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 says 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 says, 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. So that's the barrier. How do we get to the point where we can understand: Yes, racism is real. Racism is a reality. And it is exacerbating poor health outcomes amongst Black people.”
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.
The two issues were developed with guidance from the advocacy collaborative as well as a guest editorial committee comprised of Black experts in health equity: Notisha Massaquoi, assistant professor, department of health and society at the University of Toronto; Dr. Mojola Omole, surgical oncologist and journalist in Ontario; Camille Orridge, a senior fellow at the Toronto health policy charity the Wellesley Institute and Bukola Salami, associate editor at CMAJ and associate professor of nursing at the University of Alberta.
Massaquoi says their work went far beyond preparing the two issues; it included reviewing all processes the journal uses throughout the year that hinder diversity on its pages.
She says articles submitted for academic publishing are most often reviewed by editorial committees that don't include Black researchers. As a result, reviewers don't fully grasp the context of the article or question the credibility of the research and dismiss the pitch.
Patrick estimates the journal has published six to seven articles and a few blog posts by Black authors in the last 18 months amid a concerted effort to boost representation. Actual data is unavailable because the CMAJ does not ask submitting authors about their race or ethnicity, however this is being considered, she says.
Patrick acknowledges that minority authors are "super-rare" when looking at the 111-year history of the journal, which publishes 50 online issues per year and a selection of articles in a monthly print version.
"Research is something that you only get to do if you know the right people. If you haven't had those kinds of connections throughout your childhood in your schooling, do you ever know the right people?" says Patrick.
"We just keep on getting the same kind of thinking reinforced over and over and over again from a small subsection of our medical population."
Massaquoi says that's why it's important for the CMAJ to work on methods used to recruit writers familiar with Black issues and improve the diversity of its pool of reviewers.
She says she’s "absolutely confident” these steps can make a difference.
“This is the premier journal that our medical professionals are using so that they understand the newest and the most innovative, up-to-date information on health care in Canada,” Massaquoi says.
“And if it's absolutely devoid of any material that's going to help them understand working with Black communities, then we're doing our profession a disservice."
Patrick says the CMAJ is consulting outside experts to look at equity issues and interview staff and people who submit to the journal, as well as members of the anti-Black racism special issue working group.
"They're going to come back to us with a report about where our organization is in terms of equity, diversity and anti-racism and help us to come up with a really meaningful plan for how we're going to work on these issues going forward," she says.
"We're not just putting out a statement that's meaningless. We've committed to real work in this area."
This report by The Canadian Press was first published Oct. 24, 2022.
Cassandra Szklarski, The Canadian Press
