death of George Floyd at the hands of police in May sparked outrage over racist policing practices. The resulting protests have endured far longer than any in recent memory and have spread across borders. In Canada, the protests have spurred discussions about racism in our own country. These discussions have been fueled further by the violence currently occurring against Indigenous fisheries in Nova Scotia, and Joyce Echaquan's death in Quebec. This issue became very personal to me when I was recently asked if racism was a problem in Canada and whether I had experienced it. I told them that based on my own experiences, it does. For example, at the beginning of the pandemic a man yelled at me from his vehicle that the Chinese were to blame for COVID-19 and told me to go back to my country. This was just one example of a racist interaction: a person antagonizing me based on my race and seeing me as inferior and even unworthy of remaining in the country both of us were born in.

However, racism is more than negative interactions. Systemic racism describes how social systems, institutions, policies, and practices reinforce and perpetuate racial inequality. In my own area of study, health inequities, there are clear indications that systemic racial inequities in health and mortality are persistent and severe. For example, Black Canadians are more likely to report hypertension and diabetes in comparison to white Canadians. These differences are driven by many different social determinants of health, not just exposure to police violence.

Race and social determinants of health

The social determinants of health indicate that the social and economic conditions into which people are born, grow, work, live, and age influence their health and wellbeing. Social, political, and historical factors create barriers to accessing social goods, power, opportunities, safety, and clean drinking water among other social determinants. This leads to unfair and avoidable differences in health status between populations.

Several ways racism can influence health have been identified: 

• Racism can lead to a prolonged stress response and subsequent trauma; both have proven to be detrimental to health.
• Victims of racism can experience feelings of shame, which can lead to depression and anxiety. To cope with stress and trauma, victims are less likely to get enough sleep and are more likely to engage in coping mechanisms that are ultimately harmful, such as alcohol and drug use.
• Racial inequality can erode social cohesion, which is the glue that keeps members of a society together. A lack of social cohesion can lead to social exclusion, isolation, and a lack of trust between racial groups in society which can lead to fear, aggression, and violence. This violence contributes to heightened mortality rates for racial minorities.
• Racism can lead to barriers and decreased access to social goods and services, such as health care among racialized groups. Therefore, racism is a public health crisis. Such inequality is driven by bad policies, which demand a political response.
  
  

A legacy of racism

Just as in the case of interpersonal racism, many Canadians believe that systemic racism isn’t an issue here. A brief look at our own history suggests otherwise. Canada’s colonial founding was rooted in racist beliefs that justified violence and genocidal practices against Indigenous peoples. Colonial policies, enshrined in laws like the Indian Act, aimed to decimate Indigenous cultures, religions, and languages while dispossessing people of land, therefore stripping their social determinants.

Residential schools forcibly removed Indigenous children from their families to be re-socialized by white Canadians. Indigenous women have been subjected to forced sterilization. Additionally, Black people have experienced racism throughout Canada's history. Racial slavery existed in New France and in British North America. Africville, a Black community established in Halifax in the early 1800s, was razed along with other racialized communities all over Canada in the 1960s to make room for gentrification.

Social systems that allow racial discrimination remain today. Black and Indigenous people are routinely subjected to unfair treatment by the criminal justice system. They are significantly more likely to be stopped and/or arrested and to be physically assaulted by police than white people.

Canada's electoral system strongly favours white Canadians, resulting in legislative bodies not representative of Canada's population. Quebec's Bill 21, which bans religious symbols in the public sector, effectively blocks many black and brown women from careers in the public sector. As employment and income are major determinants of health, these policies impact not only economic opportunities, but are detrimental to the mental health and well-being of minority women. Genocidal policies continue to negatively impact the health and well-being of Indigenous peoples in Canada to this day. An example is the 1,000 Indigenous women who were murdered over a span of thirty years. Clearly, our historical realities shape the health of Indigenous, Black, and racialized people in Canada today.

Building a better future

To end racism and create a more equitable and therefore healthy society, simply condemning racism is not enough. Health inequities stemming from system racism are avoidable and changeable. Canadians need to acknowledge how their history of colonialism and racism links to our current reality. Racialized Canadians disproportionately lack access to power, resources, health care, and the other social determinants of health. For instance, visible minorities comprise 22.3 per cent  of Canada's population but around 14.8 per cent  of the Canadian parliament. Structural and policy changes should be implemented that eliminate barriers, redistribute resources and ensure necessities for Indigenous, Black and other racialized people to live and thrive.

Changing the electoral system in Canada to proportional representation, which has shown to elect more representatives from diverse racial backgrounds is one example. Ensuring that clean, and safe water in First Nations is also imperative. Seventy three per cent of First Nations' water systems are at high or medium risk of contamination. Directing funds towards social programs that meet the needs to Indigenous and white populations in order to prevent police brutality is another potential intervention. Improving access to healthcare and education to racialized groups experiencing barriers is also a potential systemic change. Ultimately, ending racism includes ensuring the social determinants of health are equitably distributed among all Canadians of all racial backgrounds, to create a healthier society.

Recognizing Canada's colonial and racist past and how it is pervasive in contemporary society, is the first step. The will to change the racist systems and structures that cause social and thus health inequities is a challenge that white Canadians need to champion. This is a very tough task but failure to do so will lead to a society with increasing social and health inequities.

To learn more about how race, income and other social factors determine health watch Roman Pabayo’s This is Public Health Lecture. For more information about the School of Public Health’s pledge against racism, read Dean Shanthi Johnson’s statement.