{"id":445,"date":"2024-08-29T14:03:58","date_gmt":"2024-08-29T18:03:58","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/?post_type=chapter&#038;p=445"},"modified":"2026-08-24T19:41:59","modified_gmt":"2026-08-24T23:41:59","slug":"how-racism-manfests","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/chapter\/how-racism-manfests\/","title":{"raw":"4.1: How Racism Manifests In Nutrition and Dietetics","rendered":"4.1: How Racism Manifests In Nutrition and Dietetics"},"content":{"raw":"It is well documented and common knowledge among leaders engaged in anti-oppression education how difficult it can be to convince even the most interested healthcare professionals of the connection between social inequities and biomedical outcomes (Atkins &amp; Brady, 2016; Ng &amp; Way, 2021; Wellington, Lee, Ng &amp; Mensah, 2021; Ng, Wellington, &amp;Pabani, 2024).\u00a0 So we offer this chapter to assist you in your journey of seeing and making sense of the connections.\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h3 class=\"textbox__title\"><strong><span style=\"color: #000000\">Interactive Activity: <\/span><\/strong><span style=\"color: #000000 !important;font-weight: 400 !important\">\"Cultural Humility in Dietetic Practice\": An Interactive Case on ABR, Traditional Foodways, and Diabetes Management. A branching case scenario created by Halima Cherif Hassana, RD, B.Sc from Quebec.<\/span><\/h3>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nWalk through the branching scenario for an example of how bias and systemic racism show up in a dietetic workplace.\r\n\r\n[h5p id=\"71\"]\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n\r\n&nbsp;\r\n\r\n<!-- Keywords Box: Custom styled to Grey background with a Red border -->\r\n<div class=\"textbox shaded\" style=\"background-color: #f5f5f5 !important;border-left: 6px solid #D9381E !important;padding: 15px\">\r\n<blockquote>\"There's just not enough Black people entering the profession to provide culturally affirmin, anti-racist care\"- Amira Oyesegun<\/blockquote>\r\n<\/div>\r\n&nbsp;\r\n\r\nAccording to data from the Public Health Agency of Canada (PHAC, 2020), frequent exposure to racial discrimination and systemic exclusion is strongly associated with elevated risk factors and disproportionate chronic disease rates among Black Canadians. In the context of healthcare, racism operates as a structural determinant that manifests primarily through three distinct pathways:\r\n\r\n<span style=\"color: #000000\"><em>Click on each section below to see details<\/em><\/span>\r\n<div style=\"margin-top: 20px;margin-bottom: 25px;font-family: sans-serif\"><details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\"><summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #b71c1c;cursor: pointer;border-left: 6px solid #b71c1c\">Structural racism in health research, health education and healthcare<\/summary>\r\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\r\n\r\n<em>The barriers to receiving just, culturally informed, affirming and competent care that are created by systemic racism.<\/em>\r\n\r\n<em>Examples:<\/em>\r\n<ul>\r\n \t<li>Limited access to Black health care professionals due to Canada's long history of discriminating against Black students (e.g. Queen's University's 1918 ban on Black students) (Queen\u2019s Alumni Review, 2020)<\/li>\r\n \t<li>Before 2021, the estimated glomerular filtration rate (eGFR) calculations used a race-based multiplier that artificially inflated kidney function scores for Black patients,\u00a0leading to delayed diagnoses and barriers to organ transplant waitlists (American Kidney Fund, 2026)<\/li>\r\n \t<li>Delayed, missed or failure to diagnose mental health issues and cognitive delay in Black communities (CanFASD, 2026; Olanlesi-Aliu, Giwa &amp; Salami, 2025)<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/details><details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\"><summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #111111;cursor: pointer;border-left: 6px solid #111111\">Limited access to prerequisites for health<\/summary>\r\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\r\n\r\n<em>Systemic and institutional barriers that restrict equitable access to adequate income, employment, safe housing, and food security.<\/em>\r\n\r\n<em>Example:<\/em>\r\n<ul>\r\n \t<li>Compounded health complications resulting from structural environmental toxin exposure and lack of urban resources (NCCDH, 2018).<\/li>\r\n<\/ul>\r\n.\r\n\r\n<\/div>\r\n<\/details><details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\"><summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #1b5e20;cursor: pointer;border-left: 6px solid #1b5e20\">The accumulation of chronic allostatic stress<\/summary>\r\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\r\n\r\n<em>The long, exploitative and oppressive history of treatment by White scientists and health professionals toward Black people perpetuates the prolonged physical and psychological wear-and-tear caused by systemic policies and interpersonal discrimination. This chronic stress pathway directly:<\/em>\r\n<ul>\r\n \t<li><em>Adversely impacts long-term metabolic and physiological health.<\/em><\/li>\r\n \t<li><em>Influences coping or health behaviours (such as altered physical activity levels or smoking).<\/em><\/li>\r\n \t<li><em>Impairs safe and equitable healthcare access.<\/em><\/li>\r\n \t<li><em>Affects other downstream neuroendocrine and biological mechanisms related to health.<\/em><\/li>\r\n<\/ul>\r\n<em>Examples:<\/em>\r\n<ul>\r\n \t<li>Physiological changes due to stress (weathering and high allostatic load) and a significantly greater likelihood of developing early-onset chronic diseases (Siddiqui et al., 2017; NCCDH, 2018).<\/li>\r\n \t<li>Elevated risk profiles for clinical hypertension and childhood cancer (Siddiqui et al., 2017).<\/li>\r\n \t<li>Deep-seated psychosocial trauma from navigating biased institutional environments (NCCDH, 2018)<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/details><\/div>\r\n<span style=\"text-align: initial;font-size: 1em\">Braveman et al. (2022) and the National Collaborating Centre for Determinants of Health (NCCDH, 2018) report that Indigenous and Black populations experience the most severe health inequities in Canada. With Black communities living with:<\/span>\r\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%\" border=\"0\">\r\n<tbody>\r\n<tr>\r\n<td style=\"width: 22.8477%\">Health Issue<\/td>\r\n<td style=\"width: 77.1523%\">Disparities in the Black Canadian Population<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 22.8477%\"><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Metabolic diseases<\/span><\/td>\r\n<td style=\"width: 77.1523%\">\r\n<ul>\r\n \t<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Diabetes: Black Canadians have a higher rate of diabetes than White Canadians.<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/li>\r\n \t<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Cardiovascular diseases (CVD): Hypertension, stroke, high cholesterol, ischemic heart disease and other forms of CVD are the leading causes of death for Black adults.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 22.8477%\"><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Mental health<\/span><\/td>\r\n<td style=\"width: 77.1523%\">\r\n<ul>\r\n \t<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadians experience more disparities in accessing mental health services.<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/li>\r\n \t<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadians reported poorer mental health and greater financial insecurity during the COVID-19 pandemic.<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 22.8477%\"><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Cancer<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/td>\r\n<td style=\"width: 77.1523%\">\r\n<ul>\r\n \t<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadian cisgender women may be under-screened for breast cancer and cervical cancer.<\/span><\/li>\r\n \t<li>Black Canadian cisgender women have lower diagnosis rates despite a higher mortality risk of uterine cancer<\/li>\r\n \t<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadian cisgender men have higher rates of prostate cancer and poorer screening rates.<\/span><\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<em><strong>Note:<\/strong> Current research and data reviewed failed to investigate, recognize or include similar health risks for gender-diverse Black Canadians, subsequently highlighting the need for safe, affirming and inclusive research.<\/em>\r\n\r\n(Black Health Alliance, n.d; Mental Health Commission of Canada, 2021; Statistics Canada, 2025)\r\n\r\n&nbsp;\r\n\r\n<header class=\"textbox__header\" style=\"background-color: #3ca137 !important;color: #000000 !important;padding: 18px 20px !important\"><strong>Figure 4.1:<\/strong> Structural pathways and clinical manifestations of health inequalities for Black Canadians. Data adapted from PHAC (2020) and NCCDH (2018).<\/header>\r\n<div class=\"textbox__content\" style=\"background-color: #b9dcb9 !important;color: #242424 !important;padding: 20px !important\">\r\n\r\n<a href=\"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1.jpeg\" target=\"_blank\" rel=\"noopener\">\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1.jpeg\" alt=\"Structural pathways and clinical manifestations of health inequalities for Black Canadians. Data adapted from PHAC (2020) and NCCDH (2018).\" width=\"1708\" height=\"920\" class=\"alignnone wp-image-3188 size-full\" style=\"text-align: initial;font-size: 1em;cursor: zoom-in\" \/>\r\n<\/a>\r\n\r\n<\/div>\r\n<h2>Manifests in Nutrition and Dietetic Practice<\/h2>\r\n<p style=\"line-height: 1.5;color: #242424;margin-bottom: 12px\">Systemic racism within nutrition and dietetics operates beyond an abstract level. Here are a few examples of how it can shape daily assessment, diagnostic criteria, and standard interventions:<\/p>\r\n<span style=\"color: #000000\"><em>Click on each section below to see details<\/em><\/span>\r\n<div style=\"margin-top: 20px;margin-bottom: 25px;font-family: sans-serif\"><details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\"><summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #b71c1c;cursor: pointer;border-left: 6px solid #b71c1c\">Structural racism in nutrition research, nutrition education and the nutrition care process<\/summary>\r\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\r\n\r\n<strong>Gaps and biases in practitioner knowledge<\/strong>\r\n<ul>\r\n \t<li>Healthcare workers unable to recognize indicators of nutritional status or systemic illness (e.g. jaundice, cyanosis, or severe paleness\/pallor)\u00a0 because they are not trained to spot these variations on darker skin tones. Subsequently, nutritional deficiencies or chronic health conditions are missed, or treatment is delayed (Stanford Center for Continuing Medical Education, n.d.)<\/li>\r\n \t<li>Nutrition professionals' use of BMI or visual assessment of body composition contributes to weight bias, fat phobia and assumptions of poor health within Black communities (Strings, 2023).<\/li>\r\n \t<li>Making an incorrect nutrition assessment and plan after misjudging a patient's nutrient intake because they are unfamiliar with traditional foods or preparation methods<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/details><details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\"><summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #111111;cursor: pointer;border-left: 6px solid #111111\">Limited access to prerequisites for health<\/summary>\r\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\r\n\r\n<strong>Low income and lack of access to health benefits\/insurance coverage<\/strong>\r\n<ul>\r\n \t<li>Low income, unemployment or precarious work conditions often limit access to employer-sponsored health benefits, creating barriers to accessing dietetic services.<\/li>\r\n \t<li>Subsequent dependence on limited access to free community dietetic services that may not be culturally affirming, particularly since there are very few Black dietitians practicing in Canada and non-Black dietitians have limited training on culturally affirming and anti-racist practice.<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/details><details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\"><summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #1b5e20;cursor: pointer;border-left: 6px solid #1b5e20\">The accumulation of chronic allostatic stress<\/summary>\r\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\r\n\r\n<strong>White racial framing<\/strong>\r\n<ul>\r\n \t<li>The disrespectful and discriminatory behaviour of nutrition professionals who belittle cultural foods and ways of eating indirectly requests that Black patients deny parts of their cultural identity (Kumanyike, 2006)<\/li>\r\n<\/ul>\r\n<strong>Pathologizing health management adaptations (e.g. cultural racism)<\/strong>\r\n<ul>\r\n \t<li>Nutrition professionals pointing blame at cultural and individual eating patterns and cooking traditions (e.g. cooking with oils high in saturated fats such as palm oil or regular inclusion of large portions of starchy foods like provisions)\u00a0 for health issues (e.g. diabetes, hypertension, obesity) while ignoring the current and historic systemic inequalities that perpetuate health issues (Ng, 2023).<\/li>\r\n<\/ul>\r\n<strong>Black communities' distrust of non-black nutrition professionals and their messages<\/strong>\r\n<ul>\r\n \t<li>Black patients withholding essential information to avoid judgement, being controlled or being harmed. (e.g. not telling a dietitian about their complementary and alternative medicines)<\/li>\r\n \t<li>Black people avoiding or ignoring recommendations intended to improve their health, rendering public health nutrition strategies and clinical dietetic interventions useless. (Etowa, Beagan, Eghan &amp; Bernard, 2017; Beagan &amp; Chapman, 2012).<\/li>\r\n<\/ul>\r\n<\/div>\r\n<\/details><\/div>\r\nUltimately, we cannot speak about public health disparities that affect <a href=\"\/\/pressbooks.library.torontomu.ca\/abrdietetics\/back-matter\/glossary\/)\">racialized <\/a>populations without directly examining how our systems, institutions, and clinical cultures construct these conditions. Doing so leads to the development of chronic diseases within the Black community while also facilitating the visual and systemic erasure of Black individuals (Balde &amp; Perreault, 2026).\r\n\r\nThe upcoming series of case studies and video interviews in the next few chapters offers direct insight into the variety of ways anti-Black racism within food, nutrition and dietetic practices impacts Black individuals and communities, patients and practitioners, students and educators.\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\"><span style=\"color: #000000\"><strong>Video 4.1: <\/strong>Matthew Adgbuyi, a Black Dietitian from Alberta, lists and describes three ways ABR manifests in the dietetic profession and how they can negatively impact the health and well-being of Black Canadians.<\/span><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n[embed]https:\/\/youtu.be\/RlnVAM-Imiw[\/embed]\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\"><span style=\"color: #000000\"><strong>Video 4.2: <\/strong>Three Black Canadian Registered Dietitians from Quebec and Nova Scotia talk about how anti-Black racism and biases manifest health inequities for Black Canadians<\/span><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n[embed]https:\/\/youtu.be\/yuq1WgtM5bs[\/embed]\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox__content\" style=\"padding: 0 40px 30px 40px !important;overflow: hidden\"><\/div>\r\n<div class=\"textbox textbox--exercises\" style=\"width: 100% !important;max-width: 100% !important\"><header class=\"textbox__header\">\r\n<h3 class=\"textbox__title\" style=\"color: #000000 !important;margin: 0;padding: 0\"><strong>Stop and Reflect<\/strong><\/h3>\r\n<\/header>\r\n<div class=\"textbox__content\" style=\"padding: 0 40px 30px 40px !important;overflow: hidden\">\r\n<div style=\"max-width: 100%;margin: 0 auto\">\r\n<p style=\"line-height: 1.5;color: #111111;margin-bottom: 20px\"><strong>The issues of weight bias and stigma, the myth of laziness, and not trusting Black people to make intelligent, informed and ethical decisions about their health and the health of their loved ones are deeply rooted in anti-Black racist and dehumanizing beliefs used to justify the Atlantic Slave Trade.\u00a0<\/strong><\/p>\r\nGo down the rabbit hole and see it for yourself. Search for these racist historical views online (i.e. academic databases, search engines, Google Images), and reflect on your findings. How do they relate to what you might have been taught, what you teach or how you practice nutrition and dietetics?\r\n<ol>\r\n \t<li>Slavery and fatphobia<\/li>\r\n \t<li>Slavery and the myth of laziness<\/li>\r\n \t<li>Black intellectual inferiority and slavery (Thomas Jefferson, Benjamin Banneker)<\/li>\r\n<\/ol>\r\n<div style=\"background-color: #ffffff;border: 1px solid #ccd1d9;border-radius: 6px;padding: 18px\">\r\n\r\n<label style=\"font-weight: bold;margin-bottom: 8px;color: #242424\" for=\"safe-spaces-journal\">Type your reflection below:<\/label>\r\n<div style=\"justify-content: space-between;align-items: center;margin-top: 10px;flex-wrap: wrap;gap: 10px\">\r\n\r\n<span id=\"safe-spaces-status\" style=\"font-size: 0.9em;color: #6b7280;font-style: italic\">Your writing saves automatically in this browser as you type.<\/span>\r\n\r\n<button id=\"safe-spaces-clear\" style=\"background: #fdfaf9;border: 1px solid #b91c1c;color: #b91c1c;padding: 6px 14px;border-radius: 4px;font-size: 0.9em;cursor: pointer\" type=\"button\">Clear reflection<\/button>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n&nbsp;","rendered":"<p>It is well documented and common knowledge among leaders engaged in anti-oppression education how difficult it can be to convince even the most interested healthcare professionals of the connection between social inequities and biomedical outcomes (Atkins &amp; Brady, 2016; Ng &amp; Way, 2021; Wellington, Lee, Ng &amp; Mensah, 2021; Ng, Wellington, &amp;Pabani, 2024).\u00a0 So we offer this chapter to assist you in your journey of seeing and making sense of the connections.<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h3 class=\"textbox__title\"><strong><span style=\"color: #000000\">Interactive Activity: <\/span><\/strong><span style=\"color: #000000 !important;font-weight: 400 !important\">&#8220;Cultural Humility in Dietetic Practice&#8221;: An Interactive Case on ABR, Traditional Foodways, and Diabetes Management. A branching case scenario created by Halima Cherif Hassana, RD, B.Sc from Quebec.<\/span><\/h3>\n<\/header>\n<div class=\"textbox__content\">\n<p>Walk through the branching scenario for an example of how bias and systemic racism show up in a dietetic workplace.<\/p>\n<div id=\"h5p-71\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-71\" class=\"h5p-iframe\" data-content-id=\"71\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Cultural Erasure Manifesting Negative Health Outcomes in Clinical Nutrition\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><!-- Keywords Box: Custom styled to Grey background with a Red border --><\/p>\n<div class=\"textbox shaded\" style=\"background-color: #f5f5f5 !important;border-left: 6px solid #D9381E !important;padding: 15px\">\n<blockquote><p>&#8220;There&#8217;s just not enough Black people entering the profession to provide culturally affirmin, anti-racist care&#8221;- Amira Oyesegun<\/p><\/blockquote>\n<\/div>\n<p>&nbsp;<\/p>\n<p>According to data from the Public Health Agency of Canada (PHAC, 2020), frequent exposure to racial discrimination and systemic exclusion is strongly associated with elevated risk factors and disproportionate chronic disease rates among Black Canadians. In the context of healthcare, racism operates as a structural determinant that manifests primarily through three distinct pathways:<\/p>\n<p><span style=\"color: #000000\"><em>Click on each section below to see details<\/em><\/span><\/p>\n<div style=\"margin-top: 20px;margin-bottom: 25px;font-family: sans-serif\">\n<details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\">\n<summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #b71c1c;cursor: pointer;border-left: 6px solid #b71c1c\">Structural racism in health research, health education and healthcare<\/summary>\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\n<p><em>The barriers to receiving just, culturally informed, affirming and competent care that are created by systemic racism.<\/em><\/p>\n<p><em>Examples:<\/em><\/p>\n<ul>\n<li>Limited access to Black health care professionals due to Canada&#8217;s long history of discriminating against Black students (e.g. Queen&#8217;s University&#8217;s 1918 ban on Black students) (Queen\u2019s Alumni Review, 2020)<\/li>\n<li>Before 2021, the estimated glomerular filtration rate (eGFR) calculations used a race-based multiplier that artificially inflated kidney function scores for Black patients,\u00a0leading to delayed diagnoses and barriers to organ transplant waitlists (American Kidney Fund, 2026)<\/li>\n<li>Delayed, missed or failure to diagnose mental health issues and cognitive delay in Black communities (CanFASD, 2026; Olanlesi-Aliu, Giwa &amp; Salami, 2025)<\/li>\n<\/ul>\n<\/div>\n<\/details>\n<details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\">\n<summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #111111;cursor: pointer;border-left: 6px solid #111111\">Limited access to prerequisites for health<\/summary>\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\n<p><em>Systemic and institutional barriers that restrict equitable access to adequate income, employment, safe housing, and food security.<\/em><\/p>\n<p><em>Example:<\/em><\/p>\n<ul>\n<li>Compounded health complications resulting from structural environmental toxin exposure and lack of urban resources (NCCDH, 2018).<\/li>\n<\/ul>\n<p>.<\/p>\n<\/div>\n<\/details>\n<details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\">\n<summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #1b5e20;cursor: pointer;border-left: 6px solid #1b5e20\">The accumulation of chronic allostatic stress<\/summary>\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\n<p><em>The long, exploitative and oppressive history of treatment by White scientists and health professionals toward Black people perpetuates the prolonged physical and psychological wear-and-tear caused by systemic policies and interpersonal discrimination. This chronic stress pathway directly:<\/em><\/p>\n<ul>\n<li><em>Adversely impacts long-term metabolic and physiological health.<\/em><\/li>\n<li><em>Influences coping or health behaviours (such as altered physical activity levels or smoking).<\/em><\/li>\n<li><em>Impairs safe and equitable healthcare access.<\/em><\/li>\n<li><em>Affects other downstream neuroendocrine and biological mechanisms related to health.<\/em><\/li>\n<\/ul>\n<p><em>Examples:<\/em><\/p>\n<ul>\n<li>Physiological changes due to stress (weathering and high allostatic load) and a significantly greater likelihood of developing early-onset chronic diseases (Siddiqui et al., 2017; NCCDH, 2018).<\/li>\n<li>Elevated risk profiles for clinical hypertension and childhood cancer (Siddiqui et al., 2017).<\/li>\n<li>Deep-seated psychosocial trauma from navigating biased institutional environments (NCCDH, 2018)<\/li>\n<\/ul>\n<\/div>\n<\/details>\n<\/div>\n<p><span style=\"text-align: initial;font-size: 1em\">Braveman et al. (2022) and the National Collaborating Centre for Determinants of Health (NCCDH, 2018) report that Indigenous and Black populations experience the most severe health inequities in Canada. With Black communities living with:<\/span><\/p>\n<table class=\"grid landscape\" style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td style=\"width: 22.8477%\">Health Issue<\/td>\n<td style=\"width: 77.1523%\">Disparities in the Black Canadian Population<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.8477%\"><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Metabolic diseases<\/span><\/td>\n<td style=\"width: 77.1523%\">\n<ul>\n<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Diabetes: Black Canadians have a higher rate of diabetes than White Canadians.<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/li>\n<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Cardiovascular diseases (CVD): Hypertension, stroke, high cholesterol, ischemic heart disease and other forms of CVD are the leading causes of death for Black adults.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.8477%\"><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Mental health<\/span><\/td>\n<td style=\"width: 77.1523%\">\n<ul>\n<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadians experience more disparities in accessing mental health services.<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/li>\n<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadians reported poorer mental health and greater financial insecurity during the COVID-19 pandemic.<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 22.8477%\"><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Cancer<\/span><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none white-space-prewrap\"> <\/span><\/td>\n<td style=\"width: 77.1523%\">\n<ul>\n<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadian cisgender women may be under-screened for breast cancer and cervical cancer.<\/span><\/li>\n<li>Black Canadian cisgender women have lower diagnosis rates despite a higher mortality risk of uterine cancer<\/li>\n<li><span class=\"a_GcMg font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Black Canadian cisgender men have higher rates of prostate cancer and poorer screening rates.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><em><strong>Note:<\/strong> Current research and data reviewed failed to investigate, recognize or include similar health risks for gender-diverse Black Canadians, subsequently highlighting the need for safe, affirming and inclusive research.<\/em><\/p>\n<p>(Black Health Alliance, n.d; Mental Health Commission of Canada, 2021; Statistics Canada, 2025)<\/p>\n<p>&nbsp;<\/p>\n<header class=\"textbox__header\" style=\"background-color: #3ca137 !important;color: #000000 !important;padding: 18px 20px !important\"><strong>Figure 4.1:<\/strong> Structural pathways and clinical manifestations of health inequalities for Black Canadians. Data adapted from PHAC (2020) and NCCDH (2018).<\/header>\n<div class=\"textbox__content\" style=\"background-color: #b9dcb9 !important;color: #242424 !important;padding: 20px !important\">\n<p><a href=\"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1.jpeg\" target=\"_blank\" rel=\"noopener\"><br \/>\n<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1.jpeg\" alt=\"Structural pathways and clinical manifestations of health inequalities for Black Canadians. Data adapted from PHAC (2020) and NCCDH (2018).\" width=\"1708\" height=\"920\" class=\"alignnone wp-image-3188 size-full\" style=\"text-align: initial;font-size: 1em;cursor: zoom-in\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1.jpeg 1708w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-300x162.jpeg 300w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-1024x552.jpeg 1024w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-768x414.jpeg 768w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-1536x827.jpeg 1536w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-65x35.jpeg 65w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-225x121.jpeg 225w, https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-content\/uploads\/sites\/398\/2024\/08\/image-1-350x189.jpeg 350w\" sizes=\"auto, (max-width: 1708px) 100vw, 1708px\" \/><br \/>\n<\/a><\/p>\n<\/div>\n<h2>Manifests in Nutrition and Dietetic Practice<\/h2>\n<p style=\"line-height: 1.5;color: #242424;margin-bottom: 12px\">Systemic racism within nutrition and dietetics operates beyond an abstract level. Here are a few examples of how it can shape daily assessment, diagnostic criteria, and standard interventions:<\/p>\n<p><span style=\"color: #000000\"><em>Click on each section below to see details<\/em><\/span><\/p>\n<div style=\"margin-top: 20px;margin-bottom: 25px;font-family: sans-serif\">\n<details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\">\n<summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #b71c1c;cursor: pointer;border-left: 6px solid #b71c1c\">Structural racism in nutrition research, nutrition education and the nutrition care process<\/summary>\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\n<p><strong>Gaps and biases in practitioner knowledge<\/strong><\/p>\n<ul>\n<li>Healthcare workers unable to recognize indicators of nutritional status or systemic illness (e.g. jaundice, cyanosis, or severe paleness\/pallor)\u00a0 because they are not trained to spot these variations on darker skin tones. Subsequently, nutritional deficiencies or chronic health conditions are missed, or treatment is delayed (Stanford Center for Continuing Medical Education, n.d.)<\/li>\n<li>Nutrition professionals&#8217; use of BMI or visual assessment of body composition contributes to weight bias, fat phobia and assumptions of poor health within Black communities (Strings, 2023).<\/li>\n<li>Making an incorrect nutrition assessment and plan after misjudging a patient&#8217;s nutrient intake because they are unfamiliar with traditional foods or preparation methods<\/li>\n<\/ul>\n<\/div>\n<\/details>\n<details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\">\n<summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #111111;cursor: pointer;border-left: 6px solid #111111\">Limited access to prerequisites for health<\/summary>\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\n<p><strong>Low income and lack of access to health benefits\/insurance coverage<\/strong><\/p>\n<ul>\n<li>Low income, unemployment or precarious work conditions often limit access to employer-sponsored health benefits, creating barriers to accessing dietetic services.<\/li>\n<li>Subsequent dependence on limited access to free community dietetic services that may not be culturally affirming, particularly since there are very few Black dietitians practicing in Canada and non-Black dietitians have limited training on culturally affirming and anti-racist practice.<\/li>\n<\/ul>\n<\/div>\n<\/details>\n<details style=\"border: 1px solid #e0e0e0;border-radius: 4px;margin-bottom: 10px;background-color: #ffffff\">\n<summary style=\"padding: 15px;font-size: 1.15em;font-weight: bold;color: #1b5e20;cursor: pointer;border-left: 6px solid #1b5e20\">The accumulation of chronic allostatic stress<\/summary>\n<div style=\"padding: 15px;border-top: 1px solid #e0e0e0;color: #242424;line-height: 1.6;background-color: #fafafa\">\n<p><strong>White racial framing<\/strong><\/p>\n<ul>\n<li>The disrespectful and discriminatory behaviour of nutrition professionals who belittle cultural foods and ways of eating indirectly requests that Black patients deny parts of their cultural identity (Kumanyike, 2006)<\/li>\n<\/ul>\n<p><strong>Pathologizing health management adaptations (e.g. cultural racism)<\/strong><\/p>\n<ul>\n<li>Nutrition professionals pointing blame at cultural and individual eating patterns and cooking traditions (e.g. cooking with oils high in saturated fats such as palm oil or regular inclusion of large portions of starchy foods like provisions)\u00a0 for health issues (e.g. diabetes, hypertension, obesity) while ignoring the current and historic systemic inequalities that perpetuate health issues (Ng, 2023).<\/li>\n<\/ul>\n<p><strong>Black communities&#8217; distrust of non-black nutrition professionals and their messages<\/strong><\/p>\n<ul>\n<li>Black patients withholding essential information to avoid judgement, being controlled or being harmed. (e.g. not telling a dietitian about their complementary and alternative medicines)<\/li>\n<li>Black people avoiding or ignoring recommendations intended to improve their health, rendering public health nutrition strategies and clinical dietetic interventions useless. (Etowa, Beagan, Eghan &amp; Bernard, 2017; Beagan &amp; Chapman, 2012).<\/li>\n<\/ul>\n<\/div>\n<\/details>\n<\/div>\n<p>Ultimately, we cannot speak about public health disparities that affect <a href=\"\/\/pressbooks.library.torontomu.ca\/abrdietetics\/back-matter\/glossary\/)\">racialized <\/a>populations without directly examining how our systems, institutions, and clinical cultures construct these conditions. Doing so leads to the development of chronic diseases within the Black community while also facilitating the visual and systemic erasure of Black individuals (Balde &amp; Perreault, 2026).<\/p>\n<p>The upcoming series of case studies and video interviews in the next few chapters offers direct insight into the variety of ways anti-Black racism within food, nutrition and dietetic practices impacts Black individuals and communities, patients and practitioners, students and educators.<\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><span style=\"color: #000000\"><strong>Video 4.1: <\/strong>Matthew Adgbuyi, a Black Dietitian from Alberta, lists and describes three ways ABR manifests in the dietetic profession and how they can negatively impact the health and well-being of Black Canadians.<\/span><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Chapter 4 Manifestation of ARB in Nutrition Part 1\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/RlnVAM-Imiw?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><span style=\"color: #000000\"><strong>Video 4.2: <\/strong>Three Black Canadian Registered Dietitians from Quebec and Nova Scotia talk about how anti-Black racism and biases manifest health inequities for Black Canadians<\/span><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Chapter 4 Manifestation of ABR in Nutrition Part 2\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/yuq1WgtM5bs?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<\/div>\n<\/div>\n<div class=\"textbox__content\" style=\"padding: 0 40px 30px 40px !important;overflow: hidden\"><\/div>\n<div class=\"textbox textbox--exercises\" style=\"width: 100% !important;max-width: 100% !important\">\n<header class=\"textbox__header\">\n<h3 class=\"textbox__title\" style=\"color: #000000 !important;margin: 0;padding: 0\"><strong>Stop and Reflect<\/strong><\/h3>\n<\/header>\n<div class=\"textbox__content\" style=\"padding: 0 40px 30px 40px !important;overflow: hidden\">\n<div style=\"max-width: 100%;margin: 0 auto\">\n<p style=\"line-height: 1.5;color: #111111;margin-bottom: 20px\"><strong>The issues of weight bias and stigma, the myth of laziness, and not trusting Black people to make intelligent, informed and ethical decisions about their health and the health of their loved ones are deeply rooted in anti-Black racist and dehumanizing beliefs used to justify the Atlantic Slave Trade.\u00a0<\/strong><\/p>\n<p>Go down the rabbit hole and see it for yourself. Search for these racist historical views online (i.e. academic databases, search engines, Google Images), and reflect on your findings. How do they relate to what you might have been taught, what you teach or how you practice nutrition and dietetics?<\/p>\n<ol>\n<li>Slavery and fatphobia<\/li>\n<li>Slavery and the myth of laziness<\/li>\n<li>Black intellectual inferiority and slavery (Thomas Jefferson, Benjamin Banneker)<\/li>\n<\/ol>\n<div style=\"background-color: #ffffff;border: 1px solid #ccd1d9;border-radius: 6px;padding: 18px\">\n<p><label style=\"font-weight: bold;margin-bottom: 8px;color: #242424\" for=\"safe-spaces-journal\">Type your reflection below:<\/label><\/p>\n<div style=\"justify-content: space-between;align-items: center;margin-top: 10px;flex-wrap: wrap;gap: 10px\">\n<p><span id=\"safe-spaces-status\" style=\"font-size: 0.9em;color: #6b7280;font-style: italic\">Your writing saves automatically in this browser as you type.<\/span><\/p>\n<p><button id=\"safe-spaces-clear\" style=\"background: #fdfaf9;border: 1px solid #b91c1c;color: #b91c1c;padding: 6px 14px;border-radius: 4px;font-size: 0.9em;cursor: pointer\" type=\"button\">Clear reflection<\/button><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"author":503,"menu_order":1,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-445","chapter","type-chapter","status-publish","hentry"],"part":442,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/chapters\/445","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/wp\/v2\/users\/503"}],"version-history":[{"count":88,"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/chapters\/445\/revisions"}],"predecessor-version":[{"id":3737,"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/chapters\/445\/revisions\/3737"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/parts\/442"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/chapters\/445\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/wp\/v2\/media?parent=445"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/pressbooks\/v2\/chapter-type?post=445"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/wp\/v2\/contributor?post=445"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/abrdietetics\/wp-json\/wp\/v2\/license?post=445"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}