Here’s Why Black People in Canada Are Healthier Than Those in the U.S.

In the U.S., health disparities are blunt realities: Black infants die at more than double the rate of white babies, middle-aged black men run double the risk of heart attack of white peers, and, overall, blacks experience higher rates of diabetes, certain cancers, and asthma. Socioeconomics has long been blamed as one of the core causes of these wide, persistent health disparities, but the truth may lie elsewhere.

Researchers are finding that racism and a legacy of American slavery may play an even bigger role in health disparities, a revelation that is being unearthed by diving deep into numbers that compare the health of America’s black population with that of blacks in a country where the African slave trade wasn’t significant: Canada.

Chantel Ramraj, a researcher at the University of Toronto’s Dalla Lana School of Public Health, set out to compare the differences between the health of blacks and whites in Canada and the U.S. The study, published in the journal Social Science and Medicine, found that black Canadians fare better than black Americans, even after controlling for socioeconomic factors and bad health behaviors. Researchers believe that means there must be other reasons why disparities exist between the two countries, such as the biological legacy of slavery and ongoing systemic racism in America.

“After accounting for differences in socioeconomic resources, racial inequalities in health remained. In fact, some widened. What this tells us is that the relationship between race and health is not a fixed phenomenon: It seems to be influenced by societal contexts,” Ramraj told TakePart.

The study found that in the U.S., blacks had 80 percent higher odds than whites of self-rating their health as poor; in Canada, blacks’ odds of poor self-rated health were similar to whites’. Blacks’ odds for hypertension were 1.52 times greater than those of whites in the U.S. but only 1.27 times greater than those of whites in Canada. After controlling for insurance status (in the U.S.; Canada has a national health program), income, employment, education, and smoking and drinking habits, blacks’ odds for hypertension got worse, increasing to 1.75 times greater than whites’ in the U.S. and 1.6 times greater than whites’ in Canada.

“In other words, given the same level of education, employment, and family income, blacks still have higher odds of poor health than whites,” Ramraj said. American blacks consistently fare more poorly than Canadian blacks.

This study is one of the most comprehensive on the topic to date. It examined a broad range of racial categories and specific health outcomes and behaviors by analyzing data from 162,271,885 Americans and 19,906,131 Canadians surveyed over a 10-year period.

There is a possible caveat: Black-white inequalities may be smaller in Canada than in the U.S. because a greater percentage of the black population are immigrants, who are often healthier than longtime residents. But the researchers stressed it is “equally consequential” that U.S. blacks are more likely to have ancestors who were exposed to slavery, segregation, and ongoing racial discrimination.

“Black slave descendants carry the cumulative burden of historical and ongoing discrimination in the U.S. that leaves them with fewer resources and opportunities—which make the largest difference for health,” Ramraj said, noting the additional toll taken by the “small but routine experiences of discrimination that are pervasive in American society.”

The research team concluded that racial inequalities in health are “biological expressions of racism and not of racial differences.” The implication of such a finding, they wrote, is “rather provocative” because it means “the link between race and health is context-dependent and, thus, modifiable by social action.”

One reason for the “reverse gradient” relationship between socioeconomic status and health, Ramraj said, is that blacks face discrimination in educational, occupational, and financial attainment—and they have for decades, ingraining anxieties about attaining equal treatment. For example, previous research shows that on average, black males earn 44 percent of the wage return that white males earn, and blacks are 52 percent less likely to be promoted compared with whites.

In another social psychological analysis of racial health disparities, researchers described how racial bias leads to poorer health among black Americans: “First is the already well-documented physical and psychological toll of being a target of persistent discrimination. Second, implicit bias can affect physicians’ perceptions and decisions, creating racial disparities in medical treatments.”

So, in addition to the stress of everyday discrimination, minority health is also affected by racism within medical care settings. Because of the bias—even unconscious bias—that exists in the health care system, many minorities receive a distinctly lower standard of care than whites, with potentially deadly consequences. Research suggesting minorities face more barriers to receiving care and often receive inferior care, are offered certain treatments less often, or are otherwise treated differently is published with shocking regularity.

Ramraj’s findings support the assertion of Columbia University researchers who wrote in the August 2015 Annual Review of Sociology that “there is evidence that racism has a fundamental association with health, independent of socioeconomic status.”

Camara Jones, a family physician, an epidemiologist, and the president of the American Public Health Association (who was not involved in the study), explained the cultural phenomenon of race being a social, not biological, construction: “The racial group to which you are assigned is based on the culture you live in—on how a particular culture interprets your appearance.”

She said in the U.S., she is considered black, while in other countries, she may be deemed brown, colored, or white because of the shade of her skin. If she stayed in that other country long enough, she said, she would “begin to display the health markers of the group to which she had been assigned.”

Jones said that when it comes to achieving racial health equity, tackling poverty is just one piece of the puzzle: “Attention must also be given to the social determinants of equity, such as racism.” She said all three types of racism—institutional, personally mediated, and internalized—contribute to poor health outcomes among minorities in any given culture.

“Racism is not some abstract miasma,” Jones said. “It’s an institution that we must work together to dismantle.”