Black History Month: Clinical Musings

Is race a “risk factor”?

The question is more complex than it looks and requires us to consider both biological and social dimensions.  

“Race” is a term which has no biological or physiological roots.  99.9% of our DNA as humans is universally shared. Racial classification is a social phenomena – the cataloguing of outward appearing physical differences that hide the scientific and genetic fact of our overwhelming human similarity.  

The social processes of creating and maintaining categories using physical characteristics to define or classify people is a devastatingly powerful way to claim that people with one subset of appearances are “the norm” – the rest are “other”.    Coming into the world and being assigned status in a group other than the normative one is very bad for one’s health. 

In Canada, a Black person has to contend with a life course affected by the intergenerational poverty created  by longstanding laws and policies against Black land ownership,  forcing  Black people into unsafe or industrialized neighborhoods and lower paying jobs.  Black people have also had to contend with the hostility of  institutions such as justice, health, and education which claim “neutrality” but have yet to truly contend with the fact that racism was baked into the founding stories of all longstanding institutions and traditions. 

For a Black person, the social determinants of health are a direct result of othering, based on race. The social determinants of inequity is a better descriptor of what is actually occurring.

What does this mean for the health of our patients?  Think of the role stress plays in disease – we know that chronic stress accelerates inflammation, challenges mental health and lowers defenses for infectious disease.  There are few things more stressful on a daily basis than being Black in a society which continues to preserve the social category of “white” as normal and good – often at the explicit expense and exclusion of “Black”.  

Does it feel uncomfortable to read about race in the HFAM newsletter?  If so, I am sure you are not alone.  

What we need to grapple with is this:  The social construction of “race” – and its resulting hierarchy leading to racism –   is the most significant risk factor for the poorer health outcomes of Black people.   Therefore, as family doctors, don’t we have a moral and ethical duty to figure out how to talk about it more?  And I, (and hopefully all of you), don’t think its appropriate or fair for that work to be delegated to Black and racialized colleagues. 

In the coming months, I am hoping that we, as a community of family doctors – a precious resources for the health of all Hamiltonians – can start to have these conversations more honestly and openly.   Black History Month gives us the chance to open a door  – we can make the choice to see what we can learn, unlearn, and change for years to come. 

Cathy Risdon MD. (with thanks to Dr. Tejal Patel).

Dr. Cathy Risdon is a founding member of the GHHN Family Medicine Executive