Crises of Visibility: The Activism of MDs

  • Emily Cadotte

Among the many varied effects of the pandemic, the visibility of systemic inequities has been significant: the sight of encampments across the GTA; the imagery of protests for Black Lives and defunding the police; and cellphone footage of police brutality shared on social media platforms. Alongside the rest of us, healthcare practitioners witnessed those injustices, perhaps even more acutely, and from a different lens: the inscription of systemic forms of oppression on the body. 

These inscriptions are typically articulated in public health discourse through the framework of “social determinants of health” (SDH). The SDH broadly encompass all conditions under which humans live.1 This includes a person’s economic, housing, and employment status, their integration into a social network, the surrounding air quality, pollution, and geographic factors in which a person resides. The World Health Organization’s 2005 Commission on SDH recognized the social environment’s “direct influence on access to health care and lifestyle choices.”2 But it curiously omits the risk of violences associated with the social environment, including police violence. In Toronto, the risk of experiencing violent police force is five times more likely as a Black Torontonian than a white one, while the specific risk of being fatally shot by police is twenty times more likely.3,4 Policing is an impulse to collect what’s deemed unsightly to a classist, anti-Black, and anti-Indigenous society and put it away into prisons and other elsewheres, where the privileged needn’t be confronted with the troubling visuals of racialized poverty and its many forms of resistance. By opening the criteria of a public health concern—which is to say a collectivized concern voiced by the medical community—to encompass violence at the hands of police, it’s more difficult to feign ignorance or invisibility. 

Enter Doctors for Defunding Police, which began in June 2020 as an initiative by a handful of medical doctors “concerned about the toll anti-Black and anti-Indigenous policing was taking on the health of residents in the City of Toronto.” It goes without saying that this was a summer of reckoning with police brutality, especially those most egregious forms often reserved for individuals in mental health crisis, facing housing insecurity, or criminalized due to their racial background. The group’s initial press release identified the healthcare system’s complicity “in systemic anti-Black and anti-Indigenous racism [which] often works in concert with police services, especially as it relates to mental health crises.”5 Respectability politics are often leveraged to keep policing impervious to critique, but doctors have a similar leverage in terms of shaping public discourse, specifically around what gets included in conversations about health. Doctors for Defunding Police now includes over 600 members from diverse medical, cultural, and racialized backgrounds within Canada. 

Doctors for Defunding Police is expanding not only in size but also in scope, acknowledging the interrelated crises of addiction, housing, and policing. This is reflected in their recent membership in an activist coalition, comprising several organizations in the GTA that—in a statement titled “Another Toronto is Possible”—voiced support for harm reduction models, equitable forms of housing, and moves away from the criminalization of poverty in the city.6 The coalition cites the municipality’s police budget spending (which is about double the combined budgets of Toronto Public Library, Public Health, Toronto Region Conservation Authority, Toronto Community Housing Agencies, and the Association of Community Centres)7 as a cause of underfunded social services.8 

Relatedly, and with an overlap in signatories for a growing total of more than one thousand, are Doctors for Justice in LTC (Long-Term Care)—who have turned their attention toward another form of housing in crisis. Concerned about the health of both workers and residents, Doctors for Justice in LTC note that Canada had the highest proportion of LTC deaths as compared to other OECD countries,9 with Ontario’s LTC death toll at around 2,000 at the time of publishing their press release in January 2021. This number amounts to a humanitarian crisis, and one that cannot be made right for the families of lost loved ones, in part due to Premier Doug Ford raising the threshold for liability of wrongdoing for LTC operators, many which are private and for-profit.10 In light of this, the first demand from Doctors for Justice in LTC is immediately removing the profit motive from LTC, noting that “for-profit LTC homes have had far worse outcomes during the pandemic as compared to non-profit and municipal LTC homes.”11 It is because of the system’s opacity that so many infractions around staffing ratios and infection control protocols at LTC homes are able to slip through the cracks, especially during lockdowns. It’s difficult to hold LTC operators accountable (in particular those private and for-profit long-term care homes) when so few can witness what’s happening from the inside. Much like policing’s attempt to hide unsightly inequities through force and incarceration, privatized LTC homes apply the insidious, out-of-sight-out-of-mind model that works in favour of for-profit interests. Doctors for Justice in LTC’s press release makes clear that LTC homes are gravely understaffed, and with the province’s current nursing shortage, this troubling reality will worsen unless immediate governmental action is taken. 

Many social systems in Canada, from housing to healthcare, find themselves on the brink of collapse. And it’s no coincidence, given that so many were established on the unsustainable foundations of settler-colonial capitalism. Doctors are beginning to expand the notions of SDH to incorporate the language of decolonial and anti-capitalist thought, turning a critical gaze on narrower definitions of public health. Making these concerns around police violence and inadequate care in LTC visible and heard through a public health lens places them in that unavoidably visible and discursive space we call the public. It’s difficult to gauge the impact activist medical groups have on policy measures at the municipal, and especially provincial, level. But there have been developments such as the City of Toronto’s Community Crisis pilot projects, which launched in the spring of 2022 in four targeted neighbourhoods.12 Only a few months old, one of the major concerns is an underuse of the Community Crisis service, with few direct calls from community members or 911 diversions by dispatchers.13

This could represent a learning curve, or another question of visibility: how to assess a need when you can’t see the problem? What assumptions of criminality are made by bystanders? Can trust be established between civilian, non-civilian, and response teams dubiously in the middle? 

In the meantime, crises of health and housing remain visible throughout the GTA. As witnesses to these systemic inequities on the intimate level of the body, doctors are offering not only their professional medical opinions but their personal and experiential ones on the root causes of systemic bodily harm. They see the effects of stress, trauma, and anxiety on their patients. They work in the environments of chronically underfunded long-term care and tend to the often-fatal effects of inadequate housing. As professional members of the community, these groups of largely BIPOC doctors are speaking out about not only the symptoms of systemic injustices, but its causes.

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