How does systemic racism predispose people to COVID-19?

Amid all the confusion about COVID-19, one alarming pattern has emerged around the world: the fatal coronavirus is affecting a disproportionate number of racialized people.

Over the last week, Toronto city officials revealed neighbourhood data to show a correlation between the rate of infection, racialized communities and lower incomes. In Montreal, a CBC analysis revealed the city's poorest and most racially diverse neighbourhoods are hit hardest by COVID-19.

The finding is no surprise to public health physician, Dr. Onyenyechukwu Nnorom, who has been drawing attention to the health disparities between racialized and Black people in Canada since well before COVID-19. 

Nnorom is a family doctor and public health and preventive medicine specialist whose work focuses on racism and how it impacts health. She is also an assistant professor at the University of Toronto in the Faculty of Medicine and at the Dalla Lana School of Public Health, and is the president of the Black Physicians Association of Ontario. 

This is part of her conversation with Dr. Brian Goldman, host of the CBC podcast, The Dose, in which she explored the question, "How does systemic racism predispose people to COVID-19?"

We know from data around the world that there are higher rates of COVID-19 in neighbourhoods where there are higher numbers of racialized people. Why is that?

Well, for every country, in every context, there will be differences. The most common factor with regards to racialized people being more vulnerable to COVID-19 infection, and as we've seen in the United States with COVID-19 deaths, is actually systemic racism. The reason is because it's social determinants of health that drive poor health outcome, not just with COVID-19 infection, but overall health.

For those who might not know, what is meant by the term "social determinants of health?"

The social determinants of health are the conditions that we live in: where we eat, where we sleep, where we play, where we work — it's really the conditions that we live in that determine our health. You can think about it as categories like education, income, early child development, employment, our social environment, or physical environment. It's our social conditions and contexts that determine our health outcome and might predispose us to certain illnesses or diseases. 

Is race itself a risk factor for COVID-19?

Race is an indicator of racism, as in systemic racism. Race is not itself a risk factor because race is a social construct. But in medicine, we think about particular groups and their predisposition to disease and we think of it as race being biologically based. But if you speak to population geneticists, when we map the human genome, there's more genetic difference between a particular "racial group" than there is between groups. Even if you go back to Darwin's work, you can see that he actually says, we're not different subspecies, we're all the human species, we're not genetically separate groups. But in medicine we teach that, and when you look at the history, it was really founded in inaccurate science. It's very, very, very damaging, because then when we see disparities, like with COVID-19, we start to wonder, 'Oh, what's wrong with that population?' We start to pathologize populations and say, perhaps something is genetically wrong with them. But in fact, it's the social factors. If we zoom out from the topic of racism, which is a tough topic, we can think about other studies that have shown us that your postal code matters much more than your genetic code.

So, race itself isn't a risk factor for COVID-19, and yet there are calls for something called race-based data. What's behind the push for race-based data right now in the time of COVID-19?

It's to identify the patterns of who was most at risk, and the push is coming from different directions. For a lot of Indigenous communities, the push is towards having data sovereignty so that they would own and collect and report on their own data because that kind of data has been used against them to stigmatize and pathologize. For a lot of Black communities, the push is to actually start to see these disparities as had been done in the United States, and then use it to advocate for system change. 

What are you seeing day to day in your work and life in Toronto?

Most of my time is in education. Many young people have seen the death of George Floyd on TV, and a lot of my colleagues are feeling quite traumatized. This whole situation has opened up so many wounds that people try not to think about, as far as their own lived experience of anti-Black racism. For my non-Black colleagues, certainly for my Indigenous colleagues who also experienced or have communities that experienced police violence, systemic racism and the kind of outcomes we talked about before, going to work is also a different type of painful. Overall, for everyone, there is this sense of collective pain, but also a collective hope. I think there's an understanding that right now, we as a society, in Canada, in the United States and internationally, we are writing history. COVID-19 showed us all of the inequities in society that we were ignoring. 

There are no quick fixes, but is the first step recognizing that there are people who are deeply traumatized by the events of the last couple of weeks?

Yes, I think that is the first step. There are many allies who have approached the Black community and said, you know, how can I help? How can I be an ally? And because we have that video of the death [of George Floyd] just a couple of weeks ago, and then was shortly followed by the death of Regis Korchinski-Paquet in Toronto, one of my colleagues described it's almost as if you're going to a funeral where people are in mourning, and you're asking the family of the deceased, 'I feel really uncomfortable… can you help me to understand what is going on right now? Can you help me?' And it's just not the right time to ask those kinds of questions because we are experiencing trauma and mourning. People are not sleeping well. People are not eating. People are really feeling down. It's just about taking a step, taking a breath, and then reading about how you can be an ally and help.

Is there a role for physicians in helping us get through this?

I think specifically for doctors, there are resources from Black communities who have made recommendations on how health care can be improved using an anti-oppression lens. There's also the United Nations report on the condition of African Canadians that came out in 2017. Also learning and taking courses on cultural safety and oppression, because it's those biases, those behaviours are very much ingrained in the way that we've learned medicine and the way that we practice. Maya Angelou says, "When you know better, you do better." So, let's start to know, let's start to do better.

Written and produced by Arianne Robinson. Q&A edited for length and clarity.