Racism and Canadian general medical and public health journals

Dear Editor:

The 2020 pledge from medical journal editors to utilize their institutional power to “actively examine the effects of racism on society and health and to take action to eliminate structural racism in their editorial processes” followed calls to examine racism in health literature that pre-dated George Floyd’s murder by the police (Brown et al., 2019; Krieger, 2014; Ogedegbe, 2020; Sexton et al., 2020). Like other businesses, journals may shy away from naming racism despite taking public positions against racism (Patrick, 2021; Rivara et al., 2021; Nature, 2020).

Canadian exceptionalism is the notion that racism is a problem elsewhere such as in the United States (Kwak, 2019). We determined the number of articles in Canadian general medical and public health journals that mention racism. We used the methods of a previous study (Hardeman et al., 2018) to identify articles published in the Canadian Medical Association Journal (CMAJ), the Canadian Family Physician (CFP), and the Canadian Journal of Public Health (CJPH) between 1 January 1990 and 30 June 2021 that included the word “racism” or any of its derivatives (such as “racist” or “racial discrimination”) anywhere in the title, abstract, or body of the text.

Between January 1990 and June 2021, 0.8% (295/34,869) of articles in the CMAJ, CFP, and CJPH mentioned racism; 0.6% (138/24,660) in the CMAJ, 3% (101/3031) in the CJPH, and 0.8% (56/7178) in the CFP. Of the articles that explicitly named racism, the majority were non-empirical studies, such as commentaries and letters (Table 1). The number of articles mentioning racism has increased over time and especially after 2010 (Fig. 1). The number of articles that focused on racism or institutionalized racism as a core concept was lower than the number of articles that mentioned racism in passing (Table 1). For most articles, passing mentions entailed naming racism in the Introduction or Discussion as a possible explanation for research results or as future directions, rather than as an intentional effort to centre racism as a core research focus.

Table 1.

Analysis of article type for journals that included the word “racism” during the period 1990–2021.

Source: Authors’ analysis. CMAJ, Canadian Medical Association Journal; CFP, Canadian Family Physician; CJPH, Canadian Journal of Public Health

	CMAJ	CFP	CJPH
Total # of articles from journal websites	24,660	7178	3031
Total # of articles that included the word “racism” anywhere in the text	138	56	101
Total # of commentaries/viewpoints/letters	126 (91%)	47 (84%)	43 (43%)
Total # of empirical studies (Introduction, Methods, Results, and Discussion, or review with significant data component)	12 (9%)	9 (16%)	58 (57%)
Total # of articles where racism is centred/named as a central concept	62 (45%)	20 (36%)	37 (37%)

Fig. 1.

The average number of articles that include the word “racism” anywhere in the published text from January 1990 to June 2021

Between 1990 and 2021, we found articles that did not explicitly name racism when it arguably should have been mentioned. Instead, some articles mentioned “discrimination” or “inequity”, refraining from explicitly mentioning structural racism even once (see ESM Appendix 1). Some of these articles cited works in which institutional racism is mentioned as a core concept.

Racism is rarely mentioned in Canadian medical and public health journals and is seldom the focus of empirical studies. Our findings related to Canadian medical and public health journals are similar to those for journals in the USA and the United Kingdom in that racism is rarely mentioned (Hardeman et al., 2018; Krieger et al., 2021). Although studies linking racism and health are published, rare mentions of racism in general medical and public health journals could signal racism is unimportant. An analysis of the world’s top four medical journals—The Lancet, The New England Journal of Medicine, JAMA (the Journal of the American Medical Association), and the British Medical Journal—found that less than 1% of articles published in the last 30 years included “racism” anywhere in the text (Krieger et al., 2021). The limited mentions of racism may have a variety of impacts, including limiting the evidence base available for clinicians and policymakers to draw upon, and may indirectly affect research funding decisions (Krieger et al., 2021). Medical and public health journals being important parts of the health care ecosystem, problems covered in them likely reflect broader issues and, likewise, changes to medical and public health journals could have wider effects that should be carefully tracked.

Supplementary Information

Below is the link to the electronic supplementary material.