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The Great Equalizer Amplifier: A Conversation with Dr. Onye Nnorom

By Milena Casciato

Similarly to the way we proclaim that “cancer doesn’t discriminate,” the COVID-19 pandemic had initially been labelled as the “great equalizer.” Well, this could not be further from the truth.


In Toronto, the distribution of cases saw disproportionately high numbers for non-white ethno-racial groups, making up 83% of total cases (1). Data from the Toronto Star showed that the wealthiest and whitest neighbourhoods experienced immediate drops in cases with closure or-ders, while cases in the poorest and most racialized neighbourhoods continued to soar (2). It ap-pears that in the face of a global struggle, existing inequalities are not forgotten, they are ampli-fied.


To learn more about anti-Black racism in the context of COVID-19 and the healthcare system, I spoke with Dr. Onye Nnorom, a public health and preventive medicine specialist as well as the president of the Black Physicians’ Association of Ontario, among other roles. We spoke about the collection of race based data, black representation in medicine, and more.


Race has long been listed as a risk factor for various diseases, including COVID-19, when the real risk factor is racism. How has the idea that disproportionate health outcomes are based on biology negatively impacted racialized communities?


Dr. Nnorom: Race is a social construct but the concept of race arose at the time of the scientific revolution, the age of European imperialism and theories on biological differences were used to justify atrocities like slavery and colonization. Despite the human genome project, which taught us that there is more genetic difference within a 'race' than between them, we still hold on to these false ideologies to explain disparities between groups. It allows us to come to implicit con-clusions in medicine that non-white people are somehow biologically flawed and less healthy be-cause of biological reasons, and to be complacent when we see inequities - differences in health outcomes that are due to social factors like poverty and systemic racism or other social determi-nants of health. This matters because we can do something about social factors; as a society, the onus is on us to change policies, practices and behaviours that negatively impact people’s health. Falsely attributing the differences to genetics is bad science but also gives society an excuse to maintain the status quo, and ignore social determinants of health like systemic racism.



Why is there a need for more black physicians and how will this directly positively impact black health? Additionally, what kind of training should be included in medical education so that future physicians are better equipped to serve black communities?


Dr. Nnorom: Historically, there have systemic barriers that have led to black people being un-derrepresented in medicine and certainly extremely underrepresented in leadership. Medical stu-dents need to learn about Black population health, but there is also a greater potential for cultural dexterity when students learn in a more diverse classroom. Cultural dexterity is a term that refers to being able to provide culturally competent or culturally safe care to different groups. There is very good evidence that black patients have better outcomes with black doctors, as seen from

studies in the United States. We also know that clinics like the TAIBU Community Health Cen-ter, which was established to serve the needs of the black population in the Greater Toronto Area, came about through community advocacy because they were not receiving culturally ap-propriate care. The big picture is that historically underrepresented populations that have deep connections to marginalized communities, are able to offer a different perspective and transform healthcare when given a greater voice and ability to hold leadership positions.



There has been criticism of the pandemic response strategy as it does not account for racial and socio-economic biases. Once a vaccine is available, what can be done to ensure that these criticisms are not warranted again?


Dr. Nnorom: In my opinion, a vaccine will solve some problems but not all. Many of the groups that are disproportionately affected by racism and other forms of social injustice that were ampli-fied by COVID-19 also have a (warranted) mistrust for medical and pharmacological institu-tions. If I'm part of a group that society 'left behind', neglected during the pandemic, why would I trust the vaccine? As we know vaccine hesitancy in general is linked to trust so this context is going to be a significant challenge, because many of the groups that are disproportionately af-fected, may not be willing to take it, at least not initially. This hesitancy has been reported with regards to the American vaccine trials – African American and Latinos have not enrolled in the trials at the same rate as the general American population and a major factor (though not the only one) is mistrust.



The need for the transparent and comprehensive collection of race-based data during the pandemic has been highlighted. Are there any potential consequences of this data collection and how should it be utilized by clinicians, public health officials, and members of govern-ment?


Dr. Nnorom: There are numerous consequences, these have been highlighted particularly by Black and Indigenous communities who have seen race-based data used to stigmatize African Americans in the United States and Indigenous communities here in Canada without much pro-gress to achieving equity. The data is not sufficient for change - but I do believe it is necessary. I encourage students to read the critiques of race-based data collection brought forth by many scholars because if the data collection is not handled in a culturally safe way, with BIPOC or other affected communities at the table, it can be harmful. It can be used to pathologize and stig-matize groups if genetic assumptions or other unfounded racist assumptions are made about these groups.



An example of such critiques Dr. Nnorom refers to was written by LLana James, a PhD candi-date at the university of Toronto (3). In her article, James discusses that despite any benefits of race-based data, action against racism would likely not be prioritized. Potential harms include a false sense of anonymity and biased algorithms with potential impacts such as determining an individual’s insurance rates, all while insufficient data laws fail to provide much protection.

James also notes that similar data-collection in the United States has not proven helpful in reduc-ing the number of deaths in the Black community.


Dr. Nnorom says many provinces and BIPOC communities are trying to find ways to collect race based data in a culturally safe way, with BIPOC voices at the table. Ultimately, the collection of data is necessary but not sufficient for change – there needs to be a political and societal will to take effective action to address the inequities that are identified by the data. The outcome of in-terest is not “more data”; the outcome of interest is health equity – that everyone is given an equal opportunity to reach their full health potential and that they are not disadvantaged by their racial/social status.



Thank you to Dr. Nnorom for your time and for being such a powerful voice throughout the pan-demic and beyond. If you would like to learn more about Dr. Nnorom, check out her website: https://dronnorom.com/, where you can also listen to her podcast: Race, Health, & Happiness.



References

1. De Villa, E. (2020, July 2). An Update on COVID-19 Presentation for the Board of Health. Retrieved 2020, from https://www.toronto.ca/legdocs/mmis/2020/hl/bgrd/back-groundfile-148594.pdf.

2. Allen, K., Yang, J., Mendleson, R., & Bailey, A. (2020, August 02). Lockdown worked for the rich, but not for the poor. The untold story of how COVID-19 spread across To-ronto, in 7 graphics. Retrieved 2020, from https://www.thestar.com/news/gta/2020/08/02/lockdown-worked-for-the-rich-but-not-for-the-poor-the-untold-story-of-how-covid-19-spread-across-toronto-in-7-graphics.html.

3. LLana James PhD Candidate. (2020, September 15). Race-based COVID-19 data may be used to discriminate against racialized communities. Retrieved 2020, from https://theconversation.com/race-based-covid-19-data-may-be-used-to-discriminate-against-racialized-communities-138372.

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