What We Heard Report: Dialogue on Anti-Black Racism and Black Health in the Health Research Funding System

Overview

The Canadian Institutes of Health Research (CIHR) convened a Dialogue on Anti-Black Racism and Black Health in the Health Research Funding System with members of the Black health research community in March 2024. The dialogue took place virtually over two half-days.

The purpose of the dialogue was to bring together members of Canada’s Black health research community to discuss structural inequities within CIHR’s health research funding system. Throughout the dialogue, many participants elaborated on anti-Black racism and related drivers of funding system inequities and emphasized an urgent need for action to improve Black health outcomes. The dialogue will inform how CIHR can effectively address anti-Black racism and support a more equitable funding system through its policies, processes, and practices.

The dialogue was co-designed by CIHR and health researchers over a period of two months. Co-design refers to a participatory approach whereby external participants are treated as equal collaborators and decision-makers in an engagement process and is, therefore, an important form of power-sharing. External collaborators were invited to co-design the vision, objectives, and agenda, with CIHR. Dialogue participants were identified during the co-design process and comprised of Black researchers and community partners with diverse disciplinary backgrounds who had engaged with CIHR in the past. Observers included CIHR staff from across functional teams who will be involved in the implementation of CIHR’s Anti-Racism Action Plan.

The dialogue was facilitated by two co-leads, one internal to CIHR and the other external. The structure of the meeting followed an agenda which participants and facilitators co-refined at the beginning of the dialogue.

Following an initial exploration, the agreed-upon discussion topics were:

• How can CIHR better support and promote Black excellence and expertise in health research?
• How can CIHR address anti-Black racism within its policies through rethinking structures such as peer review?
• What is needed to move forward on Black health (e.g., declaring anti-Black racism as a determinant of health, supporting a formalized structure on Black health research)?
• What are specific activities that federal and provincial departments and agencies can work on together to advance this work while exploring its linkages to other populations?

Summary of What We Heard

Discussions centered on the individual and structural barriers that drive inequities in CIHR’s funding system as well as strategies to create a more equitable funding system for Black health researchers and the health research community. The views and experiences shared in the dialogue included:

• Anti-Black racism is a structural determinant of health and negatively impacts Black health and population health outcomes.
• The persistence of anti-Black racism in the health research ecosystem contributes to the limited career trajectories of some Black researchers.
• Anti-Black racism manifests in CIHR’s operations and organizational culture through a disregard of Black perspectives and experiences.
• Anti-Black racism negatively affects the funding outcomes and career trajectories of Black health researchers.
• Black researchers have consistently called for reforms to funding policies and processes that have disadvantaging effects but are rarely engaged by CIHR.
• CIHR should acknowledge and take accountability for how it has perpetuated harm to Black health researchers and communities before beginning to build trusting relationships and research partnerships with them.
• CIHR should draw from the diverse disciplinary expertise and knowledge of Black researchers through ongoing consultations between Black researchers and senior decision-makers.
• CIHR should invest in Black trainees by recognizing their excellence and strengths and supporting their skills development throughout the academic research pipeline.
• CIHR should advance sustained funding support for research on the determinants of Black health outcomes.
• CIHR should support mentoring and training initiatives for the next generation of Black trainees to ensure they remain in the academic research pipeline and are prepared for professional research roles.
• CIHR should conduct extensive analyses to identify how specific policies, processes, and aspects of its organizational culture may disadvantage Black researchers. Simultaneously, CIHR should use findings to develop relevant interventions, and engage Black researchers, community members, and patient partners.

This report’s themes are organized under three broad categories based on what was heard at the dialogue.

Participants’ Reflections on Inequities Shaping CIHR’s Funding System

• CIHR’S Organizational Culture

  Some participants observed that anti-Black racism exists within CIHR’s organizational culture. These participants detailed that while CIHR perceives itself as institutionally fair and neutral, they have experienced anti-Black bias and discrimination in many of their interactions with the organization.

  They described examples of implicit and explicit anti-Black sentiments expressed by their academic peers on advisory or peer review committees that were not identified or held to account. For example, when Black peer reviewers have drawn attention to applications thematically focused on Black health inequities, their peers have minimized the topic as unworthy of attention in the Canadian context or have questioned the validity of existing evidence in a hostile manner. These participants indicated that Black researchers have provided written complaints to CIHR on their experiences of anti-Black racism in advisory or peer review committees, and the organization has not offered formal recourse measures or apologies. According to these participants, such examples illustrate that CIHR’s institutional culture does not acknowledge the existence of anti-Black bias and discrimination in its processes and does not prioritize robust measures to redress anti-Black racism.

  Some participants also highlighted that CIHR’s organizational culture informs the conceptual frameworks which guide its anti-racism work. They noted that equity, diversity, inclusion, and anti-racism frameworks do not sufficiently attend to combatting anti-Black racism in CIHR’s policy context.

  Other participants shared other examples that demonstrate a lack of commitment to meaningfully address anti-Black racism:

  • CIHR has not yet substantively examined or acknowledged how its organizational culture, policies, and processes may facilitate structurally inequitable opportunities and outcomes.
  • A lack of disaggregated demographic data collection to identify racial and ethnic disparities in CIHR’s funding system.
  • CIHR’s senior leadership has not gained the trust of Black health researchers and organizations.
• Peer Review Process

  Some participants suggested that the barriers they encounter in the peer review evaluation of grant and award applications should be understood in the context of a structurally inequitable peer review process, overall. These inequities contribute to the limited participation of Black peer reviewers and the low funding success rates of Black grant applicants.

  A few participants indicated that their informed contributions are not sought out or valued on peer review committees compared to those of their non-Black peers. For example, a participant expressed that they and other Black researchers are often overlooked and not invited to participate in peer review committees that fall within their research domains. Another participant expressed that when they participate in peer review committees, their expertise is not as respected or taken seriously by their peers due to anti-Black bias. Additionally, other participants indicated concerns that CIHR has implemented EDI criteria for grant applications, yet peer reviewers are not adequately knowledgeable to assess these criteria. This results in peer reviewers treating EDI criteria evaluations as a tokenistic, check-box exercise rather than building sufficient EDI knowledge and applying this knowledge to their evaluations. According to these participants, these examples highlight that CIHR’s peer reviewer process is structured in a way that disempowers Black researchers from fully participating.

  These participants shared other examples of barriers in the peer review process, including:

  • Peer reviewers dismissing ideas about racism and health and racial health inequities in reviews.
  • Failure of peer review committee chairs to intervene if racist sentiments are expressed on peer review committees.
  • Failure to retain Black peer reviewers to continue serving on peer review committees.
  • The refusal of peer reviewers to reflect on how their internal biases may impact their participation in the peer review process.
  • The absence of ways to resolve complaints on racism in the peer review process.
  • Doubts about the impartiality of the peer review process, identifying it as opaque with little public information shared on each peer review decision-making stage; how individual peer reviewers are selected for committees; peer review committee discussions; and peer reviewer comments on grant applications.
  • The grant evaluation criteria enable the subjective review of grant applications, leading to peer reviewers favorably scoring their preferred applications.
  • Expertise mismatch, such as peer reviewers of population health research grant applications not being trained in population health approaches and peer reviewers of applications on specialized Black health research topics not possessing subject matter expertise.
  • Conflict of interest policy preventing applications by researchers specializing in niche Black health topics to be reviewed by relevant subject matter experts.
  • The existence of exclusionary peer review networks, whereby the same few highly influential White academic researchers often recommend one another to serve on grant review committees.
• Capacity Building and Training

  Many participants discussed the lack of sustained CIHR investment in capacity building and training for Black graduate students and early-career researchers. They identified the lack of support for Black trainees as being informed by CIHR’s inability to adequately assess specific needs of Black trainees in the context of an inequitable academic pipeline which distributes opportunities unequally.

  These participants observed that Black trainees are not less capable, but rather, lack CIHR investment to support their potential as future independent academic researchers and professionals. Along this line of discussion, a participant pointed out that Black trainees are already excellent and criticized the framing of improving their success in the research funding environment as a capacity building issue as an inherently racist framing.

  A participant indicated that Black trainees are not actively recruited to participate in CIHR’s skills-building programs, including the reviewer-in-training program. Another participant noted that CIHR does not do targeted outreach to Black academic groups enough for institution-based information sessions on how trainees can successfully apply for grants and awards. A few participants expressed concerns with the lack of sustained CIHR awards for Black students, especially at key stages along the academic pipeline, such as the beginning of their graduate studies and during the transition from post-doctoral fellows to early-career researchers. According to these participants, these examples illustrate that CIHR has not adequately recognized the barriers which limit opportunities for Black trainees to have equitable access to building grant writing and peer reviewer skills in academia compared to other trainees.

  These participants highlighted other areas where CIHR has not invested in Black trainees, including:

  • Absence of funding for trainer-trainee mentorship programs.
  • Absence of training sessions on grant writing skills.
  • Absence of comprehensive information sessions on the grant application processes.
• Research on Black Health

  Some participants shared frustrations about a perceived lack of respect for Black health research excellence at CIHR and in Canada. These participants shared that research dedicated to the study of the determinants of Black health is not supported through research funding. They emphasized that most research in this domain is conducted by Black researchers whose work is informed by their unique insights and perspectives. They associated the absence of policy and programmatic interventions to substantively improve Black health outcomes in Canada with the lack of specific CIHR research funding support.

  These participants discussed other concerns related to CIHR’s lack of support for Black health research, including:

  • Absence of a formalized structure to advance Black health research.
  • Inadequate funding opportunities which support interdisciplinary or transdisciplinary methods.
  • Insufficient funding opportunities for health intervention research.
  • A lack of recognition of Black studies analytical approaches.

  Black Health Researchers

  Participants also highlighted that Black health researchers produce high-quality research across CIHR pillars, yet they are not given adequate recognition nor is their work widely circulated or cited. These participants explained that Black health researchers face greater barriers to academic success than their peers, as they often produce research without CIHR grant funding and other resources. Participants raised these examples to illustrate how Black health researchers experience cumulative barriers which begin with a lack of respect for Black health research in Canada and are compounded by CIHR’s lack of action to advance Black health research, including their lack of funding support.

Participants’ Reflections on External Inequities Shaping the Canadian Health Research Ecosystem

• Academic Environments

  Some participants discussed structural inequities which negatively shape academic environments, the careers, and overall wellbeing of Black academic researchers and trainees. They include anti-Black racism;^{Footnote 1} racism in knowledge production (e.g., epistemic racism^{Footnote 2}); an institutional Matthew effect;^{Footnote 3} exclusion from academic networks; and a lack of permanent employment. Many participants emphasized that Black academics, particularly Black women, are overextended with EDI service work, commonly known as the ‘equity tax’. The equity tax reduces the amount of time that Black academics can allocate to grant applications and academic research, limiting their potential for academic promotion.^{Footnote 4} Accordingly, a participant shared that they routinely cautioned Black early career researchers “from touching EDI work for their first three years as academic researchers and focus on building their research portfolios.”

  A few participants also emphasized that many Black academics quietly serve as informal mentors to Black trainees, and advocate for trainees as they navigate academic environments. A trainee noted that gatekeeping is a major source of inequity in academia. They detailed that Black trainees are often excluded from gaining academic and research capital through structures that limit their opportunities to be funded, co-author research papers, be supervised by highly influential researchers, present at academic conferences, and be exposed to tacit knowledge.

• Health Equity Reseach Capacity

  A few participants highlighted that Canada is not training people in the core approaches to health equity, which are population health methodologies at the intersection of the social sciences and epidemiology. More specifically, social epidemiologists identified that population health researchers with statistical training are often “clinical epidemiologists, which means they work with patient cohorts and don’t use population health approaches which involve understanding and measuring how structures affect groups in society.” Additionally, people with some exposure to understanding Black health and the structural determinants of health, from social sciences fields, are not receiving adequate statistical training. As a result, there is limited research output on Canadian health inequities, broadly, and racial health inequities, particularly. These participants noted that this limited research capacity is compounded by the lack of standardized race and ethnicity data collection in Canada which is acute across all provincial healthcare systems. Accordingly, there are major difficulties for health researchers who would like to identify Black health inequities or measure the impact of policy interventions on these inequities.

• Persistent Black Health Inequities

  Many participants drew attention to the persistence of Black health inequities in Canada. These participants conceptualized health inequities as the “unjust and unfair distribution of diseases and health conditions, which are ultimately determined by social and political systems.” They emphasized that concerns about Black health inequities have been discussed by Black communities in Canada for decades without significant policy responses. Additionally, these communities have tried to raise public awareness about Black health inequities but have not been supported by provincial and federal agencies.

  Referring to existing academic literature on Black mortality and morbidity rates, a few participants indicated that Canada’s Black population has the highest mortality rates for various diseases and health conditions, compared to non-Black population groups. Breast cancer and HIV-AIDS are specific health conditions with higher Black mortality rates. One participant also framed anti-Black racism as a disease which can negatively affect all population groups. Many participants noted difficulties in tracking health disparities and identifying health inequities in Canada as disaggregated race and ethnicity data are not routinely collected.

• Black Health Knowledge Mobilization and Policy Development

  Many participants emphasized that after research on Black health is developed, findings should be practically applied to knowledge mobilization efforts and policy development. They observed, with concern, that even existing knowledge on Black health outcomes does not penetrate federal and provincial policy domains, where major health interventions are developed. These participants noted that some policy forums, including the Best Brains Exchange, are not suitably designed to discuss anti-Black racism in Canadian health institutions and policy contexts, as the engagement approaches are typically prescriptive and do not meaningfully engage Black researchers and communities as key actors in the policy development process. Moreover, these participants noted that many policy forum organizers are not sufficiently knowledgeable to substantively discuss the topic of anti-Black racism in health care and research funding contexts. Additionally, some participants clarified that academic researchers are not directly responsible for driving policy changes, which tend to require political mobilization by many actors.

Participants’ Recommendations to Address Structural Inequities Shaping CIHR’s Funding System

• Creating an Inclusive Organizational Culture

  Some participants suggested that CIHR’s organizational culture requires a structural shift to combat anti-Black racism and become more inclusive. To achieve this, they recommended the following:

  • CIHR should develop robust accountability structures to document CIHR’s past harm done to Black health researchers and communities and to repair relationships with impacted parties.
  • CIHR should engage with Black health researchers and communities as it shapes actions and performance indicators to combat anti-Black racism in its organizational culture.
  • CIHR should be more transparent with Black health researchers by communicating more frequently on progress made to combat anti-Black racism in its organizational culture, through and beyond developing an anti-racism action plan.
  • CIHR should analyze whether and how its internal policies and processes are associated with anti-Black racism.
  • CIHR should investigate and combat anti-Black discrimination in hiring and promotional practices.
  • CIHR should collect disaggregated demographic data to identify racial and ethnic disparities and apply relevant findings to policy and programmatic interventions.
• Restructuring the Peer Review Process

  Many participants noted that the CIHR peer review process needed restructuring so that Black research excellence is not stymied. They recommended that:

  • The peer review process should revisit how research is assessed, including supporting transdisciplinary approaches, perspectives, conceptual frameworks, and methodologies.
  • CIHR should reform its conflict-of-interest policies to enable applications by researchers specializing in niche Black health topics to be reviewed by relevant subject matter experts.
  • CIHR should recruit peer review committee members with expertise in population health methodologies to review relevant applications.
  • CIHR should create structured evaluation rubrics to limit the influence of subjective bias on application evaluations.
  • CIHR should establish a mandatory reviewer training module on racism and racial bias in application evaluations.
  • CIHR should improve Black representation on peer review committees through targeted outreach to Black subject area experts to serve as peer reviewers.
  • CIHR should develop a targeted recruitment strategy to recruit Black trainees to CIHR’s reviewer in training program.
  • CIHR should target recruitment of Black patient partners to serve on peer review committees.
  • CIHR should recognize grant review service by compensating reviewers.
• Formal Structure Supporting Black Health Research

  Many participants articulated that a formal structure to advance Black health research in Canada is needed to strategically advance research on Black health topics, build capacity for trainees, coordinate advocacy efforts to influence policy development, and mentor Black health researchers and professionals. Participants proposed that such a structure could be situated within the umbrella of a National Black Health Strategy and serve as a platform and support the sustained development of research on Black health matters.

  These participants placed a strong emphasis on the role a formalized structure could have in training future cohorts of Black health researchers. They provided programmatic examples such as hosting mentorship opportunities for Black early career researchers focused on Black health, and other Black early career researchers who are interested in receiving professional advice from more senior Black researchers and allied professionals who may share similar experiences.

  Some participants described specific priorities that they envisioned for such a structure with a focus on Black Health research, including:

  • Research priorities: the social and structural determinants of health; Black francophone health; Black queer and trans health; Black wellbeing; health in all policies approaches; the science of policy implementation; artificial intelligence, bias, and health care; quantitative methodologies for smaller populations.
  • Advocacy and programmatic priorities: knowledge mobilization; policy development; interventions addressing Black health research funding inequities; research capacity building and bridging; trainer-trainee mentorship opportunities; Black data governance mechanisms; standardizing race and ethnicity data collection.
  • Long-term priorities: Developing a 10-year plan to track the health care use and health outcomes of Black populations in Canada.

  Other participants described ways to build strategic-buy in for a potential structure on Black Health research with policymakers and the health research community:

  • By developing a concept note, meeting with parliamentarians, and platforming the idea at conferences.
  • By leveraging existing, Black-focused policy initiatives^{Footnote 5} including the United Nations International Decade for People of African Descent.

Next Steps

CIHR is finalizing the Anti-Racism Action Plan which will be accompanied by a high-level Implementation Plan including details about our anti-racism actions, when actions will be done, how progress will be measured and reported, and how actions will be adjusted. Recommendations from this dialogue will be incorporated into the final version of the action plan to ensure that we address the effects of anti-Black racism in CIHR operations. They will also shape how we measure progress towards achieving equitable participation for Black researchers in CIHR’s funding system. CIHR commits to continued engagement with Black researchers and organizations to implement the action plan and to define actions beyond its scope.

Date modified:

2024-11-22