Equity, Diversity, and Inclusion in Health Research
Written by Sophia Linton, PhD'24 (Candidate), Graduate Student TA
On September 14, 2023, the Department of Medicine welcomed Dr. Jason Berman, who delivered the prestigious TIME lecture. Dr. Berman's presentation centered on integrating Equity, Diversity, and Inclusion (EDI) principles into clinical research. After his presentation, Dr. Berman graciously met with TMED students to have an extended conversation. It was a transformative session for all those in the audience.
In the wake of George Floyd's murder and the discoveries of unmarked graves at the sites of former Indigenous residential schools, the health sciences community has made a conscious effort to promote EDI and anti-racism efforts. Editorial pieces were published, like "We need to act now" by Editor-in-Chief of eLife, Michael B. Eisen, highlighting the inequalities experienced by Black scientists and calling on the scientific community to remedy these injustices(1). Dr. Berman explained that at the Ontario Hospital Association, an anti-racism task force was established whose mission was to "provide a call to action to hospital-based research institutes on anti-racism actions and practices to identify, challenge, and change the values, structures, and behaviors that perpetuate differential treatment of individuals based on racial and ethnic identity." Working groups were created to focus on EDI in the workplace through retention/advancement and hiring, to promote mentors/role models and youth in STEM, and to better understand provincial participation in research.
It may not come as a surprise to know that there are numerous benefits to incorporating EDI in healthcare. In his presentation, Dr. Berman cited these advantages, including increased job satisfaction and morale, reduced absenteeism, heightened creativity and productivity, and an enhanced reputation for the institution. Implementing EDI within medicine has improved patient outcomes by fostering greater sensitivity to the needs of underrepresented minorities, providing patients with more choices, and ultimately resulting in better compliance. Further, diversity in research leads to more rigorous work, greater innovation, and better dissemination.
To incorporate EDI into clinical research, a dynamic and cyclical process must occur that begins at the project's inception with engaging diverse and inclusive groups. Dr. Berman covered key components of this approach (Fig. 1), including inclusive data collection and ownership, analysis, and interpretation through an equity-based lens, equitable and inclusive knowledge translation, and the maintenance of system-level accountability within an inclusive and equitable working environment designed to reduce barriers.
Dr. Berman illustrated these concepts throughout his presentation while referencing research involving Indigenous people in Canada. The research landscape involving Indigenous peoples is rapidly changing, especially considering their growing population. According to the 2021 Census of Population, the Indigenous people represent 1,807,250 people, or 5% of the Canadian population. In fact, Indigenous children are the fastest-growing segment of the Canadian population and comprise close to 50% of the people in remote communities(2).
Research involving Indigenous people requires a deep understanding of cultural nuances, as First Nations, Inuit, and Métis have unique histories, cultures, and traditions(3). Adopting a holistic worldview, implementing a strength-based approach, and respecting traditional ways of knowing and sharing, such as storytelling, are just some of these nuances. Dr. Berman explained that genuine engagement with Indigenous groups involves consultation, active involvement in project design, and knowledge sharing. Further, it includes allowing Indigenous partners to shape terminology and conducting data analysis using an equity and anti-racist-based lens, which may involve tools like GBA+ and an intersectional approach while acknowledging one's positionality. All these efforts must occur within a framework of "Ownership, Control, Access, and Possession (OCAP ®), especially regarding knowledge translation(4).
In our extended conversation with Dr. Berman, it became apparent that we, as TMED students, have a unique role to play in the health research community by incorporating EDI principles into our research and graduate program. We are also particularly susceptible to the systemic frameworks put in place by our institutions, programs, and especially by our supervisors and laboratories. Therefore, we must apply the learnings from these Medical Grand Rounds to recognize and address barriers in our research practices, including the systemic obstacles underrepresented groups face, such as gender biases and unconscious biases. Importantly, we must foster an inclusive, equitable, and safe workplace where diverse perspectives and identities can influence and shape research. In my own capacity as the TMED graduate TA, I am committed to leading by example, continually educating myself on relevant principles and research, holding myself accountable, being open to acknowledging mistakes, and recognizing my position of privilege. As Dr. Berman aptly noted, we can all serve as ambassadors for EDI starting today.
1. Eisen MB. We need to act now. eLife. 2020 Jun 5;9:e59636.
2. Statistics on Indigenous peoples [Internet]. [cited 2023 Sep 18]. Available from: https://www.statcan.gc.ca/en/subjects-start/indigenous_peoples
3. Government of Canada IAP on RE. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans – TCPS 2 (2022) – Chapter 4: Fairness and Equity in Research Participation [Internet]. 2023 [cited 2023 Sep 18]. Available from: https://ethics.gc.ca/eng/tcps2-eptc2_2022_chapter4-chapitre4.html
4. The First Nations Information Governance Centre [Internet]. [cited 2023 Sep 18]. The First Nations Principles of OCAP®. Available from: https://fnigc.ca/ocap-training/