Quick Facts
A social determinant of health is a non-medical factor that influences a person’s health (e.g., income, education, environment, social status, childhood experiences, housing, social support, access to health services)- Race is also a social determinant of health, one that disproportionately affects members of the BIPOC (Black, Indigenous, and People of Colour) community
- Racism can affect a BIPOC person’s health directly, if experienced in a healthcare setting, or indirectly, as systemic racism as a whole can lead to negative health outcomes
- BIPOC Canadians often experience more barriers in accessing the healthcare system, higher rates of misdiagnosis, and can be more likely to have their pain dismissed or minimized
- Systemic racism can lead to mental and physical impacts such as higher rates of hypertension, chronic stress, depression, and anxiety
- Other social determinants of health are intertwined with race and can contribute to negative health outcomes (e.g., gender, poverty levels, criminal justice inequities, education and literacy levels, environmental factors)
- On PEI, various non-profits such as the Black Cultural Society and BIPOC USHR, are collaborating with private businesses and government organizations to raise awareness of racism and offer training to reduce instances of racism in the workplace
- In 2023, the government of PEI launched an Anti-Racism Action Plan and established the Anti-Racism Office; they also launched a service of anti-racism microgrants to encourage organizations to focus on anti-racism work
The Longer Story
Although race as a social determinant of health is not unique to women and gender-diverse individuals, it merits highlighting on this website due to intersectional considerations.
A non-medical factor that influences a person’s health is called a social determinant of health. These factors include things like gender, income, education, environment, social status, childhood experiences, housing, social supports, and access to health services.
Race has also been identified as a social determinant of health, one that disproportionately affects members of the BIPOC (Black, Indigenous, and People of Colour) community. As systemic racism exists throughout institutions, including health care, studies have shown that BIPOC people face discrimination and, at times, inferior health care. It is critical that we listen to the experiences of BIPOC communities and their journey navigating the health care system.
Racism can affect a BIPOC person’s health, both directly and indirectly.
Racism within Healthcare Systems
Many sources, both nationally and here on PEI, have reported on racism within the health care system. A BIPOC person seeking health care services may face longer wait times, have the legitimacy of their pain questioned or minimized, experience misdiagnoses, and be more likely to be dismissed without treatment, among other examples of health inequities caused by systemic racism, as summarized in an article published by CanWaCH (Canadian Partnership for Women and Children’s Health), a membership of over 100 non-government organizations, civil society organizations, academic institutions, health professional associations, and private companies.
Indigenous People in Canada report being ignored in hospital waiting rooms. They also report instances where staff have assumed incorrect and harmful stereotypes about Indigenous People while evaluating their care (i.e., assuming them to be homeless, abusing various substances, and being negligent parents).
BIPOC women and gender diverse individuals face additional challenges dealing with racism experienced in the health care system. Black women and gender diverse people in childbirth have reported being ignored and/or not being offered medication due to harmful stereotypes related to pain tolerance (the incorrect belief that Black people have a higher tolerance to pain than white people). Indigenous women and gender diverse individuals have reported health care workers attempting to coerce them into sterilization.
Some medical conditions are more dominant in the BIPOC community, but sometimes get missed, not taken seriously, or misdiagnosed. Sickle cell disease, for example, is a painful condition that was caused by a genetic mutation that originated in Africa. As a result of geographic origin of the mutation, sickle cell disease disproportionately affects Black people. Despite being the most common genetic blood disorder in the world, Black people reporting symptoms of sickle cell often report not having their symptoms taken seriously. The US-based non-profit Sick Cells, an advocacy group for people with Sickle cell disease, has collected over 200 stories of BIPOC sickle-cell patients experiencing inferior healthcare due to systemic racism. Similar stories have been reported in Canada.
Other medical conditions present different in the BIPOC population. Lyme disease, for example, is known to produce a ring-like rash at the infection site. Educational campaigns, medical textbooks, and other health-related promotional material have all cited this rash as an early sign to watch out for. However, in darker-skinned people, this rash is identified much later in the Lyme disease trajectory, and because of this, Black people and people of colour often won’t get diagnosed with Lyme until much later, putting their health at risk.
Additionally, beliefs that exist among the medical profession about BIPOC people’s pain tolerance can put BIPOC people’s health at risk. Black and darker-skinned people giving birth, for example, are often offered less pain medication than white people giving birth. The assumption that Black and darker skinned people somehow have elevated pain tolerance over white people is false and harmful.
In the United States, Black people are three to four times more likely to die from childbirth-related complications than white people. Canada, unfortunately, does not have any data collected on mortality rate of BIPOC people from childbirth.
Because of these negative experiences, BIPOC Canadians may delay or avoid seeking treatment in a health care facility.
Historically, medical students were trained on the model of the white cisgender male as the healthcare standard, which explains why many conditions that disproportionately affect women, gender diverse people, and BIPOC people get overlooked. Images in textbooks were often of white people, and white people served as the standard model for training simulations (including medical ‘dolls’). Many drug companies only test their products on cisgender men, so they do not have to factor in hormonal reactions with the product they are testing. Even diagnostic tools, like pulse oximeters were designed to work optimally on white skin, leading to less accurate readings when used on people with darker skin.
A lack of BIPOC medical professionals in the system has also contributed to maintaining the white status quo. As more BIPOC people work in the healthcare system, this visibility should aid in reducing racism in the workplace; however, a workplace should not count on staffing more BIPOC people as the only way to combat systemic racism. Non-BIPOC professionals need to be more aware of how racism shows up in the medical system and educate themselves on how to reduce it.
Racism in Society
As stated in Social Determinants and Inequities in Health for Black Canadians,
“Well-documented examples at institutional and societal levels include racial profiling; over-policing (e.g. surveillance, harassment, excessive use of force) and under-policing (e.g. under-responsiveness, abandonment) of Black communities; over-representation of Black people in criminal justice systems; over-representation of Black youth and children in child welfare systems; systemic discrimination and under-treatment in hospitals and other healthcare systems; and low representation or absence of Black people in leadership positions across institutions and systems.”
It's not just the systemic racism experienced in a health care setting that can negatively affect a BIPOC’s health—the cumulative effect of systemic racism felt across institutions and in society at large can influence a person’s mental and physical health. An article published by the National Institute of Health concluded that “the ultimate impact of experiences of racism is associated with deleterious outcomes such as chronic stress and trauma .”
The following statistics show that systemic racism can have a negative effect, both directly and indirectly, on BIPOC Canadians—they are taken from the Social Determinants and Inequities in Health for Black Canadians, Primary health care access among First Nations people living off reserve, Métis and Inuit, 2017 to 2020, and Let’s Talk Racism and Health Equity [PDF]:
- 14.2% of Black Canadians (18+) and 18.2% of Indigenous people living off reserve in Canada report their health to be fair or poor, compared to 11.3% of white Canadians
- 64.0% of young Black women (12-17) report their mental health to be ‘excellent’ or ‘very good,’ compared to 77.2% of white women of the same age
- Statistics Canada reported that Black Canadians are 2.1 times more likely to be diagnosed with diabetes than their white Canadians
- The criminal justice system disproportionately targets BIPOC Canadians
- In 2017-2020, significantly higher proportions of First Nations people living off reserve (20.3%), Métis (17.9%) and Inuit (56.5%) across Canada reported being without a regular health care provider, compared with their non-Indigenous counterparts (14.5%)
- Racism can increase the risk for hypertension, chronic stress, and various mental health conditions
Additionally, Indigenous People in Canada often experience intergenerational trauma due to the history of colonization, including the residential school system. For more information on health services for Indigenous People, check out the Health Hub’s Indigenous Health article.
Much work needs to be done across all systems, including our health care system, to identify systemic racism, including more research on the effects on BIPOC people’s health.
Taking Action to Eliminate Racism in Health Care
Reducing the health effects of racism on BIPOC communities requires a decolonizing approach across systems. The first step is listening to, and believing, the experiences of BIPOC individuals and their specific health care journeys. Systemic change, anti-racism training, and anti-racist policies will only be effective if they are based on the first-hand experience of those who have experienced racism. Additionally, health care professionals need to recognize and embrace Indigenous-led traditional practice of health. Health care providers should also apply a critical lens during medical training and education to understand how the foundations of some practices, tools, tests and assumptions are rooted in a history of exclusion.
Another area to consider is representation of BIPOC people within the health care system. When there is limited visibility of a particular group, it can lead to feelings of exclusion and distrust within that community. Hiring and supporting more BIPOC health care workers is crucial in reducing harmful stereotypes and disparities in health care access and outcomes. Additionally, including more BIPOC representation in medical training materials—e.g., textbooks, manuals, marketing materials—helps to disrupt the association of white people being status quo.
PEI’s Anti-Racism Action Plan
The PEI Government is taking steps to address systemic racism across the province. In 2023, a new Anti-Racism Office was established. That same year, a five-year Anti-Racism Action Plan was released. The PEI Government also works with various community partners, such as BIPOC USHR, the Black Cultural Society, and Indigenous nations and groups, to offer training opportunities to various health care organizations and professionals.
As well as various educational resources, BIPOC USHR also includes resources for BIPOC people, including health-related options.
Sources
BIPOC USHR. (n.d.). Resources.
CBC News. (2020, June 26). Racism in Canadian medicine: Doctors speak out. CBC News.
CBC News. (2021, September 18). P.E.I. health-care workers speak out about racism in the system. CBC News.
Government of Canada. (2020). Social determinants and inequities in health for Black Canadians: A snapshot.
Government of Canada. (2021). Social determinants of health: A Canadian perspective.
Haq, R., McDonald, C., Lang, E., Kalenga, M., & O'Campo, P. (2019). "Let's Talk Racism and Health Equity." National Collaborating Centre for Determinants of Health. [PDF]
Mitchell, F. (2017). The social determinants of health in Manitoba's Indigenous communities: A comparison of status and non-status First Nations. International Journal of Circumpolar Health, 76(1).
Ohchr.org. (n.d.). Indigenous peoples’ health report: A perspective on health equity in Manitoba.[PDF]
Sick Cells. (n.d.). Racism in sickle cell: Why Black lives in the healthcare system are forgotten.
Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial bias in pulse oximetry measurement. N Engl J Med 2020;383:2477-2478.
Williams MT, Khanna Roy A, MacIntyre MP, Faber S. The Traumatizing Impact of Racism in Canadians of Colour. Curr Trauma Rep. 2022;8(2):17-34. doi: 10.1007/s40719-022-00225-5. Epub 2022 Mar 24. PMID: 35345606; PMCID: PMC8943361.
Published date: August 2024
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