Chapter 1: Understanding Racism and Anti-Black Racism

Understanding Anti-Black Racism in Health and Healthcare

Have you ever been told to love the skin you were born in because that is the skin you will die in? What if the skin you were born in is quite literally the source of illness and even death? In countries where race-based health data are gathered, racism is recognized as an illness-inducing oppression that is linked to poor health outcomes.

A research team at Harvard University linked racism and racial discrimination to higher rates of morbidity and mortality among racialized groups in the US (Williams et al., 2016). Racialized people must contend with racial inequities, exclusion, poverty, community violence, stressful encounters in public spaces, incarceration, and even murder of family members. The associated stress is linked with greater risk for cardiovascular diseases, diabetes, and liver and kidney diseases. Black people not only have an earlier onset of these diseases, but also higher death rates (Calvin et al., 2003; Clark et al., 1999; Williams, 2012; Williams & Williams-Morris, 2000).

Researchers in many countries have also identified an association between racism and mental health. Studies in the UK and the US have confirmed more diagnosis and severity of psychosis-related mental illness among Black people of Caribbean and African heritage (Mouzon & McLean, 2017; Nazroo et al., 2020). 

Racism is also associated with negative effects during pregnancy: studies in the US and Canada have found that Black women are more likely to experience perinatal loss, and more likely to die from pregnancy-related complications (Berger et al., 2019; Taylor, 2020). The chronic stress of racism has stronger effects on pregnancy among Black women, regardless of socioeconomic status.

Kim Anderson’s Story video [6:08]

Overall, racism affects physical and mental health in many ways due to the multiple forms and levels of discrimination, and the continuous exposure to stress (Williams & Etkins, 2021). Anti-Black and other forms of racism play a significant role in social and health disparities within Canada. Race-based data are rarely collected in Canada, but we know that anti-Black racism creates inequitable access to healthcare resources for Black Canadians, reflecting similar health trends in the US (Dryden & Nnorom, 2021).

The Canadian healthcare system is generally admired, but our healthcare practices continue to be influenced by colonial practices and Eurocentric culture (Simpson, 2012). We want a healthcare system that is reflective of Canada’s diverse society. We need to start in our classrooms, our clinical settings, and our communities. We must listen to the voices of those experiencing racism to learn about how racism affects their health.


Berger, H., Melamed, N., Murray-Davis, B., Hasan, H., Mawjee, K., Barrett, J., McDonald, S. D., Geary, M., & Ray, J. G. (2019). Prevalence of pre-pregnancy diabetes, obesity, and hypertension in Canada. Journal of Obstetrics and Gynaecology Canada, 41(11), 1579–1588.

Calvin, R., Winters, K., Wyatt, S. B., Williams, D. R., Henderson, F. C., & Walker, E. R. (2003). Racism and cardiovascular disease in African Americans. The American Journal of the Medical Sciences, 325(6), 315–331. 

Clark, R., Anderson, N. B., Clark, V. R., & Williams, D. R. (1999). Racism as a stressor for African Americans: A biopsychosocial model. American Psychologist, 54(10), 805–816.

Dryden, O., & Nnorom, O. (2021). Time to dismantle systemic anti-Black racism in medicine in Canada. Canadian Medical Association Journal, 193(2), E55–E57. 

Mouzon, D. M., & McLean, J. S. (2017). Internalized racism and mental health among African-Americans, US-born Caribbean Blacks, and foreign-born Caribbean Blacks. Ethnicity & Health, 22(1), 36–48. 

Nazroo, J. Y., Bhui, K. S., & Rhodes, J. (2020). Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociology of Health & Illness, 42(2), 262–276. 

Simpson, J. (2012). Chronic condition: Why Canada’s health care system needs to be dragged into the 21c. Penguin Canada.

Taylor, J. K. (2020). Structural racism and maternal health among Black women. Journal of Law, Medicine & Ethics, 48(3), 506-517. 

Williams, D. R. (2012). Miles to go before we sleep: Racial inequities in health. Journal of Health and Social Behavior, 53(3), 279–295. 

Williams, D. R., & Etkins, O. S. (2021). Racism and mental health. World Psychiatry, 20(2), 194.

Williams, D. R., Priest, N., & Anderson, N. B. (2016). Understanding associations among race, socioeconomic status, and health: Patterns and prospects. Health Psychology, 35(4), 407–411.

Williams, D. R., & Williams-Morris, R. (2000). Racism and mental health: The African American experience. Ethnicity & Health, 5(3–4), 243–268.

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