In Canadian health-care research, “who is Black” can vary widely

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The inability to find a common term to describe Black people in Canadian health research can perpetuate inequities, a University of Ottawa professor says.

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We need precise, accurate language because research informs public health policies, training for health-care workers and culturally appropriate and antiracist health-care practices, says Dr. Jude Mary Cénat, an associate professor of psychology and the director of University of Ottawa’s Interdisciplinary Centre for Black Health, Canada’s first academic research centre dedicated to studying the biological, social and cultural determinants of health for Black communities.

In Canadian health-care research, the definition of “who is Black” can vary widely. Terms such as “African-Canadian,” “Caribbean” and “African” are inconsistent and make it difficult to compare studies, he says.

The terms may include people who do not identify as Black, such as those who are from North Africa, and people from Caribbean nations including Cuba, the Dominican Republic and Puerto Rico, who consider themselves to be Latin American.

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From a health research point of view, that can be a problem, Cénat says. One example: A 2019 review of breast and cervical cancer among “Black Canadian” women included 23 studies, but only seven had unambiguously Black participants. Some studies considered “Africa” as a single block and included participants from North Africa, who may self-identify as Arab.

“Most people from Africa are Black. But you can’t assume they are Black,” Cénat says. “You can’t say Elon Musk (who was born in South Africa) is Black.”

Meanwhile, studies rarely differentiate between Black people whose ancestors have lived in Canada for centuries and those who are recent immigrants, he says. The 2016 census found that the 10th most commonly listed country of origin for people in Canada self-identifying as Black was the United States.

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Getting a more precise answer may be as simple as asking people “What is your skin colour?” says Cénat, whose commentary was published this week in the Canadian Medical Association Journal.

Researchers have to ask multiple questions, but the first one is how the subject identifies themselves, he says.

Cénat suggests asking research subjects the basic question: What is your skin colour? From there, it can lead to unraveling other questions about origins and ancestry. It’s also important to give research participants the opportunity to give more than one answer so that multiracial people can self-identify.

Asking questions related to race, ethnicity and region of origin may make some people uncomfortable. “We avoid that question. We ask people about their origin, not their skin colour,” Cénat says.

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But health researchers can preface their questions by explaining why the questions are being asked and saying that the answers may help to improve health care for Black people in Canada.

“Researchers don’t have to be afraid of it,” he says.

If Black health research continues to be based on data that are unclear or inaccurate, there’s a risk that policies and programs will not meet the real needs of Black communities, Cénat warns.

Asking the right questions can also tease out more nuanced answers. For example, while the prevalence of diabetes is higher in Black communities than in the general population, some Black communities in Canada may be at more or less risk than others.

Cénat points out that, in Ottawa, racial minorities represent more than 30 per cent of the population.

“We need this because our population is a diverse population. We need to know more about the risk factors and the protective factors,” says Cénat, who studies the role that cultural factors play in vulnerability, trauma and resilience.

“We need to work with racial data that is precise. We need to say 10, 20, 30 years in the future that we have done something for these communities.”