Hello everyone um welcome to our Nesta talks to event we're very excited to have you here today um so today we're going to be looking at how racism impacts our health with Dr Onye.

So um i am Parita Doshi the deputy director for our healthy life mission at nesta um and we're delighted to be joined today with Dr Onye Norm who's actually joining from canada so she's gotten up very early to be with us here today um who i will give you a little bit of a brief overview too and she'll also tell us a little bit more about herself. um dr Nnorom is a family doctor and public health specialist um her work focuses on health equity and how racism impacts our health and in particular and on anti-black racism as a driver of these inequities in canada. so she's really passionate about this subject um um having experienced kind of racism herself at a very young age but she also wears lots of different hats so she works at the university of toronto she's the black health theme lead the edi lead the associate program director of public health and preventative medicine presidency program she is also the president of the black physicians association of ontario a clinical consultant on addiction mental health and also the host of a wonderful podcast which you should all check out after this if you've not already called race health and happiness so thank you for joining us today um dr nnorom i will just start first by giving a little bit of an overview of the structure of the session for for the audience um and then give a bit of an intro into kind of why we picked this topic at nesta and then we'll really be hearing a lot more from you uh in in terms of um you know exploring this topic together so we'll talk a little bit about um give the the kind of structure will be we'll do a bit of an intro from yourself for about five minutes uh we'll have 20 minutes of questions where i can kind of ask a few of the questions and we can have a conversation um we will then move over to you the audience for um 20 to 25 minutes of questions uh so please do enter your questions into the chat um we will be kind of looking at those and picking up on some of those so we really want this to be a kind of collaborative discussion so um please do enter that in and also let us know where you're calling in from um it's always really nice to hear who you are who we've got in this virtual room and where you're calling from so please i encourage you to kind of um to connect with that so that's just a little bit of the housekeeping um i will tell you a bit about nesta and why we've picked this topic and then i promise you i will hand you over um to dr Nnorom but um so at nesta we've got a healthy life mission um and our mission is to increase the number average number of healthy years lived in the uk while narrowing health inequalities um and the kind of two areas that we're focusing more of our work on is around one is around promoting healthy eating and reducing obesity and the second is around loneliness and both of these areas um contribute to some of the greatest losses of healthy life in the uk and also more broadly in other parts of the world but we also know that there's a disproportionate impact of this ill health on different groups including kind of different ethnicities and just to kind of tell you a little bit more about the picture in the uk in terms of obesity black adults are um were kind of the about 68 of black adults who are overweight or obese um in the uk versus 63 on average um so there's kind of a higher higher kind of incidence there but also just more generally across different ethnicities we've had some research in uk with nearly 1.4 million um over 55s and it showed that belonging to certain ethnic minority groups is equivalent to being 20 years older than your actual age um and you know this is accompanied by let's say long-term conditions or multi-morbidity it could be due to poor experiences of primary care insufficient support from local services low patient con self-confidence lots of different factors which you know dr Nnorom will talk us through a lot more and we'll be able to shed more light on how we can kind of improve upon but um you know there is this impact and with with covid it's really clear to all of us that you know some the the kind of disparities that some groups have up to five times greater chance of dying from covert than other groups so um you know we we want to understand this and we want to be able to improve this and create a more equitable kind of healthcare system and and kind of happier lives but for all of us um and at nesta really our mission is to design test and scale solutions around this and really try and bring in that inclusion as what we do so i'm very excited to have you with us today to talk about that um so i'm going to start just really by asking you doctor to give a bit of a five minute intro to yourself and your work um i know i i gave a little bit of a snapshot but yeah i would love to hear more directly from you yes thank you so much for having me um and so yeah so my work really focuses on the the impacts of racism and different forms of inequities so i do look beyond issues of racism itself but uh you know uh poverty and other marginalized groups that type of thing but um over here in canada we have a specialty of medicine called public health and preventive medicine uh many of us in this field are also family doctors at the same time so we're double certified and basically i as you mentioned i hold a number of hats but um it's largely involved doing uh clinical work um in black communities and looking at uh you know cancer prevention chronic disease prevention and looking at methods that work and then we might publish on it we don't even publish on everything it's actually about doing the doing and having an impact that is my passion not so much uh the research but we do publish um you know whenever possible another piece of my work is um training physicians who enter uh the field of public health and preventive medicine so some of them do become medical uh officers of health or medical health officers i believe you folks have uh similar roles in the uk although it can be held by non-physicians i think in the uk in canada it's only held by physicians um and then um quite a bit of my other work really focuses on black health specifically as the black healthy lead for the medical school and teaching around uh issues of black health and having people understand that the disparities that they either see or have learned about or might be hearing that are happening in the us or the uk basically the western world um in in general uh are are due to as systemic racism and when we're talking about the black population then you know specifically anti-black racism uh but broadly talking about how that impacts people's health uh physiologically uh you know as far as mental health and things like that and i would have to say that you know i think prior to the pandemic and prior to the unfortunate murder uh public murder of george floyd and the uprising um around black lives matter and activism across the globe that occurred prior to that prior to 2020 i think a lot of people struggled to understand how racism impacted health um either people thought that disparities like what you're describing obesity or diabetes i think most people are aware of racial disparities across the uk the us uh we don't have great data in canada but overall we know they're here in canada and thought these to be biological differences which fits within that racist construct that black and other racialized groups are somehow genetically inferior so it's kind of like well that was just meant to be and all of you were dying and it was you know determined by god um i think the the the coven 19 pandemic and the the advocacy made people really pay attention to this this issue and understand that it's it's social factors that it's not a matter of genetics per se but it actually is um the social conditions in which we live and the fact that we live in societies where uh your race determines so much of your outcome creates an extra layer of stress right we know living in the u.s the uk canada that's stressful life is stressful but an extra layer of stress that leads to premature uh conditions and premature death uh within within populations um and so i think that has actually made it much easier to have these conversations because i think people are seeing how that really plays out concretely uh in real life so so that's my work but i would say in the in the last couple of years unfortunately we've been in a pandemic for a couple of years um this issue has become much more apparent and and i love that we're meeting today because not only do we get to talk about the issue but also explore solutions sad yeah thank you so much and um yeah uh totally resonate with much of what you've got you just kind of kick us off um maybe we'll start understanding the problem a little bit more from your perspective and then we can maybe start looking at some of those solutions that you that you said that we can talk about but you know could you just paint a bit of a bit more of a picture for us on like what does that systemic inequity and inequality look like within the healthcare system um yeah okay so uh well there's two parts to that because our health outcomes are not actually determined by the healthcare system the healthcare system is like the mechanic where we go to get things fixed when something's already gone wrong right so our health is actually determined by the social determinants of health where we live where we work where we play how we gather how we eat all of those things um and so it's more of our social condition actually that determines our health and then we enter health care to seek um you know uh care when when um care is not optimal and so if we're going to talk about our society and social systems we have to talk about how racism as a structure so when i talk about racism or when those of us who work in this field we're not talking about so much the interpersonal racism that's part of it how one person treats or or behaves to another person but we more describe that as a symptom of a greater disease and that's the structural racism and that's how our policies our practices our our work cultures our society's culture continues over time and you'll see it in in you know again us uk canada for example uh to systematically disadvantage certain groups and systematically advantage right certain groups particularly people of white european descent end up being experiencing privilege and better outcomes over and over and that recreates itself and you tend to see other groups and i'll focus on blacks but certainly racialized groups um experiencing disparities over and over so you know health care you mentioned health care is just one system but whether we're talking about the judicial system the educational system because um as uh one of our scholars here dr kwan mckenzie um and he worked in the uk as well describes it's an ecological phenomenon right so this structural racism is everywhere because it was built into the system unless you're actively doing something to undo it it's just there right and it just continues to recreate itself you don't have to um intentionally go out and and uh act on it it's already built into the system so so where you have that then we talk about what are the health impacts of that how does that play out so what that means is that um again in these these you know in these countries what we see is that poverty is racialized and in in capitalist countries of course uh income or poverty is a the greatest social determinant of health right so we talk about race but rate poverty is racialized so you be if you're racialized you're more likely to be poor and that is likely to impact your health but then there's also just the legacy of stereotypes about our different groups that also play out in ability to get jobs what happens in the classroom how the police make decisions all of those things when you walk into healthcare and you say i'm experiencing you know particularly as a black woman you know i had two children right like i'm experiencing pain i'm pregnant and not being completely uh um underestimated right because of the stereotype that comes through slavery that black people have a higher pain threshold um or that women are histrionic you put both of those together around anti-black racism and then gender assumptions um about about pain and and people overreacting and you end up with a pattern where you know black women have much uh worse outcomes uh during uh childbirth and pregnancy um so there's all of these different ways in which the stereotypes uh also play out and result in poorer outcomes but the way that i kind of concretely say so these these experiences of these barriers and these daily indignities the microaggressions all of that it happens on on kind of two levels and i would say it might be similar in the uk um and canada more so than the us because of of immigrant populations being more uh likely to be racialized so what you will see is that for groups that are aware so let's say you're you're born in the uk or you're born in canada you grow up here you've been racialized from the beginning you enter the classroom you're racialized from the beginning you're labeled assumptions made about you you've internalized that you're you're experiencing it it's a form of trauma right it's a form of trauma i i've experienced even with white colleagues just calling them white people they feel it's jarring let alone that happening to a young child right you've been labeled and so it's an it's an extra layer of stress and as this happens over and over and over again where were you born what are your credentials what you know what i mean like all of these things those constant um indignities then result in people having a number of different mental health issues sometimes depression anxiety um you know cops go by you're you're you know please go by and you're you're hyper vigilant right almost like a ptsd um trying to cope with that stress with overeating or drugs or alcohol or just the everyday stress of racism is not going to have you go for a jog or have a salad like you're gonna have that hamburger and go to sleep right so it's going to affect your habits and that's going to lead to poorer health outcomes it's also going to make you more hesitant to seek health care it's also going to make you have a distrust of a vaccine where government says your group is a priority your group has never been a priority before but now that we have this thing to inject into your body you're a priority so all of that will result in poor health outcomes because you're aware of the systemic racism then we have the kind of general social determinants of health which is more um less prevalent less obvious sometimes to people who've immigrated from a country so now you're perhaps an adult or a teenager you didn't experience racialization as a child and so you actually have a sense of self which is protective um and helpful so you might not be traumatized by all those questions like where are you from or whatever you know the cops go by whatever you know you're happy to be in this new country but what you come to realize is you have to work people say twice as hard i would say often ten times as hard uh in canada a black woman is fifty percent more likely to be overqualified for her job so you're you're it's common with racialized and immigrant communities you're three jobs what you know what whatever you're just sprinting you're not you're too tired for your children you're just doing all of this trying to catch up not always realizing that it's because of your race but that is stress itself so i would say to some of my patients even if you don't know what systemic racism is because some people don't know they think of racism nobody said anything mean but if you don't know what systemic racism is physiologically systemic racism knows you because your your at you have that added stress right that that negative stress um or distress that is happening to you that also impacts your health and you're more likely to be living in poverty if you're not working three times as hard then you're more likely to just be in a lower income job and struggling and can't afford the food you need can't afford you know what whatever your your resources might be for your level of education and so that has an impact on health and i would say the kovid 19 pandemic like compounded all of that because if you're working in a lower income situation you're probably an essential worker um you're probably you know it might be a taxi driver you know or or working in fact like you're you're in jobs where you don't have time off uh paid leave you don't have benefits um you might be living in overcrowded housing like all of the things that covet 19 just loves to hug and take people down with those are probably you know either part of your life or your family's life right and we have to consider the broader context your friends your family because you're racialized um and again that distrust of vaccine that just trusts you know specifically the covenant 19 vaccine all of those then leading to much much worse outcomes you'll see in all three uh countries um in the context of covet 19 so it really amplified everything that had existed previously yeah now i think it's um it's really interesting what you mentioned about like you know whether you've lived in a country and grown up there or whether you've come you know even if you recognize it or not it's it's there's a lot of these you know subconscious things that that kind of happen that actually tangibly make a difference to our our physical and mental health um and i think do you feel like with the pandemic and more of a i guess exposing some of this a little bit more have you seen kind of any shifts either in kind of individuals recognizing it more and being able to kind of i don't know action on it or even institutions or more generally kind of what's been your sense of has there been um also obviously following the blm movements and things have you have you noticed some sorts of of of shifts either either positive or kind of negative um as a result so yes on awareness less so on action which i would have to say i'm gonna be very frank it really did break my heart that i didn't see the level of action i would have imagined like i said i mean i've been doing this work and actually even from elementary school i was one of those kids speaking about racism and appetite right so you know this has been an area that i've spoken about for a long time and and you know done the research and so here in canada there was this myth of the multicultural society and we don't have racism here so that was a barrier that we were trying to overcome and we don't have the kind of data that you folks have so for instance you know i know there you're able to and since the 90s really kind of identified disparities um and the united states had been able to do that for a long time so i think here in canada we kept thinking it had the data and so when uh covet 19 began we really advocated so you know part of the the community groups really advocating for the collection of race-based data um which was quite controversial here and we were able to you know say look you know so it was collected particularly in certain pockets of ontario and i think in manitoba so not right across the country but able to say look black people are um and racialized people are uh disproportionately impacted so now action has to be taken and so there yes there was more awareness especially with the protests and everything that happened but what we saw in canada was really mobilization of resources did not match the the data right like you would think things are data informed as far as decision making so where test kits you know testing not test kits that that came over but just initial testing we saw a similar pattern here in canada than in the united states where um it really went to more affluent areas first um so you know clinics were set up in affluent areas to do uh testing uh for covid19 um when people came from other neighborhoods they were turned away later on uh black and racialized neighborhoods got it but the lineup would then be almost half of the people who are not from those neighborhoods right like that sense that we can't go to your neighborhood but now that we have testing you're you're here um in our neighborhood and we you know generally don't turn people away then when it came to vaccine it was the same thing vaccines were more available in affluent neighborhoods and then just very more more recently um now that we have rapid tests again that happened particularly in ontario so i mean i had always said that the collection of race-based data is necessary but not sufficient for change i had always said that but to see it play out in a pandemic that way over and over and lives lost uh reports here stating that um you know if the deaths that happened in racialized communities had happened in white communities at that rate something would have been done and that's like you know a royal commission report it's like those are real people's lives those are those are moms who are you know personal support workers and nurses and and you know um service workers who died unnecessarily because there wasn't a willingness to basically recognize our humanity because of what we call skin phenotype right like you just happen to have different skin color it's absurd and scary and and saddens me but i still have hope because there still is that awareness and so what many of us who are in the margins who are black and racialized what we've been able to do with this pandemic is mobilize some resources and engage in clinics and outreach uh that has made a difference and so i don't know that that would have happened outside of the pandemic of groups realizing okay we need to give you folks some some resources to go out in community and make an impact um so that gives me hope but um but the i would have expected a greater or wanted a greater shift that would have actually saved lives um internationally really if that lens had been used yeah yeah no um totally share that um you know my family lives in kenya and i think just i was spent quite many months in uh their last year and i think just seeing even the access to vaccines the difference in the uk had been there versus you know in in a different country and i think as you say like there's there's just so many examples that we've all kind of experienced um i felt as a result of this pandemic that you know hopefully i i share that hope that you know that awareness is a starting point and we can really build on that and and work together to kind of mobilize mobilize that change so kind of looking to some of the work that you've done or you've seen or thinking about how we can um you know like move this forward um what might be some of these kind of anti-racist approaches or or or changes that that you feel we should be making what are some of the top things kind of on your mind that we can do in order to kind of start shifting shifting that balance and and and bringing more equity um to things yeah so i think there's a number of things that can be done and you know i would um i think there was a comment earlier for literature so there's a really great article um actually from the uk um and the british medical journal uncovered 19 and racism um uh i think it was january 2021 that um i think it's muhammad assad but really great kind of policy recommendations uh there i know there was a great bbc documentary on um wyskovid um killing people of color like those you know there's all of those pieces that i would actually recommend people look at but nonetheless i think that um there's kind of two areas like we talked about health and health care so broadly for health if we want to like have an impact on health then you're thinking about the social issues so that becomes you know a matter of uh policy and how people vote and thinking about more um you know equitable approaches to you know education system judicial system uh healthcare system all of that so there's the big pieces and looking at that and how you vote nobody ever wants to say how you vote but that is health period but if you want to kind of zoom in concretely on health care then it becomes looking at leadership honestly right even where i say we've been able to make uh advances with regards to um you know mobilizing resources and working in the community we've had different public health leaders here in ontario who some um i'm not gonna get specific name names but you know we're just like you know we don't need to collect race-based data and racism is not an issue versus oh no this is an issue let's make sure this happens so i think there is that need to make sure um with regards to leadership that they have either that anti-oppression training or um understand these issues or have that embedded in the leadership and so to have that those voices you really need um diversity there and i know um with nesta talks to you folks had a video recently with you know um i can't remember the name of the company but you know women really kind of offering entrepreneurship and other opportunities to diverse groups right um and saying like if we're gonna solve the problems of the future um you know the problems of the future involve all of us and so all of us have to be part of the solutions um so you do need that you need these voices at the table and i'll give you a concrete example at the beginning of the pandemic here so for us it started in um basically like we were about to go into lockdown in march 2020. uh for us here and i think it was happening internationally there was this rhetoric around uh kovan 19 being the great equalizer our black community leaders published a a commentary or or a position statement saying it is not the great equalizer and in fact black and racialized communities are going to be disproportionately impacted uh particularly racialized women working again like as psw's and all of these different service uh physicians are going to be disproportionately impacted and it's going to devastate our communities we need collection of race-based data and we need a different approach they release that april 2nd so we just as soon as we went into lockdown they're writing this it goes out april 2nd 2020. nobody paid attention to it because you're not at the table i'm not at the table you know what i mean like none of us who are racialized or or have our you know our finger on the pulse of what's happening on the ground at the table and so lots of time went by and was wasted and lives were wasted because our voices are not you know equally heard and our val and our lives are not equally valued is really what it comes down to had those um you know those leaders been able to be at the tables i think their approaches and their innovative um lens would have helped with a lot of the problem solving that we all just went down hill uh with because it was only people of privilege who can't see everything that um that is happening on the ground it's not their lived experience it's in fact not their fault but it's it's having the self-awareness to know as a person of privilege particularly if you're a white cisgender christian middle class male all of your many blind spots and being able to address a diverse community and so we ended up in a disaster um and so that is really necessary to have those voices at the table it's also necessary that we move away from just looking at the western medical model and so for us again another concrete example prior to the pandemic i worked at a community health center called taibu community health center it has a mandate to serve the black community in the greater toronto area as well as the very diverse community so um you know uh our south asian communities our indigenous groups so just very very diverse community in that area um and what we would have is we would have you know people come in i i had patients come in who had diabetes hypertension all of these things but we had uh dietitians who are from diverse backgrounds who could like have the cultural dexterity to like change up the recipes so that they were heart healthy create community so there's a community kitchen and everybody would come together of diverse you know backgrounds and try to cook you know the new hearth healthy meal right sometimes it wasn't so great tasting but other times it was fantastic and people would go home and and cook that with their families but just that sense of togetherness there would be laughter yoga there would be african dance there would be all of these things and i saw people get better i mainly was involved in d prescribing i was reducing their medications because they were getting better not just getting better with regards to diabetes and hypertension but even chronic pain because they came together and then you know um in what we call the spirit of ubuntu i am because we are and then we applied that to cancer screening and we saw you know we had cancer screening rates very low people weren't you know um were hesitant to to get their cancer screening um for you know mammography pap test all of that we asked them we listened we said what are the issues what are you worried about non-judgmental because it's that i am because we are that village model um based on that we addressed their concerns and we tripled our mammography rates we you know um increased also tripled colon cancer screening um and then we did the same thing with flu vaccine and so when covet 19 hit we said let's use the same afrocentric model so where we have clinics we um for the black physicians association of ontario we collaborate with black community organizations that have trust we tell we still work with the hospitals in public health but we explained to them that it's the legacy of anti-black racism mistreatment or just being ignored and neglected that has impacted trust so they need to do better that they can come with us and learn and then we come together and so we're able to you know have a vaccine clinic where there's music and there's food and there's things for your children and this was even before we were vaccinating children because we care about you as a person it's not just about the vaccine and if you don't want the vaccine it's okay because i still care about you we love you we want to embrace you we're going to talk about it and you can go home and think about it and then you know i'm going to look you in the eye unlike some of the other vaccine clinics and i'm going to ask you how are you i'm going to answer questions give you the vaccine and celebrate you oh great you and tell you yes you got your vaccine we celebrate you and you go home and you tell your family about it and we wish you well and you know people started to call that public health 2.0 but what what that was was combining the western lens with an afrocentric lens and as i answer this question i also want to give uh uh credit and and respect to our indigenous communities um because it's their model around cultural safety about that humility of listening and how they set up their clinics that they joined with us in solidarity for the design of our clinics so it's a concept called two wide seeing and i think that also um can address your question as well the concept of two i see is um comes from an indigenous nation here called the mikma and it's really seeing the best of the western world and the best of indigenous approaches and combining the two i would say for us coming from an atrocentric model it was almost like hg you know what i mean because we boiled from indigenous uh ways of knowing uh western approaches and then our own afrocentric approaches but it's bringing those values and not assuming that the western approach is superior because it's actually not working for a lot of people but it doesn't need to be thrown out you know throw the baby out with the bathwater it's bringing all these things in and so it's really all of that if you're able i've seen it you know what i mean as far as improving health outcomes but it requires a real shift in thinking because uh medicine is a very colonial way of thinking of uh it's it's patriarchal the male is superior the the european way is superior so i think it's really opening our minds to the beauty and the the ingenuity that exists um within other cultures and other voices um and so so yeah so i think it's a combination of those things that you would actually see i think healthcare improve right you i am because we are if you come to my clinic and i can see your humanity and i recognize my own why won't we find a way to be well yeah i love that um yeah i think so much of that i think is such such important points around like that leadership point that you make the the kind of the two-eyed seeing we've got this um phrasing from my culture um called anikanthwad which is around like seeing things from multiple perspectives and i think you know kind of really um kind of made me think of that and i think both within my own community of the south asian community but also kind of learning about what's been happening in the uk around the vaccines as well i think there's there's been some some positive shifts in the way of trying to over time realize you know we need to have different ways of engaging with different people and get them involved in that and that really kind of participatory approach just is is is kind of yeah yields yields kind of more um inclusive and more impactful results a lot of the time so um thank you for sharing uh so many examples and um and and things around that i'm conscious that i want to give enough time for the audience to also um ask some questions and um i will there was um i'll start with one that was that was kind of asked ahead of ahead of the sessions um a few people had submitted some questions and i'll also kind of um look at the ones that have been coming through the chat and we can talk through some of those but i do encourage if there's anyone else that's got any kind of burning questions in your mind please do continue to pop them in the chat um i think we've already we've got a lot of kind of nodding along through what you've said uh dr Nnoromlike from anki in uk does not admit that race racism is an issue and this must change um you know a lot a lot kind of resonating that things are similar in the uk so um so yeah just um also kind of how important the topics are that have been raised on leadership and data from from diane so um yeah thank you to those of you in the audience and and keep them coming i'll um ask a question around um which is submitted by uh eve uh riley from the richmond group so um this is my professional interest is in the intersection between people living with multiple long-term health conditions and issues of health equity um so we know there's a big gap in healthy life expectancy when indexed by deprivation and race but um is this widely enough understood i think the the kind of answer that we've had so far is possibly no but should multi-morbidity be more explicitly linked to discrimination and disadvantage with the aim of tackling this inequity so

so yeah so i think with multi-morbidity i think there's actually a lot of studies so that's why yes it is known particularly in the united states i mean i think they've done phenomenal work and a great legacy of doing um equity uh focused work i think sometimes it gets compound confounded because of their uh health care system that in and of itself uh is built in an equitable manner but a really great amount of research done there so with multi-morbidity of course where you have like hypertension and diabetes and hypercholesterolemia and then you might also have mental health issues as well which might be common and and depression and those types of things um again i think that's really the the tip of the iceberg and then when you look deeper to that people are um uh they're they're not able to cope right so there's the concept of weathering where um the everyday racism and everyday stress takes uh a toll over time causing premature aging um but also the the concept of allostatic load so again this extra stress it's not good stress good stress is the kind you can overcome and you feel empowered by but it's a stress of like it's your skin like there's really not very much you can do about your skin and uh the race that you are assumed to be and so um what that what happens over time is your your neuroendocrine system so it's it's your hormone system it's your immune system it's all of these things really end up um being uh impacted negatively over time and so it's going to affect a number of different systems so it's you know it's quite intuitive like if you think about the body holistically it's just different organs that are reacting um to this this constant uh stress and so um i think there needs to be more awareness but i think there needs to be focus on the upstream factors and and again even as you mentioned earlier at purity like when we're thinking about obesity oftentimes these are coping mechanisms so whether we're talking about alcohol drugs high carbohydrate foods and that type of thing these are poor coping mechanisms for a really cruel way that we treat people in society right so we also see increased obesity rates in lower income communities this is not a genetic uh um you know condition this is really a social condition so i think as much as possible yes we need to create awareness around these different conditions but it's it's really about the broader drivers that are causing uh these conditions to be more prevalent in groups that are socially disadvantaged yeah yeah no makes sense great um we've got a question here from kate o'hara um in the chat so um hi i'm a social statistics research student at the university of stirling in scotland what frustrates you about public health research and where do you um think research has missed the mark um i know we've talked a bit about data collection but i'm sure there's some other things as well that you've got there with that with that giggle you've got going on i think this one could take a while but um yeah oh yeah okay i don't even know where to start there's there's so many layers to it um you know so i have a master's in public health um so you know in my training here in canada even just starting off it would be you know being told that first of all in canada i was told by like a panel of of uh older white males and epidemiology and biostatistics at the time so that would have been around 2010 that um that racism was an issue was not an issue here in canada right when i stood up in class to say why aren't we collecting race-based data and they're like no it's not like in the united states and they were very condescending and spoke to me like i was slow as a black woman bringing up these issues in this like uniformly white male or mantle as we call them so so it's the it's the history and legacy of um epidemiology and how it works and and really um

discrediting uh voices that have a different perspective and so those perspectives it becomes even difficult to publish the work because it's still the power is still held by a number of these different groups it's hard to get funding for the study so i know that's the same thing in the us and the uk so there's all of these barriers like first you're gaslighted at the beginning and kind of basically told you're crazy for thinking a problem is a problem so that's going to affect your study the hypothesis that you bring the analyses um if you want to do something different because the way it's conducted is usually problematic with a number of problematic assumptions then you can't get the funding you might not be able to get a you know uh the the right partnerships in place um and then perhaps not even be able to publish but even when it's published it can be ignored um and so it's not necessarily going to create the change that you want um and so those are the challenges but it still needs to be done it just needs to be done in a way that i think is more in line with community organizing activism and anti-oppression work which is that first of all even for the clinics it's that deep listening so listening within the groups that you're working with to really understand the issues you know i was told very early on when i worked at that clinic at taibu um any problems the community is facing the community has the solutions so for all of the work we did we had to do deep listening not that fake listening that we do as researchers and clinicians we're like uh-huh but this is what the grant says but i'm gonna nod my head can you say that we you know consulted with you and then go do the thing and then publish and run away no deep listening and and understanding and then working with groups so yes the publication might go go out to address an issue but now the media is ready to uh work with you the communities are ready to amplify it and you really try to kind of mobilize resources to make that that change so that's the kind of thing that i've done so i think with um that kind of research i think it's again necessary but it's not sufficient it has to be a broad almost like movement to actually uh shift things otherwise it's just a publication that sits in the ivory tower and that just gives me a bit of a rash that type of thing that's all yeah yeah i think something in the chat that uh a social mompreneur mompreneur can i mention we've got enough data in the uk but it appears to get quickly buried um you know who's leading on this in the uk and who has the bank of evidence that we can use in the first instance and and i think that's just kind of highlights that yeah as you say like there's so many layers of of things that need to occur and you might get through one hurdle and then there's another and there's another and and actually just like ensuring that that research has that impact in the real world for real people um is is is is quite challenging but but yeah um can be done so um then i there's another question that came through um earlier from um libby papier at mind um it's a little bit you mentioned kind of some training uh that work that you do as well but it's linked to that how useful is cultural competence training in the context of reducing discrimination experience from services um is structural competence a better way forward and maybe just sharing a little bit more about maybe some of the training work that you do and how you found that that's you know what's really made that work and how is that kind of impacted on on outcomes for people yes so um so for this example i'll think about what we've done um in uh at the university of toronto and um and now more largely across the country with changing policies for increasing the number of black medical students across the country um because policy work does take a long time and so it's you know there's things that we're advocating for now but i can't kind of um uh you know claim victory probably until another one or two years so there's things we're working on now but that this is something we worked on in the past that we've seen changed so um you know i had mentioned what somebody does or says to another person is a symptom of the greater disease right and the disease is the structural piece so um you know what i i tell my healthcare colleagues is when we think about um training people like bias training and cultural competency training it's important but it's not sufficient either it's it's like you have somebody who has diabetes and you treat their ulcer their ulcer is there because the whole diabetes is out of control the sure you should put dressing on on the ulcer but it is actually unethical to keep doing that if you didn't give the person insulin or or medications or lifestyle changes to actually um get to the root cause of the issue and so no definitely those policies and structural changes that is key otherwise whatever you're training people about will continue to recur people leave organization like whatever is happening you need it to be embedded in policy and you need the right leaders in place to sustain that and you need also probably the right um expertise at the table whether that's an uh edi person and others to be at that table as well as public accountability because even if you have an edi person that person is trying to keep their job or sometimes there's somebody already working there who is forced to do edi and doesn't even have the background so the public accountability becomes key but you have to have the structural change so at u of t we had you know one medical student out of 250 like for years sometimes you know there would be maybe eight or something like that but it wasn't sustainable we advocated uh so by we the black physicians association of ontario we worked with the different institutions um particularly university of toronto to change policies and practices so there's a separate stream that is more culturally safe so it's the same criteria the criteria for entering medical school didn't change but now there's more black uh fall reviewers there's more black interviewers uh black medical students spend time with our black medical student association so it's the same protocol that was used before but it's more culturally safe and there's more representation but it's still diverse follower views while reviewers and diverse interviewers and we went from one to then six 16 and the last few years it's been in the 20s um having you know 20 or more students every year but that came through structural change i don't think that would have just been sustainable with or even occurred with just people having cultural competence training but i could say we did both and i think both are good to have i know some of my colleagues who work in anti-oppression are like forget about the bias training and the cultural competence training just change the policies i actually might what i've seen in my life is um an experience it's actually good to have both give that insulin or metformin and the dietary recommendations and treat that ulcer and keep things moving and and you see good sustainable outcomes yeah yeah no that makes sense great um we've got another question from jenny asking about is there any research on people who suffer from hating on their own race and culture and treat people of their own race worse than caucasian even though they're an ethnic minority themselves

oh dear so this is um internalized racism right and that that is um that is a factor and i don't know that there's research there might be um on on treating other people um poorly but it it happens with any form of oppression so you'll see it you know like that stereotype that women just can't get along but then i've worked in amazing organizations that are run by women and everybody is in solidarity but it's that idea that like of course when you're working for an organization where men hold the power and women have less power then you know you can only be that one woman who sits or gets the raise then you see that kind of tension and women might be more mean to each other than others you see it in lgbtq community you know like you see it in so many communities and it's a symptom of broader oppression and a poor coping way to approach it so i don't know that there is research on that but there is research on two things that are related to that so um where we talk about uh the term called allostatic load so that's where um you can measure indicators in the blood and body indicators of stress and the people who uh work in um environments where they experience racism so they're experiencing the racism but they perhaps hold it in they don't actually address the oppression and perhaps they're oppressing other people but it doesn't speak to that have worse outcomes than those who speak out against oppression and so from people who are suffering and hating on their own race odds are they're not actually addressing the the root you know the root uh cause of the oppression and so they might be suffering in that way and have a higher allostatic load actually and have poorer outcomes the other um uh example is where you internalize things like let's say you're less intelligent um and they look at what's called stereotype threat so you might be trying to disprove that and often people who might be quote unquote hating on their own group are trying to prove that they're better than everybody else and so that also has its own stress where you see um actually sometimes poor performance actually because you're trying so hard to you know overcome that stereotype um and so that's shown in like classrooms and it's not only with race again it's with gender if you tell you know young women do this math test but you know boys do better than girls that do this they actually perform worse because they're so stressed to you know um defeat the stereotype than if you just let them do the exam and didn't tell them that boys did better so so i would say those are two indirect indicators that there probably is that uh suffering occurring um and we also know it in a patriarchal system too that you know men suffer from sexism and and you know the machismo and the the toxic masculinity um even though um you know they they might experience privilege that women don't have um they will suffer too so i i believe it was um you know martin luther king who says you know even where you have a group that is suffering directly um it affects everybody indirectly so certainly for somebody who's having both of those happen at the same time experiencing racism and inflicting it on other people there's going to be a great deal of suffering in fact yeah yeah yeah um so there's an another question that coming from um aladdin previously um and it's we've kind of talked to some of these points but if there's anything else that that kind of you have to share share around it so post blm viewed through an intersectional lens what are we learning which we can apply to collaborations and alliances which feel as if they've been ineffective or are underperforming um post blm was that yeah so kind of we're not post blm black lives matter black peop

no no it's fine i just wanted to kind of point that out because i think language matters and where we tell ourselves we're post blm it's like saying we're post racial these are dangerous things to to plant into our minds right um so so so it's still an issue just not an issue in the media uh i think i think that we have to continue the work that we were doing previously and i think again for a lot of us we didn't have um like we didn't think necessarily the whole world was going to change because that happened but again there was a shift in awareness and we need to keep continue to move forward and i think there's a role for allies to play in supporting uh you know black lives matter and different activist groups advocate groups um in healthcare i'm sure you folks have um black and ethnic minority groups that are advocating for change and so it becomes amplifying those voices amplify it on on social media um amplified in spaces where you know um there isn't as much diversity and say can they come and give a talk and be paid but come and give a talk can we start to move things forward so i think we all have a role in making sure that this stays at the top um of all of our agendas um because we all actually stand to benefit from living in a more just society so i think that work just has to continue yeah yeah um we're nearly getting up but i'm gonna squeeze you in for for another one um so we i know you've talked quite a lot about you know those upstream more like systems systems change and things and things that need to happen around whether that's a judicial or educational or whatever this one's more around kind of pharmaceutical companies so um but um it's a question from leslie from vccp health in terms of how do you think pharmaceutical companies can help combat health inequity and racism um so so yeah i guess in that in that healthcare space yeah so i think um i mean specific to pharmaceutical companies the when we look at the vaccines in particular like the distrust is rooted in a legacy of um human rights violations cruelty and and um really um testing black and other racialized people uh against their will right so so i think there's that legacy to undo that it's building trust and i don't think that's specific to pharmaceutical and companies so for for the black physicians association of ontario our uh work has been uh to advocate educate you know vaccinate and now we're doing rejuvenate but the advocate was really to tell organizations that you do need to do that work of the anti-oppression training look at your strategic plan bring in the right expertise so it's a lot of the same recipe book and then start changing your practices and do that deep listening and it it's deep listening like i said listening to communities and understanding every community has a different history a different context a different reason for having that distrust and it's really important to do that and through that deep listening one um gains trust but um you need all of those pieces and it's not unique actually to to pharmaceutical companies those are the changes that need to happen across the board yeah great all right so just before we close i guess a final kind of reflection from you on you mentioned you know that that you are still hopeful um you would have obviously liked to see more change occur and and things um but you know so tell us a little bit like what makes you what makes you hopeful um you know what makes me hopeful first of all it's just i reflect on my ancestors i reflect you know on those who came before me and their struggles and how they came together in community you know i think this work of resistance like resisting status quo um and trying to maintain one's own health so i know we were talking about how allies but if you're affected then you want to maintain your own health and have that resilience it's a team sport and so what gives me hope is these you know phenomenal moments like i mentioned where we have our vaccine clinics where we do this work in solidarity with so many groups who again are seeing the humanity in ourselves and others and and coming together to problem solve and improve the health of others and for us to also feel fulfilled when we do that and so um those have been the beautiful moments for me of this pandemic that type of coming together like i said that ubuntu i am because we are and i have hope for that i have hope for that to continue um and i think it's much needed in medicine and and in our clinics we had people who were you know differently abled people who are indigenous people who are various backgrounds we have refugees come in because they felt safe in that environment right of course we had our black communities but i think that's the the beauty of it when you can bring all these pieces together and it makes everyone feel more safe and everyone to be well is a beautiful thing and so i hold on to that beauty in times of ugliness um that's part of why i have the podcast race health and happiness it's where it's affecting you as a group you hear all of these things about the toxicity of racism but we're living in it we're immersed in it you're black and racialized i love hearing about the wisdom of those who came before us and how they overcame how we can work in community and overcome and in our day-to-day lives stay resilient and and those truths actually exist they might not be in a study um but let's not engage in that kind of imp epistemic uh injustice where we only look at what's happened in the study but the wisdom that already exists of overcoming and stir thriving and so that that gives me hope wow what a wonderful way to end um this yeah really kind of uh fascinating discussion and also just you sharing so much of your wisdom and passion and enthusiasm and the way that you know you really want to make that change for people i think um it's yeah we kind of commend you on the work that you're doing um thank you so much for for joining us keep up keep up the great work and and hopefully we can all kind of as you say in that spirit of ubuntu work together to to kind of um move forward positively so um thank you again so much for your time dr Nnorom um i would also like to say a huge thank you to you in the audience for joining us um you know we really appreciate you you showing up wherever you are in the world whatever time it is thank you for taking the time out we really appreciate it and and um hopefully you feel inspired um following this conversation um and and stay connected to both uh dr Nnorom check out her her work and her podcast and also with us at nesta um in our in our health healthy lives mission and beyond so um huge thanks all round and have a great rest of the day thank you

you