The University of Toronto is preparing to launch a graduate program designed to address inequities in health care for Black Canadians, by training graduate students to better understand the issues at play. The master of public health in Black health, set to begin in fall 2023, will also prepare students to better serve Black communities.
“I was thinking about eradicating systems that did not create equity, but created violence for us,” said Roberta Timothy, the program’s initiator, inaugural director, and Black health lead at the university’s Dalla Lana School of Public Health.
After working in community health for over 30 years, Dr. Timothy was all too familiar with the impact that anti-Black racism, misogynoir (misogyny toward Black women) and other types of intersectional racism (which is often experienced as a form of violence) can have on Black people who are seeking health care. So, when she applied for the Black health lead position in July 2021, she thought it was the perfect time to bring forward her proposal.
“I went to my interview and I said, ‘What I want to do is actually create a program,’” she recalled. “And folks were supportive of it.” So supportive, in fact, that although the program was originally projected to take 18 months to get approved, Dr. Timothy’s efforts came to fruition in just five months and her proposal was accepted this past April. With interest from potential students in countries across the globe, the program will take in 10 to 15 students in its first cohort.
How it works
As part of the two-year degree, students will take six core courses, alongside the other general course requirements found in a typical master of public health program. What Dr. Timothy and her team have added to those basic requirements are courses such as a socio-historical overview of Black health, and a course on Black reproductive health. Students will also get a chance to study the impact of anti-Black racism on health, inter-generational relationships and their effects on community health, and infectious and chronic illness prevalence and treatment.
The nuance and specificity of these new courses is important because Black communities continue to experience poorer health outcomes than other communities including higher rates of chronic illness, higher rates of pregnancy and labour-related complications, as well as faring far worse than other demographics when it comes to social determinants of health.
The program will also call on the wisdom of Black elders, who Dr. Timothy said can help facilitate the learning and unlearning that’s needed for something like this to be successful. “And I say ‘successful’ not in the capitalist notion of success,” she explained, “but successful [as in] not harming students and actually empowering the next generation of practitioners to do some amazing work.”
Natalie John is a registered nurse in Toronto, and she plans to apply for admission next year. “I think this program will help solve a lot of disparities, confusion and inconsistency between the Black community and the health-care community,” she said.
Ms. John has only been a working nurse for a couple of years and she’s already seen what can happen when the health-care system does not properly address the nuanced needs of the people seeking assistance.
“I worked at a health-care facility, and [a] woman had come in with her newborn,” she recalled. Frightened and worried about her daughter’s condition, the woman raised her voice while seeking help from the staff. “A lot of the other workers … took her concern for her daughter as more of aggression instead of just great concern.”
For Ms. John, it’s crucial that medical personnel have the cultural competencies to understand the varied ways that people may present their frustration or concerns, without stigmatizing or stereotyping those individuals. She said that dynamics like this can ultimately lead to worse outcomes for Black patients, because they create a distrust of the health-care system and a feeling of being judged, which in turn discourages them from interacting with the system – even when they might need it.
Black health in academia
Akwatu Khenti is an assistant professor at the Dalla Lana School of Public Health who teaches courses on the public health implications of anti-Black racism in the criminal justice system. He believes that developing culturally competent systems for engaging with Black people in the public-health space has to start when healthcare practitioners are still in the classroom. “The academic level sets the foundations for clinical practice, public-health policy, health promotion, and harm reduction,” Dr. Khenti said.
Jared Bullard, a pediatric infectious disease specialist and associate professor at the University of Manitoba, echoed that sentiment as he recalled his own time as a medical student. “I was one of the few Black trainees in my cohort,” he said. “If the lecture was specifically talking about Black people, it was in reference to more of a tropical travel sort of medicine.”
The gap in proper training for how to care for Black patients with varied backgrounds and needs is something Dr. Bullard saw first-hand, and he hopes it will be addressed in the postsecondary system in his part of the country. “I would love to see the same thing [happen] here in Manitoba, even if it is a couple of lectures,” he said.
Students will also be taught skills in decolonizing pedagogy, a process that Dr. Khenti hopes will help set a new standard for what forms of knowledge are accepted and validated.
“There’s a lot of epistemic violence that takes place as a sort of intellectual microaggression, [where people] disqualify or invalidate other ways of knowing,” he said. “For me, it means building appreciation for the epistemic approaches of different groups, and [giving] more space to traditional wisdom that’s worked for thousands of years.”