Statement Against Racism and Violence

September 2020

Given the epochal protests occurring in North American society and worldwide against police violence directed toward Black men and women, as leaders and members of the University of Toronto’s Department of Medicine, we feel compelled to speak out.

Police violence and over-policing disproportionately affects Black and Indigenous people. In Toronto, a Black person is 20 times more likely to be fatally shot than someone who is White. In Canada, Indigenous women are 3 times more likely than non-Indigenous people to be victims of violence, and 38% of people who have been killed by police across Canada since 2017 were Indigenous. The Ontario Human Rights Commission recently detailed the severe consequences of racial profiling on Indigenous and racialized communities, and Canadian courts have consistently shown that racial profiling is not related to a few “bad apples” but is a systemic problem that permeates our institutions. We argue that police violence is a critical public health issue because it is foreseeable, recurring, life-threatening and preventable.

Public health is a branch of medicine focused on prevention of disease and injury. It goes beyond the individual patient and requires a focus on societal health. Confronting racism in law enforcement and the criminal justice system is essential for public health; however, it is insufficient. As members of the health care system, we must take responsibility as well. We recognize the presence of structural racism within the Canadian healthcare system and our complicity in its perpetuation. As physicians, we participate in a system that neglects public health. Canada spent more than 250 billion dollars on healthcare in 2019, 25% of which funded acute care hospitals, whereas only 5% of the annual budget was spent on public health.

In addition, systemic barriers limit access to health care resources for Black and Indigenous people. Racial profiling and discrimination within the health care system results in a reluctance for racialized people to seek care. Substandard access to healthcare services is only one component of challenges faced. Colonial policies and their downstream effects, including inadequate living conditions, food insecurity and the intergenerational trauma of the residential school system and child welfare policies, directly impact the health of Indigenous peoples. The power imbalance within doctor-patient relationships, the lack of acknowledgement of intergenerational trauma, the lack of representation within our own ranks of individuals from historically marginalized communities, and the limited understanding of intersectionality by healthcare workers critically undermines the experiences of Black and Indigenous people within the healthcare system.

We are leaders and members of the University of Toronto’s Department of Medicine; however, we cannot speak on behalf of all of our colleagues or students. Nonetheless, we feel that staying silent is not an option. Silence means condoning racism and permitting its perpetuation. We refuse to do so. We write this letter to hold ourselves accountable, as individuals and as a community.

Towards this end, we commit ourselves to the following:

Advocating to Reduce Racism within the Criminal Justice System

Speak out against police violence directed at Black and Indigenous individuals and communities;
Support the redirection of law enforcement funds to community-based and community-led health initiatives;
Advocate for deep reform of our law enforcement and criminal justice systems;

Advocating to Reduce Racism within the Health Care System

Critically reflect on our delivery of health care and commit to the dismantling of the scaffolds of structural racism upon which the North American health care system was built. This includes a commitment to advocate for health equity and anti-racist practices to be central to the strategic plans of all hospitals within the University of Toronto system.
Call for a review of health care spending with prioritization of funds for evidence-based harm reduction services, mental health resources and public health organizations.
Support the call by our colleagues in the Centre for Addiction and Mental Health (CAMH) and others to have specialists trained in mental health act as first responders to situations involving individuals experiencing mental health crises. In much the same way that we should not expect police officers to manage a heart attack, stroke or life-threatening trauma, we should not expect them to manage mental health crises. Health crises call for health professionals.
Work actively to limit barriers to accessing care through expanded affordable housing, public transit, and community outreach promoting living full of health and free of violence, and support a “health in all policies” approach to public policy.

Ensuring Inclusion and Equity Within the Department of Medicine

Increase representation of Black and Indigenous physicians in our training programs, faculty and staff and create a climate of welcome and respect and belonging in which all voices are heard and all can flourish. Advocate for equity, diversity and inclusion in strategic planning for partner departments and hospitals.
Critically examine our own implicit biases and assumptions and assertively address bias—both explicit and implicit—in our selection, hiring and promotions processes. This can be achieved by collecting demographic and race-based data on prior and future selection, hiring and promotions to understand existing disparities and inform efforts to address biases. Additionally, leveraging existing programs for academic advancement, such as the Clinician-Scientist Training Program and the New and Emerging Academic Leaders Program as vehicles to increase diversity and inclusion in our Faculty and leadership.
Teach and actively engage in anti-racist practices and strive for equity and justice as a fundamental mission of education, research and clinical practice. Establish curricula with a focus on anti-racism practices and inclusion and equity as part of the academic training of residents and fellows.
Systematically review race-related trainee and patient experiences and concerns within the Department of Medicine and use this information to inform training programs.