O’Brien Institute researchers advance anti-racism work in cancer care and at City of Calgary

O’Brien Institute for Public Health researchers are working to address anti-Black racism, and to promote health, equity, diversity and inclusion in government and health care.

The Canadian Public Health Association recognizes racism as a determinant of health, and calls on all agencies and organizations involved in education, research and the provision of health and social services in Canada to address racism in all its forms. 

Achieving equitable cancer care for Black Canadians

Delayed cancer care can lead to a lower chance of survival, greater problems associated with treatment and higher costs of care, which is why Dr. Doreen Ezeife, MD, is passionate about addressing the barriers to cancer screening Black Canadians face.

“Black people can be more hesitant to adopt screening programs for a variety of reasons including cultural and historical factors,” says Ezeife, a medical oncologist at Calgary's Tom Baker Cancer Centre and a member of the O’Brien Institute and the Arnie Charbonneau Cancer Institute at the Cumming School of Medicine.

For example, she says, Black immigrant women can be hesitant to adopt cervical cancer screening if they don’t have a female family physician.

Medical system mistrust and a lack of culturally sensitive care can also be a factor, which speaks to the importance of increasing the representation of Black health-care providers, says Ezeife.

She says many Black patients have a strong sense of cultural identity and community, so providing culturally sensitive care and connection can lead to better uptake of cancer tests and treatments.

To address health disparities in her own practice, Ezeife makes an effort to be aware of her patients’ cultural backgrounds and to connect them with supports and programs in their communities such as the African Cancer Support Group. She also works with patient navigators who help to translate complex health information to the patient.

“Providing culturally sensitive care empowers patients to take control of their health and be more accepting of the cancer tests and treatments that we propose. This approach has a positive impact on a patient’s cancer treatment and their overall cancer journey,” she says.

Racism as a public health issue

The Canadian health-care system is beset with inequalities that disproportionately affect Black people and other marginalized groups —and shedding light on these issues can help to drive change, says Ezeife.

The Canadian Race Relations Foundation defines anti-Black racism as “policies and practices rooted in Canadian institutions such as, education, health care, and justice that mirror and reinforce beliefs, attitudes, prejudice, stereotyping and/or discrimination toward people of African descent.”

“We need to address the systemic racism in medicine in order to improve disparities in care,” she says.

Work in recent years to address racism as a public health issue has led to improvements, but more needs to be done, says Ezeife.

One critical area for improvement is the lack of race-based medical data in Canada. Without race-based data, researchers are unable to study the impact of race and ethnicity on cancer incidence and mortality, says Ezeife.

This type of data is collected in other countries, such as the United States and the United Kingdom. Ezeife is among a growing number of researchers and patients pushing for the collection of this data in Canada.

"Our goal is to work with government and help to initiate collection of this data," says Ezeife. “Having this will allow us to create evidence-informed, targeted interventions that benefit all Canadians.”

Informing Calgary’s anti-racism work

Meanwhile, work by Dr. Régine Uwibereyeho King, PhD, is one component in the development of The City of Calgary’s Anti-Racism Strategic Plan.

“Racism has long been understood to be a key social determinant of health. Things like housing, education, income, employment, food security, and justice drive health inequities across the country,” says King, an associate professor in the Faculty of Social Work and a member of the O’Brien Institute. 

In fall 2020, through its Urban Alliance partnership with UCalgary, The City of Calgary solicited a scoping review of promising anti-racism practices across municipalities and sectors that could inform its work. King, the lead researcher for the review, which was submitted in February 2021, outlines three focus areas based on an environmental scan of anti-racist practices adopted in other municipalities.

Those areas call for institutionalizing anti-racism by mainstreaming anti-racist policies and practices; adopting an anti-racist participatory governance approach; and building equitable and vibrant communities by employing a racial equity lens in all city practices and services.

The work carried out by King “contributes to our strategic planning as it provides information on factors that will affect The City’s ongoing anti-racism work,” says Dr. Linda Kongnetiman, PhD, managing lead of The City of Calgary anti-racism program. "The final co-created anti-racism strategic plan will also be comprised of recommendations gathered through community engagement, internal assessment and a public safety strategy."

The City of Calgary’s full anti-racism strategy is expected to be released this year.