Black Mental Health Day: don’t deny Anti-Black Racism – defy it

The City of Toronto proclaimed March 2nd, 2020 as the first annual "Black Mental Health Day”. From this day forward in Toronto, the first Monday of the month of March will be used to create awareness of the impacts of anti-Black racism on the mental health of Black communities. Moreover, it will be a day to amplify the calls for action to address those impacts.

It’s a controversial and innovative move, in my opinion. While the idea of a Black Mental Health Day is potentially beneficial, the risk is that it could be misunderstood as a day to highlight a “Black problem”. In reality the converse is true, it is a day to emphasize the consequences of society’s mistreatment of Black people.

I am a Black female doctor. Specifically I am a public health physician and educator who teaches students and health professionals about the health impacts of racism. In that context I have been getting questions from non-Black colleagues and as well as from Black community members (mainly from other cities in Ontario) asking “why do Black people need a mental health day?” So I’m writing this article to describe how racism impacts health, based on the current research. I would also like to provide my own perspective on this issue as a Black Canadian.

How does racism impact health?

There is a substantial and growing body of research linking racism to poorer mental and physical health [1, 2, 3]. Before going any further, let me clarify what I mean by ‘racism’. To quote the work of Dr. David Williams, the world renown Harvard professor of sociology and epidemiology:

 “Racism is an organized social system in which the dominant racial group, based on an ideology of inferiority, categorizes and ranks people into social groups called “races” and uses its power to devalue, disempower, and differentially allocate valued societal resources and opportunities to groups defined as inferior… A characteristic of racism is that its structure and ideology can persist in governmental and institutional policies in the absence of individual actors who are explicitly racially prejudiced”[1].

So at its core, racism is a system (which was established a long time ago) and it influences our culture, beliefs and biases in North America. To be clear, the interactions between individuals is just a superficial manifestation of racism. Even if individuals are not intentionally doing something racist, they still may be upholding policies, practices, and work cultures that unfairly advantage the dominant group, and unfairly disadvantage the minority group. Systemic racism is deeply embedded in Canadian institutions, as identified by the United Nations[4]. It is also a problem that has been formally recognized by the Canadian government [5].

According to Toronto Public Health, “There is also a substantial body of evidence demonstrating a relationship between experiencing racial discrimination and negative mental and physical health outcomes”[3]. Most of this evidence comes from the US but there are other studies that demonstrate that this occurs in many other countries. The greatest health impacts appear to be in the realm of mental health. But there are numerous studies linking the stress of racism to poorer physical health outcomes, particularly risk factors for cardiovascular disease (e.g. high blood pressure) [1].

I teach my students that there are two main mechanisms by which systemic racism can impact health – direct and indirect pathways. The “direct pathway” is really through the everyday stress of dealing with discrimination in the form of micro-aggressions , the anticipation of potential racism (e.g. vigilance – many people “bleach CV’s” in anticipation of racism); or vicarious experiences of discrimination (e.g. An American study found that each police killing of an unarmed Black male worsened mental health among Blacks in the local community) [6, 7]. Put simply, being exposed to subtle forms of racism on regular basis is stressful, and this can take a toll on one’s mental and physical health.

Then there is what I term the “indirect pathway” in which historically racialized groups, particularly those of African or Indigenous ancestry [1], experience unequal and unjust treatment via the legislation, policies and practices of major institutions (e.g. educational system, employment), leading to poorer outcomes compared to White Canadians. This can occur whether they are consciously aware of it or not. Put simply, the greatest driver of ill health in North America is poverty [8, 9], and in Canada poverty is racialized [10]. According to a report by the Wellesley Institute, a Black Canadian earns 75.6 cents for every dollar a non-racialized worker earns, even when you take into account education level and immigrant status [10]. Another Canadian report demonstrated that a university educated Indigenous person working in the private sector makes on average 44% less than their non-Indigenous peers [11]. In other words, an Indigenous or racialized person might be at a lower income status despite their education, or find themselves working more hours to achieve the same income as their white counterparts. The bottom line is that these racial differences in access to educational or employment opportunities are likely to impact racialized peoples’ health outcomes in Canada [12].

Anti-Black racism is a specific type of racism. According to the government of Ontario, “Anti-Black racism is prejudice, attitudes, beliefs, stereotyping and discrimination that is directed at people of African descent and is rooted in their unique history and experience of enslavement” [13]. As stated by the Canadian Public Health Association, “Anti-black racism is ubiquitous in many Canadian institutions and is responsible for perpetuating contemporary Black poverty and unemployment, racial profiling, law enforcement violence, incarceration, immigration detention, deportation, exploitative migrant labour practices, disproportionate child removal and low graduation rates”[14]. For Black youth growing up in a society where anti-Black racism is commonplace, the stereotypes which were originally used to justify slavery (e.g. the myth that Blacks are less intelligent) can be internalized so that Black youths end up believing the stereotypes are actually true. Or in other cases, Black youth may end up working harder to overcome, and thereby they may overcompensate, sometimes to their own detriment (e.g. stereotype threat  [15]).  Or Black youth may successfully overcome these challenges but still may end up experiencing the continual stress and the isolation of being ‘the only one’ or ‘the token’[16]. Last month Dr. Kwame McKenzie, psychiatrist and Director of Health Equity at the Centre for Addiction and Mental Health, wrote an article in the Toronto Star focusing on the mental health impacts of anti-Black racism. He pointed out that “Racism makes the lives of the Black population worse than others and increases the rates of psychosis and depression by 200 to 300 per cent”[17].

So, what does this doctor think about Black Mental Health Day?

My opinion about Black Mental Health Day is based on both the scientific evidence linking racism to poorer mental health outcomes, as well as my lived experience as a person who was born and raised in Canada. I grew up in Montreal to a father from Nigeria and a mother from  Trinidad. What I saw as a child in the 1980s and teen in the 90s was the lack of opportunities for Black people. I feel this was the most damaging experience and worst cause of stress for me, my family and my community. Yes, I had incidents of inter-personal racism as a youth – being called the “N” word, kids refusing to play with me, teachers making assumptions about my intellect due to my skin color. Each incident was very painful but I was fortunate to have supportive parents and a strong community to help me maneuver those stressful and confusing situations. But I think the most damaging part was all the indirect impacts of racism (i.e. systemic racism) that were happening around us.  

In our youth, my peers and I saw that parents who pursued higher education in Canada were grossly underemployed or unemployed. Years later I read a study by researchers from McGill University that reviewed census data from 1996-2006. They reported that in Montreal, Blacks earned less than their non-Black counterparts within each occupational category. Specifically, they found that“Black persons with a graduate degree had higher unemployment rates than non-Black high school drop outs (13.4% vs. 12.0%) [18]. I didn’t understand it at the time, but I saw the impacts of systemic racism firsthand. For many Black youth there was a loss of faith in the educational system. This was particularly true for the boys, many of whom experienced the turmoil created by fathers who were not able to provide for their families. As kids we could not articulate it but we had a sense that our skin color had created limitations for us. We thought that maybe we could overcome those limitations, but it was an extra problem that our white counterparts were not grappling with during those complex teenage years.

During that time it was another painful reality check for me to realize that issues of youth violence were treated differently depending on the race of the people involved. In one incident a white teenager was shot in a drive-by shooting. There was media narrative that suggested that the shooting represented an urgent problem. There was a public outcry to change gun laws to help stop the violence. It felt very different compared to when a Black teen got shot by a stray bullet, and there was no demand for action by mainstream society to protect Black youth. If anything, there was a public narrative that further criminalized Black youth. As teenagers many of us could quickly do the math and figure out how society valued us based on the color of our skin.

Let me tell you, that’s stressful. It’s demoralizing. It’s depressing. Even in the absence of clinical depression it is an added layer of stress that white Canadian youth do not experience. Let us all acknowledge that LIFE is stressful for any human being, but if you add the social label “Black” to it, systemic anti-Black racism amplifies that stress and likely worsens the outcomes. Even for those like me who grew up with a LOT of family and community support, there is still the stress and isolation of being the ‘only one’ in certain spaces, having to represent your entire race in the classroom, boardroom, hospital – you name it. It puts you in the position where you feel that you must work twice as hard to overcome all the anti-Black stereotypes, while also trying to support and contribute to a community deeply impacted by the consequences of anti-Black racism. It takes a toll no matter your age, education level or socioeconomic status.

 A Social Prescription for all of us regarding racism: don’t deny it, defy it

In my opinion, we need Black Mental Health Day. Last week, I watched an interview with motivational speaker Les Brown. He was talking about the social labels that sometimes limit us and he recommended two steps to overcome this: 1) don’t deny it; and 2) defy it [19]. This is a great social prescription for anti-Black racism, perfect for us to think about for Black Mental Health Day. When it comes to anti-Black racism, don’t deny it, defy it -- at the societal level, the community level and the individual level.

We as a society need to understand and come to terms with the fact that anti-Black racism is real and harmful. We need to defy it and ensure there is an anti-racist/anti-colonialist lens to our legislation, our institutions, and our daily behaviours. We need policies and practices in Canadian schools, workplaces and healthcare to be inclusive, culturally safe environments. The Black Mental Health Day campaign also calls for “more support and access to culturally appropriate mental health services and programs for Black residents”, and I think that’s a great thing.

At the Black community level we need to defy racism as we always have, by celebrating our collective resilience through centuries of oppression, colonialism and slavery. But we also need to work to destigmatize the mental health challenges in our community — stigma and silence is not helping us. Black Mental Health Day focuses on “community-held events to start discussion and engagement with these issues”, and I think this is critical. In particular, TAIBU Community Health Centre has done a phenomenal job of leading this work. 

And finally as individuals we must defy racism as well. For those who are not Black, the City of Toronto recommends that this is a day to “pause, reflect and raise awareness about the barriers and negative impact of anti-Black racism on the mental health for all Torontonians”. For those of us who are Black, we must not internalize the labels and stereotypes and make sure that if we need care, we go get it and continue to advocate for quality care. Don’t give up, we need to stay connected — connected both to people who look like us and also those who do not look like us, because any human being who faces the unique challenges and stresses that we face would need support. And we need to remember the practices our ancestors have used to find joy, despite the oppression. I host a podcast called Race, Health & Happiness, which is about staying well in a racialized world. To quote one of my guests, Ritu Bhasin:

“So many of us come from ancient and indigenous cultures where our practices for hundreds and thousands of years have been rooted in a way to help us heal the body and keep the body strong and were vilified by colonizers… we have lost touch with those practices.”

We need to identify the best (and ideally, evidence-informed) Western and traditional ways of promoting wellbeing – whether that is conventional pharmacotherapy, culturally-adapted talk therapy , meditation or healing circles.

Personally, I am in full support of the concept of Black Mental Health Day. It’s controversial but well worth it because the status quo is harmful to all of us as a society. It’s time for everyone to understand that anti-Black racism is a health problem. Let’s STOP DENYING and START DEFYING the systems, structures, beliefs and practices that maintain anti-Black racism.

Sources are hyperlinked. Views are my own.

Onyenyechukwu Nnorom, MDCM, MPH, CCFP, FRCPC

Dr. Onye Nnorom is a family physician and public health and preventive medicine specialist. She is Assistant Professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health at the University of Toronto. She is also the President of the Black Physicians’ Association of Ontario, and the host of the Race Health & Happiness podcast which is about staying well despite systemic racism. Twitter/Instagram: @RaceHealthHappy