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Reimagining Healthcare and Public Health: A Plan for Anti-Racist Praxis through the development and implementation of competencies

  • Feb 27
  • 4 min read

Ashley Wilkinson, Janelle Olughor, Precious Adekoya, Robert Chin-See, Onye Nnorom, Sume Ndumbe-Eyoh & OmiSoore Dryden


Racism, a recognized determinant of health1, and specifically anti-Black racism, significantly impacts the well-being of Black peoples and communities. Research has shown that Black people in Canada experience significant inequities across a range of issues including in cancer incidence, late and delayed diagnoses, and poor quality of care, racial discrimination, and anti-Black racism in health services2, many of which can be considered the downstream impacts of structural white supremacy and racism3. A recent study4 found that 32.55% of Black participants reported experiencing significant racial discrimination in healthcare services. These experiences of anti-Black racism contributed to COVID-19 vaccine mistrust, COVID-19 traumatic stress, anxiety, depression, and stress, showing a strong association between the experience of racial discrimination in health services and health behaviors and decisions of Black people4. As further research demonstrates5 “anti-Black racism exacerbates the impact of each social determinant of health for Black communities in Canada” (p.103).


In 2021, Dr. OmiSoore Dryden, then the JRJ Chair for Black Studies in the Faculty of Medicine at Dalhousie University and Dr. Onye Nnorom, the Black Health Theme Lead for the Department of Family and Community Medicine at the Temerty Faculty of Medicine at the University of Toronto recognized the urgent need to address these concerns. They partnered to form the Black Health Education Collaborative (BHEC), dedicated to transforming medical and health professional education to improve the health of Black communities across Canada.


Currently, physicians undergo rigorous accreditation and licensure processes through bodies like the Committee on Accreditation of Canadian Medical Schools (CACMS). While CACMS standards ensure a base level of competency, which includes promoting health equity, they do not adequately address the colonial roots, the afterlife of slavery, and ongoing manifestations of anti-Black racism in Canada. Further highlighting this issue6 write that, “nursing curricula has been criticized for failing to incorporate content that would enhance competency related to care delivery for historically marginalized populations” (p.3).


Funded by the Canadian Institutes for Health Research, the research study, “Defining and Developing Black Health National Learning Competencies in Medical and Public Health Education, aims to improve public health and medical training, impacting healthcare practices and models for generations to come through the creation and implementation of competencies on Black health.  Led by Dr. Dryden, Prof. Ndumbe-Eyoh and Dr. Nnorom,  the project builds on work which identified competencies for Black health through a global literature review and a Delphi panel. These competencies informed the Medical Council of Canada learning objectives on Black health released in 2024 and will be reflected in updates to the core competencies for public health in Canada7.


By focusing on the policy landscape for Black health and integrating anti-racist praxis, this initiative tackles a crucial gap in current medical and public health education.  Addressing this systemic issue within health professions education is a macro-level/structural intervention designed to improve the care, support, and understanding Black patients and communities receive8. Implementing Black health-focused anti-racist competencies for both medical and public health professionals is a vital step towards integrating public health and healthcare delivery systems and creating a more equitable healthcare landscape.


This project is not simply about adding a module to existing curricula. It is a fundamental rethinking of how health professionals are trained, ensuring they are equipped to provide culturally safe and anti-racist care. It acknowledges that health inequities are a matter of political and policy choices and provides alternatives for more equitable futures. By focusing on Black health and centering anti-racism, this project aims to create a healthcare system that truly serves all members of the population.

 


 





References


  1. Paradies Y, Ben J, Denson N, Elias A, Priest N, Pieterse A, et al. Racism as a determinant of health: a systematic review and meta-analysis. PLoS One. 2015;10(9):e0138511. https://doi.org/10.1371/journal.pone.0138511

  2. Olanlesi-Aliu A, Alaazi D, Salami B. Black Health in Canada: protocol for a scoping review. JMIR Res Protoc. 2023;12:e42212. https://doi.org/10.2196/42212

  3. Dryden O, Nnorom O. Time to dismantle systemic anti-Black racism in medicine in Canada. CMAJ. 2021;193(2):E55–7. https://doi.org/10.1503/cmaj.201579

  4. Cénat JM. Racial discrimination in healthcare services among Black individuals in Canada as a major threat for public health: its association with COVID-19 vaccine mistrust and uptake, conspiracy beliefs, depression, anxiety, stress, and community resilience. Public Health. 2024;230:207–15. https://doi.org/10.1016/j.puhe.2024.02.030

  5. Massaquoi N, Ashcroft R, Adamson K. Health disparities, social determinants of health, and systemic anti-Black racism during COVID-19: a call to action for social work. Can Soc Work Rev. 2022;39(2):101–10. https://doi.org/10.7202/1096803ar

  6. Jefferies K, States C, MacLennan V, Helwig M, Gahagan J, Bernard WT, et al. Black nurses in the nursing profession in Canada: a scoping review. Int J Equity Health. 2022;21(1):102. https://doi.org/10.1186/s12939-022-01673-w

  7. Medical Council of Canada. Black Health [Internet]. Ottawa: Medical Council of Canada; 2024 [cited 2025 Jul 2]. Available from: https://mcc.ca/objectives/medical-expert/black-health/

  8. Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–61. https://doi.org/10.1016/S0140-6736(17)30569-X

 

 
 
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