Social Policy in Ontario

Before COVID-19, inequity in healthcare was, in effect, a pandemic for Black communities. Here are five issues that need to be addressed

Posted on February 5, 2021 in Equality Debates

Source: TheStar.com — Authors: Angelyn Francis

TheStar.com – News/Canada
Feb. 5, 2021.   By Angelyn Francis Local Journalism Initiative Reporter

Toronto has a new, $6.8-million plan to fight the disproportionate impact of COVID-19 on the Black community. But the roots of health inequity were taking hold long before the pandemic started.

“These are conversations we have been having. We’ve been advocating, we’ve been speaking about it,” said Lydia-Joi Marshall, president of the Black Health Alliance. “This is not a new crisis for the Black community …. This is just highlighting the inequities that have been happening all along.”

Marshall, who has worked in healthcare research for more than 15 years and was a speaker at this month’s TEDxToronto: Uncharted, spoke with the Star to explain five long-standing issues that have made the healthcare system unequal for the Black community. Many of these still need to be addressed.

It’s not biology, it’s racism: As a geneticist, Marshall said she does not believe in race as a biological construct. “Race is not the determinant of health. Racism is,” she said.

“We often hear all these higher rates of illness in Black people — Black people have higher hypertension and diabetes,” and we can see that and think there must be a “very specific biological reason,” Marshall said. But, really, it’s more to do with systemic barriers that make these illnesses more likely, such as disproportionate stress and lack of access to nutritious food. “What are the other social determinants?” she said.

For instance, a 2019 study by FoodShare and the University of Toronto showed that Black Canadians are twice as likely as white Canadians to be food insecure.  Without access to affordable, healthy food, health problems can fester.

“This idea that it is biological, we have to come away from that, because it allows people to dismiss the systemic and institutionalized racism of why we’re seeing such different rates.”

Microaggressions take a toll on physical health: Dealing with small, daily instances of racism can overtime lead to poorer health outcomes. “It takes a toll on our health,” Marshall said.

A study conducted by Harvard University and NPR in 2017 found that people who reported high numbers of daily indignities, such as receiving poor service in a restaurant or being treated with less courtesy than others, also ranked high in developing heart disease, or, in the case of pregnant women, ranked high in giving birth to babies of a lower weight.

“This stress, whether it is daily stress or overt … can result in illness,” Marshall said.

Mental health and wellness has a ripple effect: Marshall notes that mental health can affect other branches of health, and yet have so far not received as much attention.

Much of Marshall’s research relates to other clinical and chronic illnesses, but rates of under-diagnosed or misdiagnosed mental illness in the Black community, have “shocked” her, when she has looked at them.

Black respondents ranked the lowest in a December 2020 mental health surveyconducted by Morneau Shepell.

Barriers to mental healthcare for the Black community must be reduced, and a better understanding at the point of diagnosis developed, so the rates of under- and misdiagnosis are addressed.

Bias affects quality of care: Marshall recalls a time when her aunt called Telehealth to assess her symptoms when she was feeling ill. The questions went: “Are you healthy? Does your skin look pink?” Marshall said.

“I had to explain to her that this is just the ingrained bias — that here in Canada, the normal is not us.”

Apart from small instances such as this, the phenomenon also manifests in textbooks that are used in medical schools, hospital visits and is a hardship shared by Indigenous communities.

Mistrust of the system lingers: As concerns about hesitancy around taking the vaccine get more attention in public policy, it’s worth really considering the questions Black communities have and the source of their concerns, Marshall says.

Mistreatment has been both on a large scale historically — as with the Tuskegee study in the U.S. and nutrition experiments in the Indigenous community in Canada — but also on a smaller scale in the form of personal trips to the hospital.

Many are “asking valid questions, because of a historical pattern of the system not catering to our needs,” she said.

“Why would we trust a system that has not been built for us?”

This approach can inform the way Canada addresses vaccine concerns in the Black community.

Angelyn Francis is a Toronto-based reporter for the Star covering equity and inequality. Her reporting is funded by the Canadian government through its Local Journalism Initiative.

https://www.thestar.com/news/canada/2021/02/05/before-covid-19-inequity-in-healthcare-was-in-effect-a-pandemic-for-black-communities-here-are-five-issues-that-need-to-be-addressed.html

Tags: featured, Health, ideology, mental Health, multiculturalism, poverty

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