Unpacking the ‘Invisible’ Determinants of Black Canadians’ Mental Health By Eunice Machuhi

Unpacking the ‘Invisible’ Determinants of  Black Canadians’ Mental Health By Eunice Machuhi

There is a need to address the existing structural and institutional factors that contribute to barriers to accessing mental health information, resources, healthcare, and support for persons living with mental health illness and vulnerability,  poverty, and racism.

According to Professor Josephine Etowa, the research Chair in Black Women’s HIV Prevention and Care, evidence suggests that the Black communities are more likely to experience serious mental health problems, such as depression and other anxiety disorders.

She pointed out that health inequities within and between populations are produced and sustained through multiple, interconnected and complex pathways.

For instance, she noted that some determinants of mental health include individual biology and behavior, social and physical environment, access to quality care and policy and interventions.

As such, achieving health equity requires valuing everyone with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities.

These remarks were part of Prof Etowa’s presentation titled ‘unpacking the invisible determinants of Black Canadians’ mental health that she shared during the first-ever African Caribbean and Black Mental Health virtual session themed ‘talking about mental health’.

Other policy interventions that Prof Etowa highlighted include recognizing and addressing policies that perpetuate stigma and discrimination, including race-based gender, homophobia and transphobia. There is also a need to enable the collection of race-based data and address health inequities.

Factors influencing mental health and service use

Racism, discrimination, economic disadvantage, mistrust and fear are some of the factors she noted that influence mental health and service use. Others include cultural and social influences, biological, psychological and environmental factors.

Why Race Matters?

On issues of race, Prof Etowa indicated that personal experiences of discrimination and institutional racism are added pathogenic factors that can affect the health of racialized groups in many ways.

All indicators of Socio-Economic Status (SES) are non-equivalent across race. 

While citing examples, she noted that African Americans receive less income at the same levels of education, have less wealth at the equivalent income levels and have less purchasing power because of higher costs of goods and services compared to White Americans.

This, therefore, shows that health is affected not only by current socio-economic status but by exposure to social and economic disadvantage over the life course.


In addition, she said that because of racism, Black people have to be good but have to be 10 times better and 10 times better.

“And you always feel as though you have to prove yourself, that you have to be on top, that you're always scrutinized, because the slightest mistake you make, it will be noticed and recorded, she said.

She added, “if as a Black nurse you make a mistake, you're gone.  And they'll find a reason to get rid of you, very easily.  And, so, you're hesitant to rock the boat because it'll cause problems.

Racism and Health: The pathways

She also acknowledged that institutional discrimination could limit one’s socio-economic status attainment and group differences in SES and health.

Discrimination, she observed, can lead to reduced access to desirable goods and services, while internalized racism - acceptance of society’s negative characterization, can negatively impact health.

Further, racism can create conditions that increase exposure to traditional stressors (e.g. unemployment). Experiences of discrimination may be a neglected psychosocial stressor.


She suggested the need to increase awareness of community-led information and education and offer service provision by implementing anti-black racism training, increasing access and eliminating barriers to healthcare, and fostering partnerships and collaboration.

She also said there was a need for research and funding to increase opportunities and build capacity for ACB research.

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