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- 14 February, 2022 The Future of Health for Black Canadians
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February 14, 2022
The Empire Club of Canada Presents
The Future of Health for Black Canadians
Chairman: Kelly Jackson, President, The Empire Club of Canada; Vice-President, External Affairs & Professional Learning, Humber College
Paul Bailey, Executive Director, Black Health Alliance
Sume Ndumbe-Eyoh, Director & Assistant Professor, Black Health Education Collaborative, Dalla Lana School of Public Health, University of Toronto
Adaoma Patterson, President, Jamaican Canadian Association
Distinguished Guest Speakers
Dozie Amuzie, Head, Johnson & Johnson Innovation – JLABS Canada
Saleema Khimji, Chief Innovation Officer at MCI Onehealth Technologies Incorporated
It is a great honour for me to be here at the Empire Club of Canada today, which is arguably the most famous and historically relevant speaker’s podium to have ever existed in Canada. It has offered its podium to such international luminaries as Winston Churchill, Ronald Reagan, Audrey Hepburn, the Dalai Lama, Indira Gandhi, and closer to home, from Pierre Trudeau to Justin Trudeau. Literally generations of our great nation's leaders, alongside with those of the world's top international diplomats, heads of state, and business and thought leaders.
It is a real honour and distinct privilege to be invited to speak to the Empire Club of Canada, which has been welcoming international diplomats, leaders in business, and in science, and in politics. When they stand at that podium, they speak not only to the entire country, but they can speak to the entire world.
Welcome Address by Kelly Jackson, President, The Empire Club of Canada
Good afternoon fellow directors, past presidents, members, and guests. Welcome to the 118th season of the Empire Club of Canada. My name is Kelly Jackson. I am the President of the Board of Directors of the Empire Club of Canada, and Vice-President, External Affairs and Professional Learning at Humber College. I'm your host for today's event on “The Future of Health for Black Canadians.” Today, we're going to hear from professionals at the forefront of addressing healthcare issues, including inequity of access to healthcare by racialized populations.
I'd like to begin this afternoon with an acknowledgement that I'm hosting this event within the Traditional and Treaty Lands of the Mississaugas of the Credit, and the homelands of the Anishinaabe, the Haudenosaunee, and the Wyandot Peoples. In acknowledging Traditional Territories, I do so from a place of understanding the privilege my ancestors and I have had in this country, since they first arrived here in the 1830’s. As farmers in Southwestern Ontario, I imagine they felt a deep connection to the land, and yet likely did not recognize how that connection was built on the displacement of others. Delivering a land acknowledgement, for me, it's always an important opportunity to reflect on our human connection, and responsibility to care for the land; and to recognize that to do so, we must always respect each other, and acknowledge our histories. We encourage everyone tuning in today to learn more about the Traditional Territory on which you work and live.
The Empire Club of Canada is a non-profit organization. So, I now want to take a moment to recognize our sponsors. who generously support the Club, and make these events possible, and complimentary, for our supporters to attend. Thank you to our lead event sponsors, Johnson & Johnson, and MCI Onehealth. Thank you also to our season sponsors, Canadian Bankers Association, LiUNA, Waste Connections of Canada, and Bruce Power.
Before we get started, just a few housekeeping notes. I'd like to remind everybody participating today, this is an interactive event. So, those who are tuning in live, I encourage you to engage, by taking advantage of the question box that you can find below your on-screen video player. We reserve some time for audience questions following the presentations from our speakers. We also invite you to share your thoughts on social media, using the hashtags displayed on-screen throughout the event. If you require technical assistance, please start a conversation with our team, using the chat button on the right-hand side of your screen. To those watching on-demand later, and to those tuning in on the podcast, welcome. It's now my pleasure to call this virtual meeting to order. I am honoured to welcome Sume Ndumbe-Eyoh, Adaoma Patterson and Paul Bailey to the Empire Club of Canada's virtual stage for the first time. We'll have a chance to hear more about our guests shortly, and you can find their full bios on the page below the video player that you can see on your screen. I'd now like to invite Dozie Amuzie, head of JLABS Canada, Johnson & Johnson to deliver some opening remarks. Dozie, welcome and over to you.
Dozie Amuzie, Head, Johnson & Johnson Innovation – JLABS Canada
Thank you so much. It's an honour to be here with you today. My name is Dozie Amuzie, and I am the head of Johnson & Johnson Innovation JLABS Canada. JLABS is Johnson & Johnson's global network of life science incubators. Call to our mission and culture at JLABS, is a commitment to diversity, equity and inclusion, and we are proud to see that commitment reflected in our Canadian portfolio, which includes 27% women-led, and 35% minority-led companies. At Johnson & Johnson, we believe we are uniquely positioned to bring together science, people, technology, and the ideas needed to profoundly change the trajectory of health for humanity. And one of the biggest ways we can change the trajectory of health, is to help eradicate racial, and social injustice as a public health threat, by eliminating health inequalities for people of colour. The COVID-19 pandemic has spotlighted the racial and social injustice and inequities that have plagued societies and communities of colour. Across Johnson & Johnson, we recognize that we have a critical opportunity to expand and accelerate our commitment and momentum to address racial and social injustices in Black, Indigenous, and other communities of colour in Canada.
As the largest and most broadly based healthcare company in the world, we have always applied a scientific approach to address and overcome human health challenges. Using our deep scientific expertise, strategic capabilities, and global scale to deliver innovative solutions to people with unmet needs, we focus on the best health outcomes for patients, consumers and their loved ones. Our focus remains the same, as we commit to fighting the virus of racism, and dedicating our efforts to eliminating health inequities that impact people and communities of colour, here in Canada and around the world. We are proud to walk through community-based investments and partnerships, to raise awareness of health inequities, develop and expand programs to protect the most vulnerable communities, and advocate for interventions, and solutions to eliminate them. That's why I'm thrilled to be here for today's discussion on the future of health for Black Canadians. I look forward to learning more about solutions that may change the cost of health and healthcare for Black Canadians. To get things started, I'd like to introduce our moderator, Paul Bailey. Paul is a strategist, urban planner, and Executive Director at the Black Health Alliance. Focused on improving outcomes for Black children, youth and families, his work focuses on social planning, health equity, and addressing the causes of neighbourhood distress and inequality. Paul, over to you.
Paul Bailey, Executive Director, Black Health Alliance
Thank you, and good afternoon and thank you to the Empire Club of Canada for hosting this important conversation. We know that Black people in Canada are resilient, and have a long history of advancing interventions to improve and protect the health and well-being of our communities. However, we know that Black populations in Canada experience a disproportionate burden of challenges across the social determinants of health, are among those most burdened by significant health inequities, particularly in the areas of chronic illness and mental health. An ever-growing number of studies, public health associations and public health units correlate these poor health outcomes with experiences of anti-Black racism, and the chronic stress, and barriers to opportunity it creates. Today, you will hear from Sume Ndumbe-Eyoh, Executive Director of the Black Health Education Collaborative, and Adaoma Patterson, President of the Jamaican Canadian Association, on the future of health for Black Canadians. They will each give 10-minute presentations, followed by a question-and-answer period. So, Sume, over to you.
Sume Ndumbe-Eyoh, Director & Assistant Professor, Black Health Education Collaborative, Dalla Lana School of Public Health, University of Toronto
Thank you, Paul, for that introduction. Sume Ndumbe-Eyoh, speaking to you today from Montreal/ Tiohtià:ke, the traditional homelands of the Kanien'kehá:ka Nation, and remembering in this Black Futures Month, the long histories Black communities and Indigenous Peoples have had on these lands which we now call Canada, history which really predates colonial presence in this land. My talk today is entitled “The Urgency of Now, Policy Imperatives for Black Health and Well-Being.” We know that our health is deeply influenced by the conditions our everyday life, or simply put: where we live, work, play, love, and resist, matters. Across virtually any health concern, we see how the decisions we make in our social, cultural, economic, and political systems, create conditions which are, more or less, supportive of good health for Black communities. Anti-Black racism as a structural and cultural system, actively devalues Blackness, denying opportunities and rights, while heaping severe penalties on Black bodies. Blackness as an inferior social position was really created, and continues to be used, in the service of whiteness. And, in the Canadian context, anti-Black racism is rooted in a very Canadian history of enslavement of Black peoples, and colonization of Indigenous lands. This we know is manifested in policies and practices. It is seen when we act, but also when we fail to act.
Throughout the COVID-19 pandemic, I think we're seeing, yet again, the ceilings of racism, as a structural determinant of health and health equity. At the very beginning of the pandemic—which feels very long ago right now, two years in—Black communities raised the alarm, that the burden and impact of the pandemic was going to be severely felt, because of systemic racism. Yet we know that, across the country, our governments were very slow to respond. Not long after the start of the pandemic, in the spring of 2020, following the murder of George Floyd, by Derek Chauvin, a police officer, which set for the series of global protests, as Black communities, and those who stood in solidarity, pointed out how ongoing anti-Blackness is indeed the norm across the globe, and called for justice and accountability. Since then, unfortunately, we know that in Canada, and across the world, Black folks continue to be killed, or seriously injured, by police. So, as we all know, something happened after the uprisings. George Floyd's death, and the ensuing uprisings against racism, were quickly punctuated by commitments from institutions of all sorts. So, today I ask, are governments and institutions living up to their commitments to serve the people, to serve all people? Service which, I believe, requires a deep value and respect for Black life. So, if you're wondering what that commitment looks like, I'll paint a picture for you. The evidence and policing and health is very clear. Far from promoting safety, police presence in neighbourhoods is associated with increased psychosocial trauma for those communities. We know that Black communities are exposed to higher levels of police contact, through practices like carding, and driving stops. This constant exposure has impacts both at the individual level, but also at the community level. Between 2006 and 2015 in Canada, the incarceration rate for white people decreased by 8.5%. At the same time, in the same period, the Black incarceration rate rose sharply by 71%. Nonetheless, amidst calls to divest from policing, incidents across Canada, like say, the City of Toronto. In 2020, the City of Toronto allotted $1.2 billion to the Toronto Police Service, an amount which could comfortably house as many as 70% of people experiencing homelessness in the city. Why does this matter for Black health? We know that Black folks are more likely to be disproportionately affected by homelessness.
Nonetheless, some glimpses of hope shine through. In the Region of Peel, the Region of Peel police has ended its school resource officer program, actively removing police from schools. A look into the US context, and cities like Durham, North Carolina; instead of funding new police positions, that city has chosen to invest in increasing the minimum wage for part-time, and seasonal city workers. Still in the US, space and advocacy from youth organizations like Leaders Igniting Transformation, that advocacy has led to a diverse disinvestment from things like metal detectors in schools, police, and security in the case of Milwaukee. I’ll stay with the US, in Minneapolis, we know that a million dollars was allocated from policing into legal services for immigrants and refugees, and also for domestic violence services. While these are very promising initiatives, it's clear from the numbers I'm sharing with you that there is an opportunity to indeed scale up programs like this.
Let's turn to healthcare for a minute here. In the healthcare system, Black folks experience a wide range of mistreatment, rooted in beliefs of the simultaneous inferiority, and supernaturally of Blackness, and also the health institutions that have failed to transform themselves. Within the health system, Black people report feeling invisible, report all too frequent experiences of racial discrimination and stigma. So, as an example, imagine this: Black patients have to wait longer to see a health professional, and at the same time, end up spending less time in consultations with these health professionals. Stereotypes about Black women's sexuality result in poor quality sexual and reproductive health. Across the health system, we know that the lack of culturally appropriate health services contributes to feelings of isolation from the health system, and mistrust. We also know that patients who report having a higher level of trust in healthcare professionals, are more likely to receive better quality care. In Toronto, community-led centres like Women's Health in Women's Hands, and TAIBU, are leading the way. These organizations have shown us what anti-racist, Black-centric, culturally responsive and affirming care truly looks like. Models of this nature should be the norm across the country, alongside a mainstream health system, which has indeed transformed itself, which means divesting from white supremacist logic, and in turn supporting self-determined, and well-resourced services for Black communities. At the Black Health Education Collaborative, colleagues and I are working to ensure that medical and health professionals including learners, receive accurate knowledge and training on anti-Black racism and Black health. This work must be a mandatory requirement in the training of all our health professionals across the country. For this to become a reality, professional accreditation bodies, and universities, will need to put the right systems and policies in place.
I think COVID-19 has provided a very unfortunate case study of the ways in which inequitable and discriminatory systems put Black people in Canada at greater risk of exposure to COVID-19, a trend which holds true for many health conditions. Throughout the COVID-19 pandemic, we've seen that Black people, especially Black women, were more likely to be essential workers, in jobs which offered greater exposure to COVID-19. So, think about early in the pandemic, positions like grocery workers, or personal support workers; these roles tend to be jobs that don't provide adequate paid sick leave, or family leave, which means that, as a whole, they offer less protection to you when you fall ill. Additionally, because of the low wages provided in positions like this, folks often find themselves working several jobs, again putting themselves at increased risk of COVID-19. So, what we then see, is that we have very direct and social impacts. In Toronto, as an example, Black communities have consistently been overrepresented in COVID-19 pandemic infections. At some point in the pandemic, one in three reported cases were in Black-identified people, in a city which has just under 10% of the population which identifies as Black. At the same time, white communities have been consistently underrepresented in COVID-19 infections. So, again, where we live, work and play matters. For people living in neighbourhoods with a high proportion of racialized people, hospitalization rates have been higher, ICU admission rates have been higher, and also death rates have been higher. So, indeed, we have yet to contend with the full impact of death and grief in Black communities. Black people in Canada are more likely to know someone who has died from COVID-19. One survey found that 21% of Black people in Canada reported knowing someone who had died from COVID-19, compared to 8% of the Canadian average.
So, going forward, what does that mean? It means that we need to continue to invest in robust, ongoing, mental health supports for communities, that are attended to the very specific needs and realities of Black communities. As I mentioned earlier, Black women were amongst those who bore the brunt of economic losses, especially during the very first wave of the pandemic. Thankfully, income support programs, like CERB, played an important role in providing income security. However, the overrepresentation of Black women in poor quality jobs has resulted in this head-on collision of racialized sexism. And as such, Black women have limited resources to manage both caregiving roles and unpaid labour.
From a policy perspective, we really need to rethink minimum wage, to ensure that it is a thriving wage. Minimum wage should be a thriving wage. A recent Wellesley Institute report, calculated a thriving wage, which they describe as the cost to live a healthy life in the City of Toronto, or and the GTA area. This amount—I want to ask you for one second to take a guess, take a guess and have a number in your head. The number the Wellesley Institute came up with, was between $103,000 and $136,000, as an after-tax income for a family of four. This is, on average, about $39,000 less than the median income of a family of four in the City of Toronto. So, this calculation takes into account a very comprehensive definition of health; it includes the cost for food, for housing, for physical activity, for transportation, personal care and hygiene, healthcare services, and savings. Other policies which are needed to support meaningful employment include: paid sick leave across all jobs; access to family leave; also the creation of a clear path of permanent residency for migrant workers; and we know that we need to be improving pay equity and transparency across all sectors. So, in this context of extreme grief due to a continued assault, devaluing, and murders of Black people, we know that, across the country, Black communities continue to resist and organize. In his 1967 speech “Beyond Vietnam,” held at the Riverside Church, Martin Luther King Jr, preached about the fierce urgency of now. He said, “we are now faced with the fact that tomorrow is today, we are confronted with the fierce urgency of now. And this unfolding conundrum of life and history, there is such a thing as being too late. Procrastination is still the thief of time.” In this United Nations International Decade for People of African Descent, which ends in 2024, we need to indeed invest in emancipatory systems of care for Black communities. These systems cannot coexist, if racism and white supremacy persist. We have to fully recognize the simple truth, and work to undo it. Thank you. On that note, I'd like to pass it on to Adaoma. The floor is yours.
Adaoma Patterson, President, Jamaican Canadian Association
Thank you, Sume, and good afternoon, everyone. So, you know, Sume provided a really important perspective, and I want to build on that by looking at how community, and Black community, came together in a concrete way, to try and address much of the inequity, particularly around COVID. So, as Sume said, in the early days of the pandemic, there was a lot of discussion about who was being impacted, and why. And of course, the pandemic exposed all the problems, particularly with healthcare, but other systems. And we saw the intersection of racism, discrimination, precarious and low-wage work, converge to compound the impact of COVID-19 on Black people. System leaders seemed shocked at what they saw and heard, but community leaders were not. We actually had been raising these flags, and talking about these issues for years, but few people and decision-makers listened. Part of our response was to co-host community clinics in a space that people were comfortable in, in a manner that was familiar and safe. We received much criticism for hosting vaccine and wellness clinics specifically for Black communities, and Black people. “Why do people need their own clinics, isn't that discrimination?” people asked us on social media. So, of course, I will tell you why—and Sume spoke about some of these statistics—so, Black people represent 9% of the city's population, and yet accounted for 24% of the COVID-19 hospitalizations in Toronto. COVID-19 rates in Toronto's Black, and racialized communities, were significantly higher than those for white people. A disproportionate number of frontline healthcare, and service sector jobs, are done by Black and racialized workers—which means they worked in hospitals, nursing homes, going into people's homes and providing care there, coffee shops, grocery stores, and distribution centres throughout the pandemic. Working from home was not an option for them. In fact, many had to work longer hours and deal with rude, racist, disrespectful behaviour, simply for doing their jobs. Black people experience racism and systemic discrimination when trying to access healthcare. This leads to fear, reluctance, or avoidance of the services, mistrust, and accounted for much of the vaccine hesitancy. And we heard so many stories at the clinics over the course of 2021.
So, I just wanted to talk a little bit about what really ended up being a model of care, and community and health partners working together. So, some of the partners that came together included the Black Physicians of Ontario, Black Creek Community Health Centre, CAFCAN Social Services, the University Health Network, African Food Basket, the Black Scientists’ Task Force on Vaccine Equity, faith leaders—so, Imams and Pastors, as well as Dr. Upton Allen, and his seroMARK research study. You see here that we put Black individuals and families at the centre of our work, something that healthcare and the systems don't often do. We were equal partners with health providers in creating and delivering these clinics, using health data, our understanding of the community, and the needs of Black people, and feedback from attendees to provide a safe, judgement-free space, access to accurate information. As much as we think people are bombarded with, you know, the government and health sectors messages, people were, and are, getting counter-messages, and often told us that they were confused, and didn't actually know what was factual. We included blood pressure and glucose checks. We included things that were familiar; comfort food, beef patties, for example, soup, coconut water. We included fresh food hampers that had food people were used to; sweet potato, plantain, avocado, to address the high cost of fresh, nutritious food. We included cultural programming, including celebrating Emancipation Day on August 1st.
This model brought together Black health equity experts, doctors, community service staff, and the community to host the clinics. Volunteers were an essential component of our team. They answered questions, made sure people felt safe, ensured our seniors and other vulnerable residents were protected, and did not have to wait. Simple things like calling for taxis and Ubers, to make sure that seniors got home safely. Volunteers also worked alongside health staff, to collect race-based data, and other socio demographic data. We were committed to addressing this gap that existed in most other clinics. Throughout the vaccine initiative, there was significant pushback at many of the other city-led clinics; staff saying that they couldn't collect risk-based data, or other socio demographic data. It wasn't possible. People were uncomfortable. They didn't know how to do it. And we proved at the clinics that it could be done. And it was done. To address the gap around COVID and vaccine information, we also hosted and promoted webinars, information sessions, spoke to people about the specific concerns that they were hearing, connecting them to Black scientists and doctors, and to community members, to provide a counter-narrative to some of the social media messages.
Finally, we also worked with Dr. Upton Allen, Head of the Division of Infectious Diseases at the Hospital for Sick Children, on the seroMARK research study, that looked at how common COVID-19 infection was in the Black population, what factors were responsible for those things, and to what extent will infection rates in Black Canadian communities change over time. Black people, we know, are often not represented in much of the research that's done. And so, we felt it was important to help people understand the purpose of research, and to provide the opportunities for them to participate.
So, according to a Health Canada report, health inequities are not simply numerical differences between the health outcomes of different groups. They are unjust differences that could be eliminated, or reduced, by collective action, and the right mix of public policies. The impact of individual, institutional, and systemic racism and discrimination, throughout a lifetime, does lead to chronic stress and trauma, and there's growing evidence of the negative effects of chronic stress and experiences on mental and physical health. We learned some things. Many residents are without primary care support; people experience racism and discrimination when trying to access healthcare services. And again, we had many stories and anecdotes. Their experience creates mistrust of the system. The system is confusing, and hard to navigate, unless you have an advocate and support. The systems do not connect to the other supports that people need. Representation does matter, and we heard over and over again how powerful it was being in a space with Black doctors and nurses and vaccinators. We also learned, and tried to advocate for, the collection of disaggregated data. And you'll see a quote there from someone—it's probably small on the screen—who talked about being chronically ill, and having chronic pain and disabilities, and that the medical system was not working, and has not worked for her. But attending the clinic made her feel hopeful for communities of care, and alternative health practices that are human-centred and actively combat medical racism.
So, where do we go from here? We see restrictions are being lifted, and so, beyond COVID, there are lessons that need to be applied to how we move forward and deal with other issues, beside the pandemic. Many Black people felt that the system only paid attention to them because it was COVID, and put all of these opportunities in place because they wanted people vaccinated, but where was healthcare and other systems to support them prior to the pandemic? And will the systems transform, and be there for them after? Beyond COVID, we definitely need to eliminate the one model approach, okay. It isn't working, and hasn't worked, and again, advocates and community leaders have been talking about that for many, many years. Redesign the healthcare system to include community and social service partners who have strong relationships; increase access to healthcare by going into communities and spaces, such as the Jamaican Canadian Centre in North York, and others; ensure that organizations like TAIBU, and Roots Community Services, are sufficiently funded and sustained, and their capacity built. Black residents, as I mentioned, need support for more than vaccines. The system needs to build trust, increasing the number of Black and racialized primary care doctors and nurses, increase the research that focuses on Black health, and expand the definition of who is the expert in healthcare. There are better ways to support the health of Black Canadians, and it requires a willingness to acknowledge the role that racism, and systemic discrimination, and white supremacy plays, in preventing people from trusting a system, and getting the services they need. Community partners are key. The healthcare system cannot continue to operate in a siloed approach. And the representation matters. We need to create pathways for students, Black students, who want to pursue medicine, who want to get into nursing, and in other healthcare fields. Thank you. And I'll turn it back over to Paul.
Thank you, Adaoma and Sume for those presentations. So, you know, jumping right into the questions, Adaoma and Sume, I'm wondering, you know, both your presentations speak to the pandemic, and existing inequities that people have been mobilizing, and organizing around, for quite some time. I'm wondering if you think the pandemic has helped the cause; is the Black community better off? And what are some of the lessons from the work that you're doing, and described, that we need to be carrying forward?
I could start. I'm not sure we're better off. I think the verdict is out. Early in 2020, everyone talked about a “new normal,” and change. I think the shock of a pandemic caused everyone to really pause. You know, now things are opening up, restrictions are being lifted. Who is that going to impact, when there's no longer a concern to keep things safe? Who is going to be mostly impacted, and what are we going to do? I think there's a rush to get back to normal actually. People want to feel comfortable again, and I think that's going to prevent the proper reflection and changes, some of the good work that's been happening with things like the clinics, and other initiatives like the work that the Black Scientists’ Task Force has been doing around education. How are those getting embedded into public health, the work that public health is doing? You know, the Ontario health teams or hospitals. Where is the pause to say, what are the next steps, and how do we really move forward in an intentional way? I fear that, you know, I think we'll just rush back to what systems are used to, and then forget about many of those lessons.
I definitely have to agree with Adaoma’s point, I think one starting point is that normal never really worked for Black communities. So, the idea of going back to normal doesn't make sense for Black communities across this country. And just reflect on some of what—because what we saw at the start of the pandemic was also racism declared a public health crisis, right? So, I think if you want to say how are we doing today, you can take a look and say, okay, for all those organizations, particularly public health organizations, or healthcare organizations, who are saying racism is a public health crisis, particularly anti-Black racism, we can look at them and say, okay, what are they currently doing? And my observation, and some colleagues were doing some work around this, is that for most organizations who put out these grand declarations, most of them have failed to actually develop concrete strategies to back those statements. Where I think there has been some promise is just, I think there's been an incredible amount of community-led organizing, which has always been there. But I think, from my perspective, it just feels more visible, it seems like there's a bit a little bit more space for it. And I don't see that slowing down anytime soon, because I think communities across the country, Black communities across the country, and Black leaders, folks who are living in families, understand how important that organizing is. And, I think it's only that organizing which is going to get us to the kinds of policy and system changes which we are more calling for. So, to me, that is a glimmer of hope in all of this.
I'm wondering if you could break it down a little bit. Maybe you, Sume, first, and then Adaoma? How does anti-Black racism in very specific ways impact the health and well-being of Black people in Canada? You know, because it's a thread that follows through both of the presentations, and I think it's important to nail that down. Your first, Sume, please?
Yeah, absolutely. So, I think there's you can think about multiple pathways. In my talk, I really focused on the ways in which where we live, work, and play affect health. So, if we think about—and this holds true for all of us on the line today—a lot of our health is really not influenced by the health system. The health system does matter for our health, but a huge contributing factor to our health is know how much money we make, how safe our neighbourhoods are, if whether or not we can afford them high quality, healthy foods, the kind of education we have access to. And so, we know that in all those systems, all the systems which are important for our health and well-being, Black folks tend to experience discrimination in those systems. So, as an example, if you think about income, which Adaoma and I both spoke about, and Black folks are more likely to be represented in low-wage jobs. Even with higher levels of education, we don't necessarily see those high rates of education transform into labour market gains for Black folks, which means that, on average, Black communities are more likely to be in low-wage jobs, to be living in poverty. And what we know from the link between income, poverty, and health, is that the lack of those economic resources really impacts your health, through not just the social, but also through the biology; and there's been some speaking about it, Adaoma already spoke about the impact racism has in terms of chronic stress on the body. And there's a lot of amazing research, which actually shows that exposure to chronic stress, which happens because of anti-Blackness for Black folks, actually means that Black people, in some contexts, you know, the more you;re exposed to racism at an individual and structural level, the faster you age, and this has been called the weathering effect. So, that's another way in which anti-Black racism influences health.
Another example which comes to mind, is connection between our environment and our health. I think about work being done by Dr. Ingrid Waldron, and she was at Dalhousie, and is now in Ontario, and she was in work on environmental racism in Black and Mi’kmaq communities in the Nova Scotia area. And so what her research was really showing, was that Black and Indigenous communities in Nova Scotia were more likely to live by areas of toxic waste. And that's a very deliberate decision. It means that when we're building waste plants, those are more likely to be in low-income neighbourhoods, they're more likely to be to be neighbourhoods where Black and Indigenous folks live, which again means that as another example, you're exposed to more toxic waste, more pollution, and things like that. So, those are just a couple of ways in which we go from this somewhat abstract idea of anti-Black racism, to how what happens in the communities we live in.
And obviously we can think about the health system, right; what happens when you go into the health system? First, because of anti-Black racism, there's deep, very well-founded mistrust of the health systems, which means that folks are delaying seeking care, because you're anticipating the kind of discrimination and mistreatment you're going to get in the health system. And unfortunately, most of our health systems actually confirm that fear. So, then you walk through the door, the fear is confirmed. I mentioned the example the fact that it takes longer for Black folks to actually see healthcare providers, and when you're in front of the healthcare provider, you're not given adequate time. A lot of research talks about the fact that some of the concerns Black folks put forward are not taken seriously, it’s like, “I know they’re just making it up.” So. And also, the lack of knowledge of some of the health issues which Black folks are presenting with sometimes. An example, which a lot of folks talk about is around, say, pain diagnosis, right? So, imagine this white patient, Black patient, you walk into the hospital, you have a similar medical condition; the health provider has a diagnosis, you get a pain threshold, a pain diagnosis, it's the same for the white patient and the Black patient. Then it comes down to giving pain medication, what happens then all of a sudden? Black patient gets less pain medication, the white patient gets the accurate amount. What's that about? That is really rooted in this idea that somehow, I talked about, you know, supernaturally, like somehow Black people just don't feel the same amount of pain. And so, even though you've said your pain is at X level, and the clinical requirement is that you get a certain amount of pain medication, you don't get that. So, that those are the ways in which anti-Blackness seep into the everyday practices of the health system. Adaoma, I’ll pass it on to you.
Thank you for that. So, Adaoma, I think you talked a lot about the mobilization of the JCA Partners to respond to community needs. Why isn't as just as simple as requesting that the government care for Black communities? Why is it necessary for the JCA to—that actually doesn't really do this work—to step out and to create the space? And how's that anti-Black racism kind of fitting in there?
Yeah. I think we stepped up, and the other partners stepped up, because there continued to be this gap. So, we were talking about COVID, you know, after that initial shock of like, who is it impacting? And the response, and then the response to vaccine, as if it was just one approach, right? So, public health would host a clinic, and everyone would go, and then lo and behold, again, “oh, why aren't Black people going to those clinics? We throw out the information, you go on the website.” And again, the strategies are always this one-size-fits-all. And so, we felt it was really important to speak up and to come together with other organizations like CAFCAN to say no, Black people have the solutions to the challenges that we're also highlighting. You know, healthcare and other systems really can't make any difference without involving the people who are impacted. And as people came through the clinic, they would talk to us about some of those things, like Sume talked about pain medication, and even going into a place where they were believed. So, they would go to a doctor. Many are going to walk in clinics, because even access to that primary doctor is very, very difficult. And they'd say, “well, you know, I don't think the doctor believed me or didn't take my issue seriously. “ Or, the solution jump to prescription, before even an understanding of what the problem is.
So, as organizations, we knew that there was a role there. And it provided an opportunity to also illustrate the things that we were talking about before. To show that there is this other way to support individuals and families, and then to work on still advocating and talking about how racism is tangibly, in very concrete ways, how that is preventing people from getting access to the care. When we added things like the food basket, nutritious food, it was because we saw Black people, seniors in particular, couldn't afford it, they couldn't get to it, and then they couldn't afford it. And if they go to a traditional food bank, they're getting things that they don't know how to prepare, or it doesn't reflect their diet. And so, we kept building on the model, as again, an illustration really, to systems, that you need to pay attention. And we've proven that there's another way to do it, and even to get data from it. So, we were hearing, “no, it can't be done, no one wants to disclose race, or how much they're earning.” And we had volunteers who were able to do that.
Awesome, thank you. I think turning our attention to the healthcare system would be interesting and important. We often hear about things like the under-screened and never screened, as it relates to preventative screening, whether it be cancer or other pieces. And I think there's a piece here that weaves in, Folks feel like the healthcare system is universal. So, you're weaving through these questions around the experiences of anti-Black racism, trust, and some of the novel interventions or innovations that both you Sume, and Adaoma, have developed through your initiatives? How do some of those things come through, as it relates to transforming the healthcare system, specifically, as we get to things like chronic disease? Last bit of wrapping up there, I think, I'm often concerned about the compounding effects, right. So, if you're under screened and never screened, and we know that there's going to be a heavy backlog for preventative care and screening, you know, what does this mean? How do we kind of hold all of that in the pot and start to work at addressing? Sume, maybe you first?
So, for me, I think the first thing we need to accept is that we cannot fix our deep structural problems by simply increasing services in communities. And I think there's that urgency, let us get services to communities and we’ll solve these problems. I think, at the same time, I think that's very important, and at the same time, we need to be dealing with some of the structural issues, which Adaoma I have been speaking to. Now, coming to the services themselves, I think what the work that the JCA, and others, have done is just showing highlights of the importance of culturally appropriate and responsive care.
So, what happens when interventions or initiatives are really developed by people from that community, by experts in that community, who understand the community context, understand the science, by people from that community have the everyday lived experience of what it means to either try and manage a chronic disease, or a support a family member who's trying to live with a chronic disease, or what it means to not access care because of certain concerns. I think pulling in that expertise, which is from different sources, has to really be foundational to how our chronic disease prevention is organized. Additionally, we’re talking about community care, which can be provided in various different settings. And part of this could be realizing that, for some community members, healthcare services will not be where they go to actually access health services. So, thinking about a prevention service in different communities, which is why I think the JCA example is just a perfect example of that. It may be that we are we are delivering interventions in schools, and after school programs, in faith-based settings, because that is where folks go, that is where those relationships are already established. So, really getting outside our traditional healthcare boxes, to say, okay, we know what's best, and actually actively listening? And what the challenge of that is, oftentimes communities tell us what they want, and we think, as healthcare providers, that we actually do know better. So, we choose to discount it, because it doesn't matter what we think we know. So, I think really listening to community voices, and taking it seriously, instead of asking communities for information and then actively ignoring it.
Another challenge, which we definitely need to grapple with, is ensuring that these services are very well resourced and are sustainable. In Canada, we have this amazing habit of pilot projects, and grant-based funding, which is the recipe for disaster, because you're not funding organizations and industry to be sustainable, you're funding them to just be on this perpetual cycle of working on the next reports, trying to prepare the next grant, and that doesn't let people out to do the work they absolutely need to do. So, think about how we resource these community organizations in ways which are really long-term and sustainable, and additionally holding mainstream systems accountable. The truth is, that most Black folks are not going to get healthcare services from, say, a Black led organization. Most Black folks are getting health services from mainstream white-dominant institutions. And so, we need to ensure that those institutions are also providing culturally relevant, and affirming care, and it’s not just left to the community-led organizations to do that work.
Agreed. I think we have to do the two things at the same time. So, given the backlog, and people who may not have even seen a doctor in the last two years, it is crucial that, again, we think about what are the changes that we continue to call for, with respect to the system and healthcare. How do we, as community, because if we don't do it, then—you know, Black people, we continue to fight for changes, and we'll have to do that. And at the same time, getting healthcare providers, or the healthcare system, to let go of some of the control. And so, when there are partners, like UHN willing to do that, willing to consider different models, the more of that we do, then it helps to start to really normalize the fact that community residents are the experts, that they need to be an integral part of the redesign, and that it is okay to have a clinic blood pressure check education in that church, in that mosque, in that community space.
Thank you for that. There's another threat there, the threat around accountability. Sume just spoke about, the reality is, we can create our own institutions, which folks have been doing for quite some time. But the massive majority of Black folks in Canada will not be served enough through Black lead organizations. So, you know, dig deeper, what does that accountability look like? How do things like socio-demographic data play a role in that conversation?
Yeah, so the accountability takes the form of the continued advocacy. There really has been no other way for system transformation to happen without us continuing to name it, to look at the policy levers. So, you know, we had CERB over the past two years. We've really shown that some kind of guaranteed income is possible. We had been hearing for decades, “well, you know, it can’t—it's not affordable.” And during the pandemic, it became affordable. How do we push for that, to get something like a guaranteed income, that helps to start to address those issues? How do we push through the changes that are happening with the Ontario health teams, and the mandate that they have around some of these community care? You know, the changes that were supposed to be in place before the pandemic. How do we get them at the table, and really hold their feet to the fire? So, it's a combination of the continued push, identifying those opportunities that are shorter-term, and then the policy things that we think are important. There is no reason, coming out of the pandemic, that this issue of data collection and disaggregating the data—we should still be fighting that. We've talked about that for two years. We don't have the data, how do we know that anything is working, right? And sort of burying our head in the sand to say that, “well, we can't collect it, t's too complicated, too difficult,” is no longer an excuse. So, there are some things, definitely big-picture policy, that we've started to move the needle on. We have to make sure we don't lose those, and continue to use the smaller models that are resourced, to then show, and plant those seeds, and continue to grow that, so that they influence the system.
Yeah, absolutely. I think race-based data is critically important, and a lot of the conversation which we're having is about really measuring the impact the outcomes of systemic racism. So, how is it impacting communities? I think that work is absolutely critical. We’ve seen in places like Nova Scotia, that has actually become part of law, and so in that case, that work is moving ahead. There’s work happening in Ontario; yet in places like Québec, there is some active resistance to do that. So, the picture across the country is quite different. And so, I think the advocacy, speaking to Adaoma, is so important.
I think also, when we think about race-based data, we need to also be asking for measures which show what is happening within our institutions, and within our policy. So, being able to trace the outcomes back to particular institutional practices, or particular public policies have to be part of the kind of measurement frameworks we develop. Accountability, I believe we need to tie that to money, right, like what do institutions care about at the end of the day? Our public institutions are funded, hospitals have massive budgets, so I think one potential accountability measure is tying some of that funding to anti-racist measures, including the salaries, and performances of hospital CEOs. What is the point in having a mission statement, or strategic plan, which says, “we care about anti-racism,” but then you're never actually held accountable to it? It's never included in your performance. You can ignore it, and still get a huge bonus at the end of the year. So, I think we actually need to stop doing that, and tie CEO pay to anti-racist, outcomes, and have that apply across the board. Again, within institutions, we can think about how that becomes a regular part of everyone's job, right? Because another strategy organizations use is—and we've seen this across the board—you hire your one anti-racism person, or maybe two if you’re lucky, sometimes three, and then the burden falls on them. But how do you ensure that it's everyone's job in the ways in which are appropriate across different roles? And so, if I was doing that, then I'll be including that in my regular learning and performance conversations with staff. So, again, the ways in which we’re building accountability for the organization, but also for individuals who, at the end of the day, I think come into health system, because you want to do good, and just part of our challenge of the health system—we believe that we are, we’re always doing good, even when it's not the case—but, I think if we include some of those measures, then we make it make it real and meaningful for people, and for communities.
Thank you. I'm getting the time signal, but I want to do one more question. So, literally 15 to 20 seconds each. I'm curious about what gives you hope, in this work. Maybe name the one top thing that you think is critically important to mention. And you know, the ways that the folks listening in the room can work to mobilize those pieces. So, back to you Sume, and then Adaoma, and then we’ll go from there.
That's an easy one for me. For me, it's community. I think that's what the hope is, because I've learned over the years that you do not do this work by yourself, you do not do in isolation. So, I'm finding your people is what keeps me going and gives me hope.
Absolutely, 100% agree. I think we see the moment, and the window, and this impacts us. And so, we're not letting it go, and then we're going to sort of charge ahead. So, for me, it's also community.
We’ve reached consensus. I want to thank you, Adaoma and Sume, for the really deep and thoughtful answers to all of the questions from the audience and myself, and for the deep and thoughtful presentations which both of you did give. So, I will pass it back over to Kelly, and say thank you again to the Empire Club of Canada for having us.
Thank you, Sume, Adaoma and Paul. I'd now like to take the opportunity to welcome Saleema Khimji, Chief Innovation Officer, MCI Onehealth Technologies Inc. to deliver some appreciation remarks. Saleema, welcome.
Note of Appreciation by Saleema Khimji, Chief Innovation Officer at MCI Onehealth Technologies Incorporated
Thank you very much. My name is Saleema Khimji, and I'm the Chief Innovation Officer for MCI Onehealth. And on behalf of MCI Onehealth, we are extremely honoured to be given the opportunity to sponsor this event as part of Black History Month. I would like to extend appreciation to the Empire Club and webinar attendees, as well as to Sume, Adaoma and Paul, for taking us through a very important discussion, and bringing to light the health inequities faced by Black Canadians, and for emphasising the necessity for responsive care, and targeted programs, to proactively change this. At MCI Onehealth, we are healthcare providers working directly in the community, at the primary healthcare level. And our mission is to empower patients through promoting personalized medicine, in ways that lead to increased access, and improved quality.
By way of background, MCI Onehealth is Canada's leading high-performance clinic network group, with 25 primary care clinics; over 600 medical staff; over 500 corporate health customers; and we see over a million patients per year. So, from that foundation of family practice, we have added our virtual healthcare platform a host of specialist services, with over 50 in-house specialists, an in-house clinical research organization, and introduced a range of AI-powered technologies, including remote and real-time patient monitoring solutions. And through our in-house team of data scientists, we are developing algorithms, and AI-powered solutions for the screening, and more accurate, and faster diagnosis of chronic and rare diseases. An underlying objective of building this high-performance health care network is to enable an end-to-end system, of a more personalized information journey, that also captures a more holistic, and accurate, 360-degree view of the patient.
A key driver for the advancement of personalized medicine, is collecting and linking more diverse sources of data, and data points, eliminating bias in our algorithm development, and generating higher-quality, structured data, to share with key stakeholders, that require the data to advance personalized medicine, and to develop targeted programming, and healthcare delivery. MCI Onehealth is committed to innovation in healthcare delivery that is responsive to the needs of the community, through customised services and programming. That's why it's important to us to support initiatives that work towards closing the gaps in Canadian healthcare, that have historically excluded racialized communities from equal access to quality care. We value the opportunity to be able to listen and learn from experts in this field, as well as people with this lived experience, so that we can continue our commitment to fostering culturally adaptive and inclusive practices within our delivery of care. We are grateful to be part of providing a platform to the healthcare professionals, and community leaders that presented today, and support their work to reduce racial disparities, and promote health and wellness for Black Canadians. I'll now hand back over to Kelly. Thank you.
Concluding Remarks by Kelly Jackson
Thanks again to MCI Onehealth, and all of our sponsors for their support; and to our guests, and everybody who joined us today, or will be watching later on-demand. Our next virtual event is this Wednesday, February 16th, at 12 noon Eastern Time, join us for “Fuel for Thought” series, “Fueling Canada's Low-Carbon Future,” presented in partnership with the Canadian Fuels Association. The Honourable Jonathan Wilkinson, Canada's Minister of Natural Resources, will be joined by Susannah Pierce, Country Chair for Shell Canada. They will be engaging in a conversation on the role of the transportation sector in meeting Canada’s goal of net-zero by 2050. More details, and complimentary registration are available at empireclubofcanada.com. This meeting is now adjourned. I wish you a great afternoon. Take care and stay safe.