Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context

ABSTRACT

Objectives

A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients’ attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care.

Design

This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically.

Results

Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination.

Conclusion

Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.

KEYWORDS:

• internalized racism
• appropriated racial oppression
• internalized racial oppression
• anti-Black discrimination
• health care disparities
• health care equity

Acknowledgements

We extend a sincere thanks to Yvonne Sam (from the Council for Black Aging Community of Montréal), Dwight Best (from the ACSioN Network of Canada), and Sharon Nelson (from the Jamaica Association of Montréal) for their active assistance with participant recruitment and for providing feedback on earlier versions of this manuscript. We also thank Dr. Isabelle Leblanc and Keith Williams for providing feedback on earlier versions of this manuscript, and Gregory Gooding for actively assisting with participant recruitment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to ethics and privacy restrictions, data cannot be made available.

Additional information

Funding

This work was supported by a Frederick Banting and Charles Best Canada Graduate Scholarship-Master’s Award from the Canadian Institutes of Health Research, and a Doctoral Training Award from the Fonds de Recherche du Québec – Santé in partnership with the Strategy for Patient-Oriented Research Support Unit in Québec.