BY TYNE M. LUNN, SARAH LOGAN, MELANIE DOIRON, CHERYL CAMERON
We acknowledge the original homelands of the many diverse First Nations, Métis and Inuit peoples whose ancestors have walked this land since time immemorial. We are grateful to live, work and play on the traditional territories belonging to the First Nations, Métis and Inuit Peoples of Turtle Island.
“It is a privilege to educate yourself about marginalization rather than experience it.” – Dr. Farha Shariff (intersectional feminist and antiracist educator)
How we obtain knowledge and form our worldview is connected to who we are and our position in society. (1) As authors, we recognize that we are a congregate of European white settler descendants. Our intersectional identities, such as identifying as women, afford us both the benefits of white privilege and experiences with marginalization. As we explicitly explore racism, this content may evoke strong emotional reactions of defensiveness, shame, guilt or grief. Discomfort with terms such as white people, white supremacy, racist and racism can be barriers for meaningful discussion. We must be emotionally aware to ensure that our reactions do not block our learning and instead provide the drive to push us toward intellectual curiosity and expanded worldviews.
Let’s Get Uncomfortable
Productive conversations about race requires expanding the idea that racism is limited to individual attitudes, to a greater understanding that racism is inherited by unquestioned societal norms. Racism designates one group superior to others because of their colour or ethnicity. (2) Dr Ibram X. Kendi highlights the harmful outcomes of racism, identifying it as a social construct “of racist policies and racist ideas that produces and normalizes racial inequities.” (3) A racist policy is “any measure that produces or sustains racial inequity between racial groups” where policy refers to “written, unwritten laws, rules, procedures, processes, regulations and guidelines that govern people.” (3) Furthermore, a racist is not isolated to one who hates; a racist is any person who benefits from and perpetuates racial inequity in society, through action or inaction. (3)
The Origins of Racism in Canada
The structures of today have historical origins and our white supremacist colonial history designates Canada as a pervasively racist nation. (4) “Canada has found a way to exclude both the racialized immigrants seeking to come here since Confederation and the racialized Indigenous peoples who were here millennia before European settlers.” (5) Although today’s generations did not create these structures, inequities persist and are upheld through ongoing racist systems, laden with racist policies reflected in “significant educational, income, health and social disparities between [Indigenous] people and other Canadians.” (6,7)
White People and Privilege
White people often feel discomfort acknowledging the concept of white privilege. Canadian society structures whiteness as the default, therefore we are not required to racially identify ourselves. To see one’s race as having no significance to accessing health, security and opportunity is an idea unique to white people. (1) White privilege does not mean that white people do not struggle; it means that our struggles are not a result of our skin colour. (1,8) Nor does it assume the accomplishments of white people are unearned. White privilege means we possess a built-in advantage because whiteness is dominant in our society. (1,8)
“Implicit bias refers to attitudes that affect our understanding, actions and decisions in an unconscious manner.” (9) Implicit or unconscious biases affect everyone. In the paramedic context, biases influence decision making directly impacting patient care. This is particularly relevant to paramedic practice because of the high stress, high cognitive load we encounter daily in the work we do. (10) Where implicit biases permeate our clinical practice, they contribute to errors in judgement and critical thinking like treating a hypoglycemic patient as an opioid overdose, assuming a differential diagnosis of anxiety, or anchoring to dispatch notes while overlooking pertinent assessment findings. For example, work by Lord and Khalsa (11) found that paramedic students were suboptimal in their administration of analgesia to racialized patients.
Prowhite bias in healthcare providers, including paramedics, has been identified across many studies. (9) The disparities facing racialized patients creates mistrust with healthcare providers, leading to patients avoiding necessary care, resulting in poorer health outcomes and further marginalization. (7,12)
Racism in Healthcare
Racism exists in all areas of Canadian healthcare; it occurs even in diverse and inclusive spaces. A blatant case is the abuse seen in Joyce Eschequan’s live stream moments before her death in a Quebec hospital. (13) We witness it when clinicians gamble on racialized patients’ blood alcohol levels in British Columbia (14) or when a physician hangs a noose on an operating room door in Alberta. (15,16) Because societal systems reinforce the idea that racialized lives are inferior to white ones, we can see how neglecting the health needs of Brian Sinclair contributed to his death in a Manitoba emergency department. (17) Examples that make mainstream news are not isolated events. Where overt racial discrimination is occurring, countless more implicit racist ideas and behaviours are festering beneath the surface. (18,19)
Racism is perpetuated by a failure to recognize that both actions and inactions reinforce racial biases and prejudices. When white people insist our intentions aren’t racist, we are centering the interaction on ourselves and diminishing the racialized person’s experience. This reinforces white dominance. Unintentional offence does not negate the harm experienced by racialized coworkers and patients.
|Racism is . . .|
|● comments cast off as jokes (“I was just kidding”)
● asking where a racialized person is from (“where are you really from?”)
● assuming persons with similar coloured skin tone can provide language translation
● claiming colour-blindness or race neutrality
● lack of cultural literacy and centering white perspectives, cultures and traditions
● not believing or dismissing racialized perspectives and experiences
● shortening or not learning how to properly pronounce ethnic names
● asking Indigenous patients if they have consumed drugs or alcohol, but not asking this consistently of all patients
● underrepresentation of racialized populations in evidence based scientific medical study
● presuming underlying prejudicial health conditions
● assuming racialized persons are dangerous or deviant
● assuming inferior intelligence or capabilities when English is not their first language
● discriminatory hiring practices/policies, tokenism, exclusion from policymaking, lack of representation in leadership, and lack of support/psychological safety for racialized colleagues
Racism in paramedicine is not limited to patient care, it permeates our post-call discussions with colleagues. We talk about “ethnic drama” or how our patient played the “race card” and was “reverse racist” towards us. It seeps into our exchanges with well-meaning elderly patients whose overt racism makes us so uncomfortable we stay silent. The language we use matters. Our documentation matters. How we talk among peers about the communities we serve matters. Prejudicial expressions contribute to toxic and psychologically unsafe work environments that normalize microaggressions levied at racialized colleagues.
If we acknowledge that healthcare inequities cause poor outcomes (7) but fail to recognize that racism is a key social determinant of healthcare inequities, we continue to cause harm. Paramedics are continually incorporating new evidence into practice. The same dedication applied to evidence-based clinical practice must also be applied to our social responsibilities and obligations to our patients, peers, profession and communities.
So Now What?
Although not our intention, we have been socialized to be racist. Many of us struggle to identify and admit our own biases and prejudices because it chips away at the positive attributes and perceptions we identify with. (10) So, what can you do to explore your biases, reconcile feelings like guilt and shame and change your behavior going forward?
Identify and Address Your Bias
- Take the Implicit Association Test (20) which takes you through an exercise to assess and identify your biases across different domains such as race, religion, weight and age.
- Self-reflect on your results and review the reflective articles to help you debrief and digest the different thoughts and feelings you may be experiencing.
Commit to challenging your assumptions and unconscious biases.
Implicit Association Test
|● The Actual Versus Idealized Self: Exploring Responses to Feedback About Implicit Bias in Health Professionals (10)
● Using the IAT: How Do Individuals Respond to Their Results? (21)
Listen and Learn
Authentic allies do the work. It is not the responsibility of racialized peoples to teach us about racism; the onus is on white people to learn how racism harms and what it means to be antiracist. Asking a racialized person to explain their experiences demands they endure the emotional labour of their repeated suffering for your benefit. People of colour have been sharing their stories and recording their pain and trauma for generations; there is no shortage of content.
Racism, with its harmful implications, is structured into the DNA of Canadian society. We are called to be antiracist in both our professional and personal lives. As long as we remain reluctant to talk openly about racism in paramedicine, we will hold our profession back from our duty to provide equitable services. Antiracism starts with identifying our positionality in society, cultivating a genuine curiosity and recognizing this will be continuous and uncomfortable work. It requires us to think critically about our experiences and challenge our assumptions and sources of knowledge.
Diversify your circles, listen with the intention to understand and commit to being an antiracist ally for those you serve alongside and care for. Brené Brown teaches that shame is not a productive social justice tool; “you cannot shame or belittle people into changing their behaviours.” (22) Instead of calling people out, let’s expand worldviews by calling people IN (1) to a compassionate antiracist culture of humility, accountability and respect. Paramedics are problem solvers, let us address the urgent need for antiracism in Canadian paramedicine now. Focus on equity; equity always – in all ways.
“Do the best you can until you know better. Then when you know better, do better.” – Maya Angelou
|● Truth and Reconciliation Commission Final Report & Calls to Action
● White Fragility – Robin DiAngelo
● The Inconvenient Indian – Thomas King
● How to Be An Antiracist – Ibram X. Kendi
● So you want to talk about race – Ijeoma Oluo
Acknowledgements and Disclaimer
The authors would like to acknowledge and thank Wendy Goulet, Aisha Ali, Laura Hirello and Kathleen Fraser for their time in reviewing this article. The views and opinions are those of the authors and do not reflect official policy or position of any employer or organization.
- Shariff FD. It’s time to get real about antiracism [Internet]. Webinar presented at: Alberta Teachers’ Association Diversity, Equity and Human Rights Antiracism and Antioppression Speaker Series; 2021 Mar 13; Edmonton, Alberta. Available from: https://sched.co/gimt
- CRRF Glossary of Terms [Internet]. [cited 2021 Mar 18]. Available from: https://www.crrf-fcrr.ca/en/resources/glossary-a-terms-en-gb-1
- Kendi IX. How To Be An Antiracist. New York: One World; 2019.
- King T. The Inconvenient Indian: A Curious Account of Native People in North America. Anchor Canada; 2012.
- Cole D. The Skin We’re In: A Year of Black Resistance and Power. Doubleday Canada; 2020.
- Truth and Reconciliation Commission of Canada. Honouring the truth, reconciling for the future: summary of the final report of the Truth and Reconciliation Commission of Canada. [Internet]. 2015 [cited 2021 Mar 30]. Available from: http://epe.lac-bac.gc.ca/100/201/301/weekly_acquisition_lists/2015/w15-24-F-E.html/collections/collection_2015/trc/IR4-7-2015-eng.pdf
- Razai MS, Kankam HKN, Majeed A, Esmail A, Williams DR. Mitigating ethnic disparities in covid-19 and beyond. BMJ. 2021 Jan 15;372:m4921.
- Wilkerson I. Caste: The Origins of Our Discontents. New York: Random House; 2020.
- Zeidan AJ, Khatri UG, Aysola J, Shofer FS, Mamtani M, Scott KR, et al. Implicit Bias Education and Emergency Medicine Training: Step One? Awareness. AEM Education and Training. 2019;3(1):81–5.
- Sukhera J, Milne A, Teunissen PW, Lingard L, Watling C. The Actual Versus Idealized Self: Exploring Responses to Feedback About Implicit Bias in Health Professionals. Academic Medicine. 2018 Apr 1;93(4):623–9.
- Lord B, Khalsa S. Influence of patient race on administration of analgesia by student paramedics. BMC Emerg Med. 2019 Dec;19(1):32.
- FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Med Ethics. 2017 Dec;18(1):19.
- Richardson L. Quebec promises investigation after Atikamekw mother live-streams moments before her death [Internet]. APTN News. 2020 [cited 2021 Mar 25]. Available from: https://www.aptnnews.ca/national-news/quebec-promises-investigation-after-atikamekw-mother-live-streams-moments-before-her-death/
- B.C. health workers allegedly bet on Indigenous patients’ blood alcohol levels | Globalnews.ca [Internet]. [cited 2021 Mar 25]. Available from: https://globalnews.ca/news/7085230/bc-health-care-racist-allegations/
- Alberta health minister orders review 4 years after noose hung at Grande Prairie hospital | CBC News [Internet]. [cited 2021 Mar 25]. Available from: https://www.cbc.ca/news/canada/edmonton/alberta-health-minister-review-noose-grande-prairie-hospital-1.5636090
- Alberta surgeon who hung noose in hospital found guilty of unprofessional conduct [Internet]. Global News. [cited 2021 Mar 25]. Available from: https://globalnews.ca/news/7574343/grande-prairie-surgeon-hospital-noose-conduct/
- Sep 18 AG· CN· P, September 19 2017 9:53 PM CT | Last Updated: 2017. Ignored to death: Brian Sinclair’s death caused by racism, inquest inadequate, group says | CBC News [Internet]. CBC. 2017 [cited 2021 Mar 25]. Available from: https://www.cbc.ca/news/canada/manitoba/winnipeg-brian-sinclair-report-1.4295996
- Turpel-Lanfond (Aki-Kwe) ME. In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health care [Internet]. 2020. Available from: https://engage.gov.bc.ca/app/uploads/sites/613/2021/02/In-Plain-Sight-Data-Report_Dec2020.pdf1_.pdf
- Commission V. Public Inquiry Commission on relations between Indigenous Peoples and certain punlic services in Québec: listening, reconciliation and progress [Internet]. 2016. Available from: https://www.cerp.gouv.qc.ca/fileadmin/Fichiers_clients/Rapport/Summary_report.pdf
- University H. Project Implicit [Internet]. Available from: https://implicit.harvard.edu/implicit/takeatest.html
- Schlachter S, Rolf S. Using the IAT: how do individuals respond to their results? International Journal of Social Research Methodology. 2017 Jan 2;20(1):77–92.
- Brené on Ask Me Anything, Part 1 of 2 [Internet]. [cited 2021 Mar 30]. Available from: https://open.spotify.com/episode/5f4bgRWkDHBLopdOshelQv
About the Authors
Tyne M. Lunn is an Advanced Care Paramedic currently serving in a Community Paramedic specialty role on Treaty 8 Territory in Northern Alberta. Tyne is a patient and community advocate contributing to accessible healthcare equity through multidisciplinary provincial and national committees, project work, research and leadership. Twitter: @Tyne_River Email: tyne.lunn@AHS.ca
Sarah Logan is a Primary Care Paramedic serving the urban prehospital patients of Amiskwaciwâskahikan / Edmonton, Alberta. Her passion for healthy and inclusive communities has lead her to additional roles supporting community engagement and development. Sarah is currently pursuing her Bachelor of Health Administration studies at the University of Athabasca. Email: sarah.logan@AHS.ca
Melanie Doiron is an advanced care paramedic currently working as a Project Manager for a large healthcare organization. Her resourcefulness and innovative spirit has led to the successful development and implementation of large-scale quality improvement initiatives across different health care settings. Melanie holds a bachelor’s degree in general studies, is completing a master’s degree in health studies, and is a fellow with The McNally Project for Paramedic Research. Follow me on Twitter at https://twitter.com/msmelanie_d or LinkedIn at https://ca.linkedin.com/in/melanie-doiron-3799231b8
Cheryl Cameron is an Advanced Care Paramedic and currently the Director of Operations at Canadian Virtual Hospice. She is a member of the leadership team at the Paramedic Pay it Forward Award, provides educational and operational program expertise on a number of national initiatives in the sphere of paramedicine and palliative care and is a fellow with the McNally Project for Paramedic Research. Follow Cheryl on Twitter @cherylcookie21 or find her on LinkedIn. firstname.lastname@example.org