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Why aren’t pharmacy students better equipped to treat BIPOC patients?

Tackling systemic racism in health care
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GRACE WU/THE VARSITY
GRACE WU/THE VARSITY

The Minneapolis police’s killing of George Floyd in the United States sparked protests highlighting the issue of systemic racism against Black, Indigenous, and people of colour (BIPOC) in the midst of the COVID-19 pandemic.

Canada is not immune to systemic racism. Consider recent events like Regis Korchinski-Paquet, a Black Indigenous woman, falling to her death from her balcony in Toronto after police were called to her apartment; the brutal Royal Canadian Mounted Police arrest of Athabasca Chipewyan First Nation Chief Allan Adam; and rising anti-Asian sentiment in the wake of the COVID-19 pandemic. 

A significant concern is how racism in Canada intersects with the COVID-19 pandemic. Many of the communities that are hardest hit by the virus are those that are also racialized and low income. This trend is visible in metropolitan centres such as Montréal and New York City, as well as Toronto.

The disproportionate impact of COVID-19 on such communities is largely the result of health inequalities. Differences in socioeconomic factors — such as access to resources, education, and the health care system — can be corrupted by systemic racism, leading to disparities in access. 

In the health care sector, systemic racism is deeply embedded. This is visible in the maltreatment of Indigenous peoples; the high prevalence of chronic diseases such as obesity, high blood pressure, and diabetes in minoritized groups; and a higher proportion of minoritized people working in jobs that are deemed to be essential or that may require taking public transit, increasing their risk of exposure.

These are issues relevant to working pharmacy students because pharmacists are some of the most accessible health care workers since they can directly address and provide guidance to their patients.

I am a fourth-year student in the Doctor of Pharmacy (PharmD) program whose clinical rotations have been disrupted by the COVID-19 pandemic. Despite being knowledgeable about racial disparities and the problems related to systemic racism in the health care system, I am surprised that many in the PharmD program disregard these discussions.

In the PharmD program, we are taught how to ask patients about which medications they are taking and if they have any issues with their medications, as well as how to resolve any of their medication-related problems. We help patients choose the medication that is the most effective and safe, and we are taught that guidelines should be followed, as they are the gold standard.

However, we never question how these guidelines are developed, what studies were used, and most importantly, the extent to which these studies included or ignored minoritized groups. In a multicultural country like Canada, it is essential for pharmacists to speak to patients to gain an understanding of their cultural background. Tactics and medications that may be appropriate for some patients are not appropriate for all due to different cultural notions.

For example, some cultures view medications as something that cures disease but not something that you take regularly for chronic diseases. This means that even if a pharmacist chooses the most effective and safe medication, it may be suboptimal because the patient may refuse to take it if they see that they have to take it for the rest of their lives. 

In that case, having an important conversation with the patient is paramount. However, I was only aware of this because of an elective course I took. This points to a bigger issue, as providing solutions that are against the patient’s desires may inadvertently contribute to systemic racism by denying certain groups a voice and viewpoint of what it means to be a healthy person.

For instance, some cultures view health more holistically — not just simply treating or curing diseases. If certain groups’ viewpoints are left out in an act of systemic racism and erasure, it can lead to lower levels of trust in the health care system. 

I am a member of the class of 2021, where our racial composition seems quite skewed. There are very few BIPOC students despite the high demand for providing services to these populations. Currently, how to provide pharmaceutical care to Indigenous peoples is limited to an elective course that only accommodates a small number of students, leaving large amounts of other students ill-prepared to deal with these patients. Discussions surrounding racism in the health care profession remain virtually non-existent.

More needs to be done to bring up these issues, as pharmacists are some of the most accessible health care professionals, and they have an important role in advocating for their patients. Although a message of support and solidarity that recognizes systemic racism is a good initial step, concrete policies need to be in place. Providing lip service does not magically cause systemic racism in the health care industry to disappear overnight.

In PharmD programs, mandatory courses should include ones related to diversity within the pharmacy profession, health care in Indigenous or other minoritized groups, and delivering proper pharmaceutical care in a culturally appropriate manner. This could ensure that future pharmacy students are better equipped to deal with diverse populations, allowing us to meet our professional obligation of putting the patients first.

We should also collect race-based data related to admissions, test scores, and academic offences, as this would enable policymakers to identify trends and make informed choices to avoid making policies that reinforce systemic racism in institutions. 

Pharmacists and pharmacy students should leverage their accessibility to patients to address systemic racism in the health care system. This is not the time for pharmacy students to remain silent; let us use this as an opportunity for pharmacists to be heard and have a voice in advocating for patients.

It is disheartening when our contributions are not being recognized despite being frontline health care workers. Making concrete changes and acknowledging the challenges of systemic racism in the health care system enables future pharmacists to be better equipped to advocate for their patients, with both health-related and social issues. After all, social, economic, and political factors all ultimately affect our health. Systemic racism must therefore be treated as a public health issue, and not just as a social issue. 

We pharmacy students must acknowledge that systemic racism is alive in Canada in many institutions, including higher education and health care. When we practice pharmacy, we must avoid making mistakes that contribute to the problem.