Racism is a public health crisis, one that is as destructive and deadly as any virus.

Systemic racism merits to be tackled with the same urgency or determination as the coronavirus. Political leaders are failing to do so and they are being called out on it by a growing protest movement.

This is a time for public health to highlight what really matters to health – the socio-economic determinants, of which race is one. 

"The message the protests are delivering is: Enough of the soul-crushing brutality – physical, economic and social. The key to ending an epidemic is breaking the chains of transmission. That applies to injustices as much as pathogens." -Andre Picard

In this blog, we have consolidated resources, articles, research papers that are meant to educate us about the challenges African Americans face with the healthcare system and what we can do to make a change in our practice, clinics, and patient care.

Know It, Own It, Change It - Transforming the Way We Think and Do Health and Health Care for the Good of All

This is a panel presentation by Dr. Sandy Hilton, Dr. Mark Milligan, Dr. Maxi Miciak, and Dr. Uchenna Ossai from the San Diego Pain Summit in February 2020: 

Change is needed. As care providers and researchers, we have an opportunity to support and promote systematic change in health care and health research by addressing the implicit and explicit barriers that limit our ability to provide appropriate care to those that need it in a way that honors each person.

This dynamic presentation aims to develop awareness and promote a thriving, inclusive environment to explore these challenges and identify steps forward. Considering inter/personal engagement, organizational cultural support, and system structures, we will address fragility, inclusivity, and key points for taking action to enable access and representation in health care for all.

Our hospitals and prisons are failing because we’re using them to house people instead of to help them

This is an opinion piece by Dara Gordon & Sabrina Feldman.

The terms “rounders” and “frequent fliers” are used as shorthand for those who frequently come into contact with Ontario’s criminal justice system and our emergency rooms. But they wrongly put the onus on these groups of people when hospitals and jails are over capacity or costly. Concealed is the fact that as a province, we rely on hospitals and prisons to manage the basic needs of marginalized people who could instead be benefiting from help outside their walls; a solution that would help relieve hallway medicine but one that has received little attention.

Keep reading here.

The coin model of privilege and critical allyship: implications for health

This is an article by Stephanie A. Nixon

Health inequities are widespread and persistent, and the root causes are social, political, and economic as opposed to exclusively behavioural or genetic. A barrier to transformative change is the tendency to frame these inequities as unfair consequences of social structures that result in disadvantage, without also considering how these same structures give unearned advantage, or privilege, to others.

Eclipsing privilege in discussions of health equity is a crucial shortcoming, because how one frames the problem sets the range of possible solutions that will follow. If inequity is framed exclusively as a problem facing people who are disadvantaged, then responses will only ever target the needs of these groups without redressing the social structures causing disadvantages. Furthermore, responses will ignore the complicity of the corollary groups who receive unearned and unfair advantage from these same structures. In other words, we are missing the bigger picture. In this conceptualization of health inequity, we have limited the potential for disruptive action to end these enduring patterns.

The goal of this article is to advance understanding and action on health inequities and the social determinants of health by introducing a framework for transformative change: the Coin Model of Privilege and Critical Allyship.

Keep reading here.

Perspectives of Racialized Physiotherapists in Canada on Their Experiences With Racism in the Physiotherapy Profession

This is an article by Vazir, S et al.

Twelve Canadian licenced physiotherapists (four men and eight women, three rural and nine urban, from multiple racialized groups) described the experiences of racism they faced in their roles as physiotherapists at the institutionalized, personally mediated, and internalized levels. These experiences were shaped by their personal characteristics, including accent, geographical location, and country of physiotherapy (PT) education. Participants described their responses to these incidents and provided insight into how the profession can mitigate racism and promote diversity and inclusion.

Keep reading here.

Structural Racism, Historical Redlining, and Risk of Preterm Birth in New York City, 2013–2017

This is an article by Krieger, N et al.

The objective of this article is to assess if historical redlining, the US government’s 1930s racially discriminatory grading of neighborhoods’ mortgage credit-worthiness, implemented via the federally sponsored Home Owners’ Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation).

Keep reading here.

Desmond Cole: 'Disarm and defund police' and give money to communities

Exploring the concept of vulnerability in health care

This is an article by Clark, B MM & Preto, N.

It is important to consider the function of identifying vulnerability in health care. According to Brown, “ideas about vulnerability shape the ways in which we manage and classify people, justify state intervention in citizens’ lives, allocate resources in society and define our social obligations.” Thomasma argues that “[i]n human relations generally, if there are inequities of power, knowledge, or material means, the obligation is upon the stronger to respect and protect the vulnerability of the other, and not to exploit the less advantaged.”

International policy documents suggest that health care providers, researchers and policy-makers have ethical obligations in terms of human rights both to protect from harm and to respond to the needs of those who are vulnerable. These ideals are reflected in Canada’s health care system, which, while continuously evolving, characterizes health care as a public good and is rooted in the principles of equity and solidarity, with the goal of providing universal access to medically necessary health care based on need rather than ability to pay.

However, we must also consider the effects of discourses about vulnerability on the well-being of those determined to be in need of protection. Drawing on the social sciences, Brown presents three main critiques of the concept of vulnerability: it can be paternalistic and oppressive; it can serve to widen social control; and labelling groups as vulnerable can result in exclusion and stigmatization.

Another critique is centred around disempowerment from attention placed on deficits, dependency and passivity, rather than challenges, opportunities, autonomy and self-determination. Lastly, some commentators have rightly cautioned against embarking on a “vulnerability reducing agenda, which aims to eliminate all vulnerability, i.e., suffering, abnormality, deafness and disability, in order to create perfect human beings.” Being sensitive to the consequences of generalizations, and ensuring that we are attuned to the rich diversity within populations, will support success when striving to understand and address health care needs.

Keep reading here.

Digital Health Equity as a Necessity in the 21st Century Cures Act Era

This is an article by Rodriguez, JA, Clark, CR, & Bates, DW.

The release of final rules from the Office of the National Coordinator for Health Information Technology’s (ONC) Cures Act in March 2020 places a new focus on patients’ access to their health data.1 The ONC rules make “health data more computable and [give] patients more control of their medical record.”

Hopefully, patients will be able to interact more easily with their data through patient portals and mobile health apps, and “shop for care by comparing costs, understanding possible treatments, and expected health outcomes.”

The new rules intend to increase the pace of innovation and investment in patient-facing tools. Building on more than 300 000 health apps and $7.4 billion in digital health investments in 2019 alone, this policy environment may significantly transform the ways patients access care.

In light of the current coronavirus disease 2019 (COVID-19) pandemic, and the success in Taiwan and Singapore in using health information to identify, trace, track, and quarantine individuals, a more user-friendly system has become even more important. However, improvements in patient self-management, care coordination, quality, and cost-effectiveness may be stymied by persisting digital divides. Given the recognition of the higher morbidity and mortality for underserved patients with COVID-19, including African Americans, understanding and eliminating these digital divides are critical.

Thus, the benefits of these innovations will require active efforts to ensure the needs of diverse groups are included in design and implementation strategies.

Keep reading here.

Actions are louder than words. The goal of this blog was to help consolidate a few of the valuable resources available to us as healthcare practitioners to educate ourselves and create health equity for all. There is much more to be done because #BlackLivesMatter

This document compiles BLM funds/petitions/actionables, including self-care resources and black-owned businesses to support.