Taking a systems-thinking approach to anti-Black racism

A group of Schulich Medicine & Dentistry alumni have authored a thorough roadmap for institutions, government and policy-makers to follow in order to implement a systems-thinking approach to address anti-Black racism in Ontario.

The report entitled, "The Urgent Need for a Systems-Thinking Approach to Address Anti-Black Racism in Ontario: A Call to Action for Decision Makers and Policy Makers," includes a systems analysis looking at racism in education, social and economic systems, the justice system and health, as well as calls to action.

After the death of George Floyd, Mofiyinfoluwa (Dami) Lawal was frustrated and outraged. "I knew that this wasn't the first time that someone had been killed or hurt because they were Black, and unfortunately, it wasn't going to be the last," she said.

Lawal says she wanted to turn this frustration into something that would move the cause forward. She and a team of fellow students and alumni who co-authored the report wanted to ensure that it didn't only highlight the inequities, but also had a solutions-focused approach, with clear calls to action.

"We tried to seek out ways to move beyond outrage to action," she said.

Since her family's emigration from Nigeria to Canada, Lawal says she has observed the micro and macro factors that intersect to produce systemic racial disparities.

"These drivers have worked to endorse a cycle of poverty that has disproportionately marginalized Black communities, reinforcing a system not built for us and exposing us to inescapable hardships," she writes in the report's Preface.

Lawal began work on the report in the summer of 2020 when her intended capstone placement in Uganda as part of the Master of Management of Applied Science (MMASc) in Global Health Systems was canceled because of pandemic travel restrictions. Instead, she and a group of more than a dozen MMASc and Master of Public Health (MPH) students took virtual internship placements as Research Analysts at the Public Health Consultancy Firm ETIO, founded by Schulich Medicine & Dentistry alumni Mark Gera, Ian Hanny, and Dr. Nitin Mohan.

Working on projects of passion

EITO's mission is to promote evidence-informed, upstream, public health solutions, and they encouraged Lawal and her colleagues to work on projects of passion.

"We wanted current and future students to realize that they have the power to combine their passion with the knowledge they get on campus to enact change in the community in a meaningful way," said Mohan.

The report looks at anti-Black racism from the lens of public health, recognizing that education, the justice system, social systems and health are all intertwined.

"Where you work influences where you live, the education you get, and your representation in the justice system, which all affect your health, and they impact each other interchangeably," said Lawal. "This report was needed to offer that systems-thinking approach, and actual actionable steps to dismantle structural racism in Ontario."

The backdrop of the COVID-19 pandemic also brought to the fore many of the inequities that Black people face. Mohan says many Black people hold jobs as essential workers who are being asked to hold up the economy during the pandemic without paid sick leave. The report also highlights that one of the early key indicators for COVID-19 was bluing of the face and lips—a symptom that is extremely hard to identify on Black skin.

The report calls for changes in the health care system that would include increased research into the diagnosis of disease for Black people, the development and implementation of anti-racism and anti-oppression policies across the health sector and incorporating cultural competency and safety as a requirement in medical school training. The report includes similar calls to action focused specifically on addressing systemic racism in education, social and economic systems and the justice system.

While they focused their efforts specifically on Ontario for the purposes of this report, the action items were designed to be scalable so they could be used by other provinces or on a national level as well.

"At the end of the day, we want to keep the conversation going about anti-Black racism as a public health crisis," said Lawal. "Even if these calls to action aren't implemented right away, we want to get people thinking about how to make change."

ETIO also reached out to Public Health Insights (PHI) for their expertise and collaboration on the report. PHI is a public health communications and knowledge translation organization also founded by Schulich Medicine & Dentistry alumni, that runs a weekly roundtable podcast. The team at PHI collaborated on putting the report together, and also featured the report as part of their podcast.

"PHI was inspired to actively pursue opportunities to advocate for policies and programs that tackle systemic challenges which impact public health and global health," said Gordon Thane, MPH'19. "We were pleased to use our expertise to synthesize the report and disseminate it through podcasting."