In the wake of George Floyd’s death at the hands of police, which initiated a global reaction for racial justice, and the hard truths raised by the ‘Black Lives Matter’ movement, which forced the needed reckoning of systemic and structural violence and racism, the need for critical racial literacy (CRL) has become apparent. The next generation of service providers, including scientists, healthcare providers, researchers, and decision-makers, deserve to be enabled through CRL to strengthen equity, diversity, and inclusivity. In this paper, I argue that a CRL approach is needed to address the historical, racial, social, political, economic, cultural, and structural mechanisms that sustain racial inequities in health and healthcare. To advance racial justice and close the health equity gap, the healthcare system needs to contribute to the development of everyone’s critical evaluation of their lives and society as a whole.1

The CRL approach centres on racial justice as a foundation for critical reflection, systemic analysis, and most importantly, action. CRL has become central in my work within the Black community. Through CRL, everyday experiences of racism and associated structural barriers can be identified, questioned, and dismantled using evidence-informed strategies. In addition, CRL is founded on the frameworks and methodology for empirical research from critical race and consciousness raising theories, and builds on existing interdisciplinary racial literacy, such as critical race theory (CRT) and racial literacy. CRT is an academic concept that is more than 40 years old, with the core idea that race is a social construct, and that racism is not merely the product of individual bias, but also embedded in legal systems and policies; its basic tenets emerging out of a framework for legal analysis by scholars Derrick Bell, Kimberlé Crenshaw, and Richard Delgado, among others. Furthermore, racial literacy refers to “ideas and practices that lay bare racial injustices and encourage people to understand racial history and its impact on contemporary society, which are essential for working toward ameliorating injustices”2 (p1). Racial literacy includes understanding the ways race and racism influences the social, economic, political, health, and educational experiences of individuals and groups. Racial literacy is “having the knowledge, skills, awareness and dispositions to talk about race and racism.”3

CRL deepens the discourse of racial literacy beyond discrete cognitive skills, to ensure inclusion of the complexity and the powerful ways in which race influences the socio-economic, and political context of health and healthcare of racialized people. The goal of CRL is to create an environment of empowerment for communities and individuals, and to address the everyday acts of prejudice and discrimination, while confronting and challenging the systems and structures that perpetuate racism4 by using pedagogical tools to understand and address the marginalization and social exclusion caused by racism. CRL is “a humanizing epistemology requiring parents and educators to recognize, refute, critique, and synthesize the structure of race in daily living, moving toward actions, curricula, communication, and restructuring of oppressive structures that allow us to realize equity” 5 (p260). Through the lens of critical race and critical consciousness theories, CRL acknowledges both the process of racism and the work of anti-racism as two active efforts to make meaning and interpret racial ideas. Thus, CRL involves intentional critical consciousness raising to deconstruct these various forms of racial literacies; including those who espouse and perpetuate racist beliefs and ideas, those who engage in antiracist practices, and others who may have gaps in racial literacy. In addition, CRL requires one to have both content knowledge about race and racism and racial self-awareness, both of which are necessary to understand and navigate the social world 6; race-evasiveness, which perpetuates racism, is not a by-product of passive omission, instead, it is an active, discursive effort of racialization.7

Black people continue to experience multiple and intersecting barriers to accessing appropriate and responsive health services including, institutional discrimination; poor representation among healthcare leadership, researchers, and decision-makers; lack of awareness of available services; lack of culturally appropriate services in relevant languages; and lack of culturally competent health professionals. Social determinants, including structural inequalities and discrimination, are known to account for the disproportionate health risks and differential health outcomes experienced among Black people. In the case of the COVID-19 pandemic, excess cases and deaths have been attributed to disproportionately high rates of co-morbid conditions, structural factors, and the built environment.8,9 As we plan for post-COVID-19 recovery, there is a need for actions that mitigate the root causes of racial health inequities including structural racism. 

Population health relies not only on a well-functioning health system with universal coverage, but also on equity, diversity, inclusion, justice, and solidarity. In the absence of these factors, health inequities are magnified, scapegoating persists, and discrimination remains.10  Despite anti-Black racism having been declared a public health emergency or crisis at municipal, provincial, and national levels across Canada and been acknowledged by the federal government as a determinant of health,11-14 public health’s commitment to health equity has not gone far enough in addressing the deep structural roots of persistent, devastating racialized inequity. Working towards racial health equity and overall positive racial climate means thinking and talking about race and racism across race groups. It involves using a social justice framework to ask hard questions and challenge common assumptions, going beyond the text to see power distributions and whose interest is being served, exploring multiple perspectives, and using literature to reflect and take social action.4 Science must not only focus on what can be made possible, it must also be used to understand the repercussions of the choices we make, our indifferences and how we conduct ourselves15. CRL can provide a foundation for all people, from those who are vulnerable to those who are privileged, this occurs by analyzing inequities within systems, gaining insight into system change and anti-racism approaches, building reflexive relationships, identifying gaps in knowledge and guiding research to gain new insight about racial inequities.4

Anti-racism praxis calls on health and social service providers as well as scientists to engage critically with race and racism. CRL enables both marginalized and privileged people to participate in transformational social change; building skills to address everyday acts of discrimination, and to confront, disrupt, and change the systems and structures that perpetuate racism. These ideas, which are captured within CRL are central to the work I do and the type of healthcare transformation I am working to achieve. Although CRL has been used in other disciplines such as education and social sciences, I am using it in health in a curriculum that trains both racialized and non-racialized participants on how to analyze institutional and systemic power and inequities as well as structural barriers, understand systems change approaches, integrate anti-racism ideas in academic institutional programs, engage in allyship, practise reflexive relationships, and to monitor and measure  racialized inequities in healthcare access and health outcomes.16-19 CRL can be used to empower health service providers by helping them to recognize racism as a complex system of oppression, resulting in racialized disadvantages at multiple levels and anchored by structural barriers within institutions and systems. CRL is at the centre of our current provider capacity building program to guide the development, implementation, and evaluation of the evidence-informed intervention(s) to transform the health system’s capacity to address anti-Black racism in healthcare. In recognition of the urgent need to build capacity and reduce racism and paternalism among health providers working with African, Caribbean, and Black (ACB) communities, our team at CO-CREATH lab has developed and is implementing an online learning intervention consisting of a series of four virtual educational modules for health providers; namely critical health and racial literacy, social determinants of health and health inequities, organizational and provider cultural competency and safety, and COVID-19 impacts on health and post pandemic recovery efforts. In addition, the CO-CREATH team and its community partners have created the PEN (peer equity navigation) program which has been instrumental in community research and knowledge mobilization. CRL has been the core of this peer-led community mobilization initiative used to reach hard-to-reach areas within ACB communities. This collaborative and participatory equity learning process contributes to community capacity, empowerment, practice outcomes, and to long-term improvement in health and health equity.20 In addition, PEN is guided by the critical race and intersectionality theories and anchored in the principles of community-based participatory research; this training program is comprised of 12 modules and includes a preceptored six-week hands-on practicum in community-based health organizations.21

Conclusion: CRL is central to understanding and navigating the complex pathways through which structural racism creates inequities in the health and healthcare of racialized people. To fully understand racial health inequities, one must first understand how racism is embedded throughout the fabric of society, in all institutional and systemic processes that often go unnoticed. Through the CRL processes, the nexus of structural and interpersonal racism, embedded and encoded in routine practices can be identified, questioned, and dismantled using evidence-informed strategies. In this commentary, I advocate for training in CRL for both Black and non-Black health providers, researchers, and policy makers to actively work towards systemic and societal change. 

References 

1. 1. Mariana Pacheco M. & Chávez-Moreno, L (2021) Bilingual education for self-determination: Re-centering Chicana/o/x and Latina/o/x student voices, Bilingual Research Journal, 44:4, 522-538, DOI: 10.1080/15235882.2022.2052203
   2. Chávez-Moreno, L. C. (2022). Critiquing Racial Literacy: Presenting a Continuum of Racial Literacies. Educational Researcher, 0(0). https://doi.org/10.3102/0013189X221093365

• Howard Howard, T.R (2020). Racial Literacy: A Call to Action for Teachers. Equity,  June 19, 2020. Accessed at: https://www.hmhco.com/blog/racial-literacy-a-call-to-action-for-teachers  

1. Etowa, J. & Roelofs, S. (forthcoming). Advancing Health Equity through Critical Racial Literacy in Health Research and Practice. International Journal of Environmental Research and Public Health
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3. Brown, K. D. (2017). Why We Can’t Wait: Advancing Racial Literacy and A Critical Sociocultural Knowledge of Race for Teaching and Curriculum. Race, Gender & Class, 24(1–2), 81–96. https://www.jstor.org/stable/26529237
4. Chang-Bacon, C. K. (2022). “We Sort of Dance Around the Race Thing”: Race-Evasiveness in Teacher Education. Journal of Teacher Education, 73(1), 8–22. https://doi.org/10.1177/00224871211023042 
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14. Jones, C. P. (2002). Confronting institutionalized racism. Phylon (1960-), 50(1/2), 7–22. https://doi.org/10.2307/4149999
15. Raine, S., Liu, A., Mintz, J., Wahood, W., Huntley, K., & Haffizulla, F. (2020). Racial and ethnic disparities in Covid-19 outcomes: Social determinants of health. International Journal of Environmental Research and Public Health, 17(21), Article 21. https://doi.org/10.3390/ijerph17218115
16. Saroo S. (2020). We need to talk about racism. (2020, March 5). The BMJ. https://blogs.bmj.com/bmj/2020/03/05/saroo-sharda-we-need-to-talk-about-racism/ 
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