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The Senate

Motion to Call on the Government to Adopt Anti-racism as the Sixth Pillar of the Canada Health Act--Debate Continued

June 1, 2021

Hon. Paula Simons [ - ]

I rise this evening because I would like to resume debate on the motion of the Honourable Senator McCallum, who is proposing that the Senate of Canada call on the federal government to adopt anti-racism as the sixth pillar of the Canada Health Act, prohibiting any discrimination based on race and affording everyone the equal right to the protection and benefit of the law.

Medical racism has many faces and takes many forms. Sometimes it is easy to diagnose when we hear the stories of Indigenous patients who’ve been denied timely care because the staff in the emergency room assumed they were intoxicated, rather than sick; or stories of patients who’ve heard or overhead staff using racist slurs and epithets to describe them; or patients who’ve tried to advocate for themselves in hospital, only to have their concerns or questions brushed aside because the staff couldn’t be bothered to listen past their accents.

Those are some of the most infuriating examples of racism because they are so clearly and crudely rooted in malice and prejudice, cynicism or laziness, and we get the most angry because those stories have pretty clear bad guys and victims.

But when we talk about systemic racism in health care, we’re not just talking about that kind of personal, malevolent one-on-one racism. We’re talking about something far more insidious and much harder to root out. There are so many subtle ways such systemic racism expresses itself, like a lack of equitable access to health care, for one, perhaps because there just aren’t doctors serving remote Indigenous communities or particularly poor urban neighbourhoods. We’ve seen vivid examples of this during the COVID-19 crisis, whether we’re talking about the situation in Wood Buffalo or the situation in Brampton.

But there are other, subtler and more slippery kinds of systemic racism, racism that is harder to see because it’s predicated on blind spots in our cultural vision. Indulge me in a personal story by way of example.

I’m not a particularly petite person, but my paternal grandmother was teeny tiny and so is my mother-in-law. And thanks to the genetic lottery, I gave birth to a perfectly healthy but very petite baby girl. She remained perfectly healthy, with a perfectly healthy appetite, but she also remained at the twentieth percentile for height and weight because that’s what her genetics preordained.

On one visit to the well baby clinic, I was soundly scolded by a particularly fierce public health nurse who seemed to suggest I’d been starving my little girl and stunting her growth. I cried all the way home and almost didn’t go back to the clinic.

On my next visit, I was more than a little prickly and defensive. But this time the nurse, who happened to be Chinese Canadian herself, assured me there was nothing to worry about. The height and weight charts, she pointed out, were predicated on outdated demographic averages that did not reflect the multicultural reality of contemporary Canada. The charts were based on North American data from the mid-20th century, and they simply didn’t take into account the typical size, say, of a Filipino-Canadian baby or a baby whose parents came from Thailand or Vietnam or Sri Lanka.

Once she said it, it seemed so obvious, but for me as a young mum, ensconced in my comfortable White privilege, it was a powerful epiphany. Of course, the nurse was quite right. The default settings of those height and weight charts left out all kinds of babies — at least they did 25 years ago, when my own child was born. But as the nurse’s words of comfort sunk in, I suddenly wondered how many young immigrant mothers had been lectured and hectored by well-meaning public health nurses simply because their babies didn’t measure up, literally, to the accepted percentiles on the chart. I wondered how many times a social worker might have been called, not because the mother was doing something wrong, but simply because her kid didn’t fit a paradigm based on a more homogeneous 1950s population.

A low-stakes example, perhaps. Still, it’s an illustration of the kind of blinkered thinking that infuses much of our public health care system.

It can be something as mundane as the fact that the bland and limited entrees on a hospital menu don’t reflect the tastes and cultures of many Canadian patients. It’s hard to get better if the food the hospital dietician puts before you is completely foreign to your experience and your identity. But it can also be something far more dangerous.

What if you’re studying to be a dermatologist, but almost the only photographs you see of various skin conditions in your training are all of White skin? How are you going to recognize or diagnose a skin disorder or a skin cancer if you have no idea how a condition presents in someone who’s Black or South Asian or Polynesian?

A recent study by Case Western Reserve University in Cleveland, Ohio, for example, tracked 97,000 patients with melanoma, one of the rarest but most deadly skin cancers. It found that White and Hispanic patients had the highest likelihood of survival, while African-American patients and those from the Pacific Islands, such as Hawaii, had the lowest survival rates. The researchers concluded that doctors were far less likely to diagnose melanoma in darker-skinned patients because they were not looking for it and didn’t recognize it when they saw it.

What if the medical technology you’re using to test something is only calibrated for White skin?

In December of 2020, The New England Journal of Medicine published the results of a study that looked at the way pulse oximeters — those little monitors that track your level of blood oxygenation — work on both Black and White patients. The study found that the monitors, which are so ubiquitous in hospitals, especially in the midst of COVID, were far more unreliable for Black patients who were nearly three times more likely to suffer from low blood oxygen levels that went undetected by monitors that were designed to work on Caucasian subjects.

What if the drugs your doctor is administering have only been tested on White people?

A 2018 article in Scientific American noted that the patients who participate in clinical trials for new drugs skew heavily White — in some cases, 80% to 90%. Yet, as the magazine noted, the symptoms of conditions such as heart disease, cancer and diabetes, as well as the contributing factors, vary across lines of ethnicity, as they do between sexes.

If diverse groups weren’t part of such studies, the article argued, there’s no way to be sure whether the treatment will work in all populations or what side effects might emerge in one group or another. And since we in Canada are often customers for American-created pharmaceuticals, their problems become our problems, too.

Take the drug Tegretol, a common treatment for epilepsy, sometimes also used to treat patients who are bipolar. For many people, the drug works well, with few side effects. But if you’re East Asian, and particularly if you’re Han Chinese, Tegretol can cause a number of different and serious skin conditions, including toxic epidermal necrolysis. That’s the sort of thing which is hard to anticipate if none of your test subjects are Chinese. And that’s not the only issue. Americans of African descent, for example, are more likely to suffer from respiratory ailments than White Americans, however, as of 2015, only 1.9% of all studies of respiratory disease in the United States included minority subjects.

Nor is this just an American problem. A recent study of drug trials involving some 150,000 patients in 29 countries at 5 different time points over a 20-year span, revealed that the ethnic makeup of the subjects in the drug trials was about 86 percent White.

Now, nobody sets out with malice to write medical textbooks dominated by pictures of White patients, or to invent blood oxygen monitors that work better on White skin. Nobody set out to patent drugs that don’t work on Chinese patients or to organize drug trials that don’t include non-White test subjects. And no one set out to create exclusionary hospital menus or exclusionary charts of baby weights. But racism, especially systemic racism, isn’t always about malice or bad intentions. Sometimes it’s just about ignorance or complacency or lack of imagination. That doesn’t make it benign, it makes it more insidious. And it’s an ignorance we can ill afford if we want Canada to have a public health care system that reflects the reality of the diverse country we share.

That’s why I’m so eager and grateful to speak to Senator McCallum’s motion and especially today, when she has given us such a profound gift — her personal, moving testimony about the destructive costs of institutional racism at its worst.

We can’t root out the quiet foundational racism that often goes unnoticed unless we act with both empathy and intent. We need to ensure our student doctors, nurses, technicians, psychologists, genetic counsellors, pharmacists and biomedical researchers come from a wide range of multicultural backgrounds, and they get the training they need to recognize and diagnose conditions in all different kinds of Canadians, not because they’re blind to race, but because they are sensitive to the physical differences amongst us.

We must ensure our tests of new drugs and new medical equipment recognize our modern multicultural diversity. We can no longer make a “typical” White man our baseline subject for all new medications and gadgets. We need to know our pharmaceuticals and our medical equipment will work equally well on women and on people of a wide variety of heritages.

When we say we don’t want our health care system to be racist, we can’t just stop at rooting out a few bigoted health care workers. We need to dig much deeper, to open our eyes and find the more subtle systemic racism baked into our health care paradigms.

That’s why I want to thank Senator McCallum for giving us the important opportunity to debate, so that we can work to create a Canadian public health care system that serves us all equally and equally well.

Thank you and hiy hiy.

Thank you for that presentation, Senator Simons.

Honourable senators, I speak today in support of Senator McCallum’s Motion 41, calling on the federal government to adopt anti-racism as the sixth pillar of the Canada Health Act. This measure has been urged by advocates and experts, including the Brian Sinclair Working Group, formed in response to the 2008 death of Mr. Sinclair in a Winnipeg emergency room. He was an Anishinaabe man in need of urgent care but was neglected and ignored, growing sicker and sicker as every patient in the ER was prioritized over him for treatment.

We know from countless reports and studies that the unacceptable actions and inaction that ended Mr. Sinclair’s life continue. Our debate today occurs as the coroner’s inquest proceeds into the death of Joyce Echaquan. Ms Echaquan died last year, enduring racist taunts and cruelty from the health care professionals responsible for her care.

At the inquest last week, some hospital staff witnesses initially took the position that there is no racism at the hospital where Ms. Echaquan died, pointing instead to conditions of stress for staff who were under-resourced and overworked. Coroner Kamel rejected these claims and eventually witnesses came forward with evidence of harmful stereotypes about Indigenous people that circulated at the hospital.

Members of the Sinclair Working Group rightly remind us that pressures on staff do not create the prejudices Ms. Echaquan and Mr. Sinclair experienced. Systemic and individual acts of racism are a reality across Canada. The extent, gravity and urgency of the situation risk being obscured and perpetuated if racism is simply accepted as an inevitable part of a busy health care system, or characterized as something that can be fixed by hiring more staff without also ensuring measures are in place for safe, fair and equal access to care.

As we seek to fulfill our collective mandate to represent minority and marginalized groups, it is our duty to be clear that racism in health and health care is real, and failing to redress it will mean that more people will die preventable deaths.

Our study of Bill C-7 in recent months examined the unacceptable reality that, for too many, health risks and suffering are not inevitable. They can be caused and exacerbated by systemic racism, including through a lack of meaningful access to health, income and social supports.

Palliative care physician Dr. Naheed Dosani, a witness before the Senate Legal Committee and a practitioner who works to provide care to those on the streets, warned that in the midst of the COVID-19 pandemic that, “Racism is a public health emergency.”

Indeed we cannot ignore the travesty in this country that neighbourhoods where inhabitants are racialized and poor have seen twice as many people die as a result of COVID-19 since the onset of the pandemic.

Canada’s health care system is grounded in principles of universality and accessibility, as set out in the Canada Health Act. Yet, especially during current public health emergencies and as Motion 41 makes clear, this is not sufficient. As we work to redress Canada’s legacy of colonialism, the health care system must be actively anti-racist.

Dean Jane Philpott of the Queen’s University Faculty of Health Sciences, herself both a former federal health and Indigenous services minister, has noted that when it comes to racism in health care:

We don’t need more studies; we need action on a suite of reforms. Steps have been laid out in multiple reports including the Calls to Action of the Truth and Reconciliation Commission and the Calls for Justice from the Inquiry on Missing and Murdered Indigenous Women and Girls.

Making anti-racism a pillar of the Canada Health Act will make clear that pursuing these reforms is an integral and defining priority at every level of Canada’s health care system.

Nowhere are the effects of colonialism and systemic racism more starkly magnified than at the intersection between health care and the criminal legal and prison systems.

Colleagues, many of us have now visited prisons together and have witnessed first-hand who fills their cells and the stark results of the systemic failure and discrimination of every other system, including the health care system. The evisceration of health, economic and social safety nets in past decades leave police, courts and prisons as the default, and the legal and penal systems as the only systems that cannot turn away people.

We must address housing, economic supports and health care, especially mental health and treatment for addictions, needed by so many who have been otherwise abandoned and abused, too often as a result of political and policy decisions. The legal and prison systems are not fit for these purposes, yet we persistently fail to face these realities.

Failing to deliver accessible and culturally safe health care and mental health care has devastating consequences, particularly for those who are most marginalized. They disproportionately end up in contact with police, in courts and in prisons, instead of receiving the treatment they need.

Last summer, the deaths of Black and Indigenous peoples during mental health checks by police officers was the catalyst for sweeping calls for urgent anti-racist action. For too many, these same interventions result in criminalization for what are health rather than criminal law issues.

According to the Mental Health Commission of Canada, two in five people with mental illness have been arrested in their lifetimes. Three in ten have had police involved in their care pathway. Federal corrections data indicates that 79% of women in federal prisons have mental health issues. Among federal prisoners, 25% are categorized as seniors, most of whom live with some form of chronic health issue and, in many cases, several overlapping chronic health issues from chronic pain to physical disability, cancer, diabetes, circulatory issues, heart conditions and dementia.

Too often, the prison system’s default of “managing” people with these sorts of complex health care needs is to place them in isolating conditions that amount to segregation and solitary confinement. Not only do people not receive the care they need, this isolation creates and exacerbates health issues. The irreversible physical, physiological, psychological and neurological harm of spending nearly all day locked alone in a cell smaller than the size of most parking spaces or bathrooms can start within 48 hours. Fifteen days in such conditions is recognized in Canada and internationally as amounting to torture.

For those in federal penitentiaries during the pandemic, entire prisons have been subjected to conditions of segregation in the form of lockdowns that have lasted for weeks and months to over a year.

These draconian conditions have disproportionately affected Black and Indigenous peoples. During the first wave of the COVID-19 pandemic, COVID infection rates for men were 10 times higher in federal penitentiaries than in the rest of Canada. For women, they were an unfathomable 77 times higher.

Dr. Dosani describes the situation for racialized patients living on the streets with cancer and other conditions requiring palliative care in the shadow of criminalization as follows:

The people I care for are scared, and they’re worried. Particularly during COVID, we’ve seen the criminalization of homelessness. Particularly, people experiencing homelessness are inhabiting parks and other spaces, because they don’t have elsewhere to go, because respites, shelters and drop-ins have had to reduce services and hours.

The response in many jurisdictions is that they’re being policed. They’re being ticketed, and this is inappropriate and leads to worse outcomes in interactions with police.

It is painfully clear that jails are not, nor should we accept that they continue to be used as, substitutes for shelters, treatment centres or mental health centres for those most marginalized, including as a result of systemic racism. Those with health needs must be able to access appropriate, comprehensive and safe health care.

Thank you, Senator McCallum, for your leadership in challenging this chamber to use its privilege and authority to stop the abandonment of those who suffer to the streets, to jails or to death. Thank you, too, for inspiring us to insist on anti-racist health care and to implement a vision and promise of accessibility and a brighter and more equitable future for all.

Meegwetch. Thank you.

The Hon. the Speaker [ - ]

Honourable senators, before calling on Senator Pate to enter debate, I noticed that Senator Richards had his hand raised. I’m not sure if he wished to ask a question of Senator Pate or Senator Simons.

Senator Richards, did you wish to ask a question?

Hon. David Richards [ - ]

Honourable senators, my question was initially for Senator Simons. I would address it to either one.

The Hon. the Speaker [ - ]

I’m sorry, Senator Richards. If you wish to ask of Senator Simons, I will have to ask for leave.

If anyone is opposed to granting leave, please say “no.”

Go ahead, Senator Richards.

Senator Richards [ - ]

Sometimes, Senator Simons, it is a matter of personal integrity, and sometimes it’s laziness and just thoughtlessness. My mother, a White woman, was tormented by a nurse while she was dying because she could not get better. Every day, the nurse would come in and torment her about not getting better. I know another White woman, who lost her child because of mistaken shaken baby syndrome.

I’m not saying that this is a bad bill. I think it should pass, but I think bigotry can walk both sides of the aisle here. A lot of times it’s laziness and ignorance that accompany it. We should be careful not to make our scope too narrow of what bigotry is and is not. Maybe you could respond to that, senator.

Senator Simons [ - ]

I would be happy to respond, Your Honour.

We’re dealing with two separate sorts of problems here. It pains me to say anything negative about health care workers in the moment of this COVID crisis when so many of them have risked their lives and their physical and mental health to care for us all. But we all know that there are a large number of health care workers, and a certain percentage of them are going to be not nice people.

When my mother was dying in hospital last summer, screaming because she suffered from deep dementia, a nurse came in and yelled at her and told her to be quiet. I said to the nurse, “She cannot understand what you’re saying and she cannot possibly follow your instructions. Why are you scolding and taunting my White, blonde, blue-eyed mother?” Because that nurse was not a nice person.

I wanted to address in my speech the much subtler problem of the kind of systemic discrimination and racism that we don’t do out of malice, but because we don’t see it ourselves. That’s what I hope to bring to this debate. Other senators, including Senator Pate, have spoken very movingly about the problem of bad actors in the health care system. I wanted to take a moment in my speech to address the issues that we don’t always think about and see — the tests, the medical equipment, the medical textbooks — that are kind of still based as though we’re living in the world of the 1960s, when our society doesn’t look like that anymore.

With systemic racism, people get very defensive and they say, “Well, I’m not a bad person. How can I be implicated in systemic racism? Because I’m not mean. I am not bigoted myself.” But all of us are part of a larger society that needs to stop being so defensive and needs to say, “Okay. I hadn’t thought of it that way before. I hadn’t thought of the fact that other people might be uncomfortable. I hadn’t thought of the fact that the medical textbook doesn’t reflect the population that I serve.”

That’s what I hoped to speak to tonight — those questions of systemic racism that are so subtle that we don’t see them. It does not mean that we are awful human beings, but that we need to expand our vision.

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