Tackling the health burden of anti-black racism and violence

As professors across Canada have been handing out syllabi and giving their first lectures of this school year, Professor Roberta Timothy has her eyes firmly set on next September, when the Dalla Lana School of Public Health at the University of Toronto will welcome the first cohort into the two-year Master of Public Health in Black Health programme.

In addition to the regular public health curriculum, the 10 to 15 students will follow a programme that includes six courses devoted to black public health, including ones on the socio-historical context of black health, chronic diseases and reproductive health and decolonising theory and method.

“A masters in public health in the field of black health is needed,” says Timothy, who proposed the programme in 2021, “because of how the experience of anti-black racism impacts black health. There’s a correlation between what I call ‘anti-black violence’ and black health outcomes.

“If we’re looking at factors such as higher diabetes rates, higher cancer rates, higher HIV rates and who has been impacted by COVID more, we see there’s a direct correlation with health outcomes and anti-black racism and violence.”

The fight for race-based data

In designing the programme, Timothy has, in large measure, drawn on her 30 years of being a public health practitioner because unlike, for example, the United States, Canada does not routinely collect race-based medical data.

“There are only two million of us, and most of us are located in Toronto, Montreal with smaller populations in Alberta. There’s this kind of notion that we don’t exist.

“We are a smaller population, we are absorbed,” Timothy told University World News, nodding to the fact that blacks account for only 3.5% of the Canadian population, while in the US blacks account for 13.4% and in states like Mississippi, Louisiana and Georgia blacks account for more than 30% of the population. “We’ve been fighting to get raced-based data,” Timothy says.

After we spoke, she e-mailed me an April 2020 letter sent to the Ontario government that called for the collection of socio-economic and race-based health data.

A total of 192 community-based health and advocacy groups and 1,612 individuals signed the letter, which underscored that “Ontario, like other provinces and territories in Canada, continues to deal with the ongoing legacies of colonisation, structural inequality and systemic racism. Responding to COVID-19 with the expectation that all people will experience the pandemic in the same way hurts the already marginalised people and communities.”

When I asked how health outcomes for blacks, who, as in the US and the United Kingdom, are disproportionately poor, differ from poor whites, Timothy noted that there is evidence that shows that in terms of HIV the black community is more impacted.

Further, she pointed to a 2015 study and one she has been working on dealing with COVID rates for two years. The 2015 study showed that in Montreal the maternal morbidity of blacks was three to four times higher than it was for whites. (Because of Canada’s universal medical system, this difference cannot be attributed to lack of access to medical care.)

“I’ve been collecting data on COVID among blacks for two years. If you look at these COVID numbers from the UK, the United States and Canada, we see the similarities in terms of how COVID has disproportionately impacted folks of African ancestry,” says Timothy.

As the students will begin learning next year in the socio-historical course, Timothy told me, this fact, as well as the higher rates of diabetes, HIV and other diseases among blacks in the US, UK and Africa, must be handled extremely carefully. This is because of the long history, going back to the early 1800s, of racialist biological determinism.

“The connection between African folks [ie, those in Africa or the diaspora] and these disorders is not biological, not as explained by the ‘biological determinist perspective’, but rather from the impact of racism and colonisation globally for black folks.

“It’s not about being black. It’s about anti-black racism and experiencing anti-black violence. It’s about the implications of that extreme grief, trauma, violence that you experience as a black person anywhere you travel. It’s about a lifetime of being treated that way that impacts our mental and physical health no matter where you are, even if you come from the African continent.”

Critiquing Eurocentric methodologies

By training Timothy is a ‘methodologist’. Accordingly, I asked her how the methodology course she is presently designing differs from a traditional methodology course. The answer does not lie in ignoring traditional methodology.

Quite the opposite, the course examines the Eurocentric history of research methodologies – in order to critique them. One notorious so-called methodology was that used by George Gliddon (b 1809) and Josiah C Nott (b 1804) in their Indigenous Races of the Earth (1857) in which, via measurements of skulls and other pseudo-scientific methods akin to phrenology, they adduced a hierarchy of brain development that placed blacks between Caucasians and chimpanzees in terms of intelligence.

As well, students will learn about the horrid Tuskegee experiment in the US. In 1932, 400 black men, impoverished sharecroppers in Macon County, Alabama, were infected with syphilis to “observe the natural history of untreated syphilis”.

None was given penicillin after its invention in 1947. By 1972 when the study ended, 128 of the men had died either from syphilis or complications arising from it. Forty of the men’s wives had been infected and 19 children had been born with congenital syphilis. The violation of ethical norms and the human cost of the study is one of the reasons why many African Americans are vaccine hesitant.

The students in the programme will learn of the importance of looking at factors such as race, racism, class, gender, gender identity and sexual orientation when they collect data.

By way of example, Timothy turned our discussion to how she would approach a study of post-partum depression among black women.

Noting the influence of Black Feminist Theory, she said, she would begin with such questions as, “How does the impact of anti-black racism impact the subject you want to inquire about? Does the question make sense to the population being studied?” An equally important question is, “How will the data from this study be used to advance the health care of black women?”

While white women also experience post-partum depression, Timothy notes, they are not burdened by the socio-historical narrative that burdens black women – a narrative that is informed by the experience of global African enslavement that violently forced black women, who had just given birth, back to work on the cotton, sugar and coffee plantations, often within hours of giving birth.

Further, because of the sundering of the black family during slavery and continued disruption of it because of the high incarceration levels of black males (which is part of the ongoing anti-black violence Timothy refers to), black women have historically been seen as the rock upon which the family relies.

“This false notion of the strong black woman is of one who is not human. We are not given human qualities. We are not allowed to be vulnerable or human.”

The violence of the state

Yet, there is a second piece of the violence that is part of this stereotype. “It is the imagining of the violence of the state. It comes from the reality that you don’t have the right to be depressed or emotional because if you are a black person who is, there is a chance that your children will be taken away from you.”

(Timothy, who comes from a working-class background, holds a PhD and has worked in public health for decades and is now at the University of Toronto, exemplified this last point by telling me that when she has to bring her children to the doctor, they are dressed up. “You’d think we were going to church. But I do this because we are racially profiled on a daily basis, even in terms of our children.”)

Timothy’s students will also learn how the experience of being a black male in Canada contributes to diabetes and cardiovascular problems such as high blood pressure.

“The question students will have to ask is how criminalisation (or the threat of it) and anti-black violence by the state contribute to these diseases in black men. The inquiry will show that no matter what their socio-economic status is, where they work or live, black men know that they are profiled on a daily basis and this creates anxiety, higher blood sugar levels and high blood pressure.”

Public health practitioners who provide health care to black men must be aware not only of the effects of being hypervigilant but also of the depression these men carry, of the intergenerational transfer of post-traumatic stress disorder and how systems of enslavement and colonisation violated black men’s masculinity, says Timothy. The heightened tension of being black in Canada does not vanish even when home.

“Your home is never really safe because you are never sure when the police are going to come in the door,” she says, referring to, among others, D’Andre Campbell, a 26-year-old immigrant with mental health issues, who was shot in his home by a constable belonging to the Peel Regional Police (near Toronto) after he had been tasered and was already on the ground.

Professor Akwatu Khenti, who teaches courses on the public health implications of anti-black racism and the criminal justice system, told University Affairs in late August that there is “a lot of epistemic violence that takes place as a sort of intellectual microaggression [that] devalues or invalidates other ways of knowing. For me, it means building appreciation for the epistemic approaches of different groups and [giving] more space to traditional wisdom that worked for thousands of years.”

Inoculation for smallpox, for example, was practised in Ethiopia and West Africa a century or more before Edward Jenner noticed that milk maids with cow pox scars appeared to be immune to smallpox. The first inoculation in America was in 1721 by Puritan minister Cotton Mather, who learned of the practice from his slave Onesimus, who had been kidnapped from Africa and whose Latin name meant useful, helpful or, tellingly, profitable.

Dismantling a system

Since the beginning of the COVID-19 pandemic two-and-a-half years ago, doctors and public health practitioners have been uncharacteristically vocal for the most part, advocating for masking, the safety of vaccines and for improving ventilation in schools before they re-opened. Timothy views the role of graduates of the Master of Public Health in Black Health programme to be similarly engaged.

“I know that I’m teaching at the University of Toronto. I’m very aware that this education system has a history of colonial violence. Yet, we are going to train people in terms of how to resist anti-black racism and other forms of violence. We’re creating a place where we create practitioners who know how the system works and, therefore, understand how to begin dismantling it.

“Obviously, we are not going to do that tomorrow. But we can begin the conversation about how being a public health practitioner is to be part of a decolonising process. It’s part of a movement towards justice, to dismantle systems that create violence.”