Canadian medical journal acknowledges its role in perpetuating anti-Black racism in health care

Canada's premier medical journal says it's eager to address the role it plays in perpetuating anti-Black racism in health care and spark the broader change needed to dismantle structural barriers to equitable care.

The Canadian Medical Association Journal says a special edition released Monday is the first of two spotlighting papers by Black authors, examining system-wide failures and urging change.

Editor-in-chief Kirsten Patrick says the peer-reviewed publication is also working on ways to ensure future issues better represent the work of Black experts and the needs of Black patients, many of whom routinely face overt and subconscious biases that compromise their care.

She credits a working group of Black academics and medical professionals with helping her and the staff confront harmful practices, noting: "I really see things that I didn't see before."

"I'm a white woman, I think of myself as progressive and feminist," she said from Ottawa.

"And I learned new things about my own internalized anti-Black racism from doing this special issue and definitely have reflected on the way that CMAJ's processes undermine minority engagements, I would say, and put barriers sometimes to people who are not white."

The two special editions follow years of advocacy by a group known as the Black Health Education Collaborative, co-led by OmiSoore Dryden, an associate professor in the Faculty of Medicine at Dalhousie University who specializes in medical anti-Black racism, and Dr. Onye Nnorom, a family doctor and public health specialist with the University of Toronto.

Dryden says work on the special issues began more than a year ago when discussions began on how anti-Black racism manifests in structural and systemic ways that ultimately prevent research from being shared. They hope the editions can help the journal's audience — largely educators and practitioners — understand the vast scope of the problem.

"In some ways, Canada very much is a welcoming place. However, that can act as a barrier in understanding how racism manifests — it's not just the racial slur. It's not just the racist targeting. But it is in the very systems of continuing to practice race-based medicine," she said, noting racial stereotypes could lead practitioners to make false assumptions about what's making a Black patient sick.

"Even if we had more funding and even if we had more Black physicians and practitioners, if we do not address the very real reality of anti-Black racism — in structures and in practice — we will continue to see poor health outcomes from Black communities."

One of the articles in Monday's edition examines the difficulties many Black patients face in getting cancer screening, molecular testing, breakthrough therapies and enrolment in clinical trials. One of the examples given is a study of immigrant women in Ontario, which found that lack of cervical cancer screening was linked to systemic barriers such as not having a female physician or coming from low-income households.

Monday's CMAJ paper also notes mortality from breast, colorectal, prostate and pancreatic cancers is higher in Black patients than in white patients, citing data from the Canadian Cancer Registry that was linked to census data on race and ethnicity. But it notes the impact of race on cancer incidence and mortality is not often studied because Canadian registries don't regularly collect race and ethnicity data, unlike those in the United Kingdom and the United States.

Other pieces in Monday's edition examine youth mental health and prostate cancer in Black Canadian men.

The second edition, set for release on Oct. 31, explores topics including gaslighting in academic medicine and Afrocentric approaches to promoting Black health.