Should we routinely collect data on race? Canada at a crossroads
By: Arjumand Siddiqi
As a health researcher, I know that one of the most consistent findings on health outcomes is that, on average, members of racial minority groups have poorer health status than whites. This hallmark pattern is largely based on the United States. In Canada, the story is less clear. More importantly, it is a story that Canadian society makes far more difficult to tell.
Data from the United States is clear. Why are there racial inequities in health? It’s not genes. The human genome project has taught us racial groups are not genetically distinct from each other. It’s not even culture. Cultures blend and vary across time and place in ways that don’t match up to racial groups either.
The science is unambiguous. Racial groups have different health status because some face more discrimination than others and, discrimination has major consequences for the wear and tear that our bodies experience throughout the course of life.
Part of this is because of the more well-known problems that United States racial minorities face in gaining access to adequate employment, income, and other resources that provide access to healthy everyday living – good housing, good food, good working conditions, and good amounts of leisure activity. In Canada, look no further for corroboration than the experimental work of economist Philip Oreopolous, whose randomized trial set in Toronto demonstrated that, all else equal, ethnic-sounding names on resumes resulted in fewer call-backs for real-life interviews than English-sounding names.
United States data suggest that there are also more ‘direct’ effects of discrimination on health. The issue is that discrimination is a chronic stressor. Biological and social scientists have come to understand and document that it is the small-but-commonplace experiences of being treated unfairly or with indignity — aptly termed ‘microagressions’ — that trigger the body to respond as it would with an unpleasant work environment, a hectic commute, or any other chronic source of stress. This response is varied, including everything from increased blood pressure to a desire to self-comfort through food, narcotics, and in turn, these are the primary reasons for sickness and death in our society.
Recently, stark examples of microagressions against racial minorities in Canada have made the front pages of newspapers. Toronto Life reported on the practice of carding in Toronto and surrounding areas, whereby black men are being stopped for police questioning with no prior cause at a pace that vastly outstrips the proportion of black males in the area. Of course, such instances have been lurking since long before even the founding of our nation.
Despite the Canadian notion that somehow we have a moral superiority that protects us from many of the problems of racism that plague our southern neighbours, there is every reason to believe that we are not immune.
It may be that our story is different than that of the United States, but there’s the problem. As it stands, we simply cannot tell our own story, not nearly as well as we must.
How big are racial health inequities in Canada and what are the processes that lead to these inequities? The answer, unfortunately, is that we simply don’t have the data to say.
Unlike the United States, the issue of routinely collecting data on race is a thorny one. Although, for example, the Ontario Human Rights Code permits the collection of race-based data (provided that the data is used to address systemic barriers, historical disadvantage and promote equality), race-based questions are simply not asked. Public institutions — like schools, hospitals and social service providers — do not methodically collect race-based data. Many national surveys ask respondents to indicate what ‘cultural or racial background’ from which they come, but this question does not map cleanly onto our social notions of race. For instance, ‘Latin American’ is juxtaposed with ‘white’ and ‘black’ when, Latin Americans are racially diverse, including both whites and blacks, and accordingly are likely to encounter discrimination at very different rates and of different types.
It is unclear why Canadians find it uncomfortable to systematically document the racial groups that we seem to readily identify as we go about our daily lives. Perhaps we assume that something about being Canadian makes us inherently not racist. After all, we are the land of universal health care, and one that has at least entered a dialogue on universal child care. It couldn’t possibly be that we systematically disadvantage people based on race. Our shameful record on Aboriginal economic and social well-being and the difficulties faced by immigrants demonstrates that we hold no immunity against discrimination at all.
Parts of the story are beginning to leak out. Using survey data, several Canadian researchers, including my team and I, have begun to document racial inequities in health in Canada. In the most complete analysis to date — ten years of Canadian Community Health Survey data — our preliminary findings show large racial health inequities in our society. Not surprisingly, Aboriginals experience many of the largest health disadvantages. However, in some cases, health inequities for other racial groups are even larger. For instance, the black/white inequity in hypertension is larger than that for all other racial groups.
In many cases, these inequities are smaller than the commensurate inequities found in the United States, but in some cases, Canada has a much worse record than that of its southern neighbour. For instance, inequity in obesity between Aboriginals and whites is far larger in Canada than the same inequity in the United States.
As a public health researcher with one foot in Canada and one in the United States, I can tell you that these results are not surprising. Since the mid 1990s, the generosity of the social safety net and the lower levels of income inequality that once created a Canadian health advantage have taken rather drastic turns for the worse. As Toronto Public Health recently reported, despite programs for low-income Torontonians, income-based health inequities have only risen in Toronto over the past decade. Indeed, such programs simply can’t overcome the precariousness of employment, decline in wages, and rise in prices that are being felt by families everywhere.
What the data are beginning to suggest is that, because of discrimination, racial minority groups in Canada are differentially experiencing these economic shocks in addition to the everyday insults and combined, it is taking a toll on their well-being. All signs underline the need for governments provide critical economic resources as the best possible chance we to tackle these issues. People need opportunities for secure employment and adequate income. Communities need resources in order to reduce the power differentials that underlie discrimination.
But we need more information to understand what is happening in our society, and what we need to do next. Put crudely, we need to get over it, and start thoughtfully collecting information about race in every facet of life that influences our access, opportunities and our health — from our educational system, to our banking and lending institutions, to our medical system. Until then, Canadians will continue to have trouble telling our story, learning the true nature of the problems our fellow Canadians face and, the solutions in which we all must participate.
I am optimistic. I think we are becoming more sensitized to the need to provide everyone with opportunities for healthy living and to collect good data in order to do so. Moments in history have produced policy proposals of guaranteed employment and debates about living wages loom present.
As citizens, we can make this happen. This election, I urge all citizens to think about how their votes can move Canada towards a society that supports all members in a way that is equal and inclusive and, to reflect on the need to know what is happening to vulnerable groups in our society and what we must do to protect them.
Register today for Racial Justice Matters: Advocating for Racial Health Equity, the 8th Annual DLSPH Student-led Conference, which will foster discussion to get us all closer towards achieving racial health equity in Canada.
Arjumand Siddiqi is an Associate Professor at the Dalla Lana School of Public Health and Adjunct Assistant Professor at the University of North Carolina, Chapel Hill. Dr. Siddiqi is interested in the role that societal conditions play in shaping inequities in population health and human development. In particular, her research compares health inequities in Canada versus the United States to understand the consequences of social welfare policies for inequalities in health and developmental outcomes.
Top photo by Lesley Tarasoff, DLSPH PhD Candidate in the Social and Behavioural Health Sciences Division.