Anti-racist health care practice (review)

Elizabeth A. McGibbon and Josephine B. Etowa’s co-authored book Anti-racist Health Care Practice exposes and addresses systemic racism in the Canadian health-care system. McGibbon and Etowa directly confront racism in health provision and Canadian society, and provide a discussion of racism and related issues (gender, class) that does not hold back criticisms. The system of racial oppression and its sustenance by white privilege is presented to the reader in a clear and straightforward way, making it impossible for the reader to deny or misunderstand his or her role in the power structures of Canadian (or American) society. The book is directed primarily at medical practitioners, as well as educators and policy makers. As such, McGibbon and Etowa have presented a “Theory-Light” version of the political philosophies that underpin their framework in order to avoid the problem of being read only by those who already engage in antiracist thought, thereby missing their target audience. This turns out to be a weakness of the book. The inclusion of hasty summaries of very complex political perspectives for the purpose of bringing medical practitioners and students up to speed and their subsequent use in examples land the book squarely between two audiences: those who already know the theories and are sympathetic to criticisms like McGibbon and Etowa’s, and those who are unfamiliar with the theories and are learning about systemic oppression for the first time.

The aim of McGibbon and Etowa’s book is to present an antiracist healthcare delivery framework that practitioners can follow, and they slowly build a foundation for this in the first four chapters. The first chapter provides a brief introduction to the framework, which will only be fully unpacked one hundred pages later. Chapter one also introduces readers to the authors and their social locations, and to important definitions of terms such as race, ethnicity, culture, discrimination, and oppression. This chapter includes a number of powerful firsthand accounts from patients and members of society about encounters with racism in the Canadian health-care system.

In chapter two, the authors present an argument for including race as one of the social determinants of health. McGibbon and Etowa make very effective use of statistical data to support the claim that race, like socioeconomic level and geographical location, is an important indicator of a person’s health expectations. They also provide a powerful exposé of Canadian history, time-lining the residential school system for indigenous peoples and explaining the process of colonization.

Chapter three gives extended criticism of cultural competence and its popularity in medical education. Chapter four provides the theoretical underpinnings of the authors’ antiracist framework by providing brief outlines of a number of sociopolitical theories. These include conflict theory, systems theory, human-rights perspectives, political economy, and feminism, antiracism, anticolonialism, and post-colonialism (these last four are presented together).

In chapter five, the authors finally present the fully fleshed-out antiracist framework to guide medical practice. The framework has three parts that presumably interact in a variety of ways: seeing the paths from stereotype to oppression, understanding the connection between oppression and policy, and acting for social change. While much ink is spent explaining the path from stereotype to oppression, the next two parts of the framework are underexplained, though it is possible that the necessary explanatory bits are present in the chapter and simply need to be brought together under clear headings so that the reader would be cued to the framework. A large part of the chapter is devoted to discussing white privilege, and McGibbon and Etowa include a list of concerns written by Elaine Tassy that is an eye-opener for white people not used to noticing everyday instances of institutionalized racism, among them the fact that contestants of their race almost exclusively win (and have their own) dating reality shows (129).

Toward the end of the chapter, McGibbon and Etowa propose that medical organizations create a social justice–based professional practice code of ethics (137). They outline the...