Addressing systemic bias and racism in our therapeutic content
Q&A with CPhA’s editor-in-chief, Dr. Barry Power
The team behind CPS at the Canadian Pharmacists Association (CPhA) has been on a mission for the better part of 3 years to conduct an extensive review of all its clinical content to address instances of bias, racism and discrimination. In this conversation with CPhA’s editor-in-chief, Dr. Barry Power, we hear about that process and how it’s improving CPS.
What kickstarted this process?
CPhA has a strong commitment to diversity and inclusivity, making it a key pillar of our most recent strategic plan. So, while our efforts to overhaul the content in CPS are part of an organization-wide priority, there have been significant efforts in recent years to acknowledge and address the long history of systemic racism and bias in health-care education and publications. We also heard and listened to our users about how the lack of diversity in our content – particularly reference images biased towards white skin – was helping to perpetuate the systemic racism in our health system.
As a leading Canadian publisher, we have a responsibility to ensure that the content we produce—content that is used by tens of thousands of health practitioners every day in Canada—is helping to support equitable care and is not contributing to the systemic racism found across our health system.
How was the process undertaken and what kind of issues did you find?
Our approach has focused on a few core elements, including the reference images found in CPS, language and content related to race and ethnicity, and language related to sexual orientation and gender identity.
In terms of images, we have taken significant steps to address a lack of diversity in reference photos. We’ve sourced and added images representing conditions on a variety of skin tones and are working on addressing the ongoing lack of Indigenous images. In tandem with reviewing and replacing the images, our editors critically assessed all content referring to race/skin colour to validate or update content, and they developed brand new content around the assessment of dermatologic conditions. We also established and implemented language to improve the descriptions of health conditions that are biased towards white skin. For example, the term “erythema” refers to skin appearing red or pink. In many people, the reaction may result in colours ranging from darker brown or black to blues and purples. In some cases, there is no visible change in skin colour. We’ve tried to address this since not everyone will present with “redness.”
In addition to updates that addressed issues related to dermatological conditions, what other steps have you taken to identify and address systemic racism found in the content?
Part of our review included a critical assessment of any language related to race and ethnicity. Our clinical editors searched key words (e.g., African, Asian, Caucasian, etc...) and conducted a review of statements and related evidence. Together our clinical editors, copy editor and scientific editors reviewed the findings and worked with chapter authors to implement proposed alternative wording or remove content if applicable.
In addition to race and ethnicity, what other aspects of the language did you address?
To further improve the inclusivity of our content, we hired experts in sexual orientation and gender diversity and worked with them on a review of our text. We then developed a section devoted to language and terminology in our style guide—a set of “rules” we are working to apply to all our content to ensure inclusive language related to sexual orientation and gender identity.
Examples from the guide include the use of gender-neutral language and avoidance of masculine/feminine pronouns, descriptions of individuals that avoid assuming sexual orientation or gender, the use of gender-neutral terms when writing about anatomy or conditions associated with biological sex, avoiding terms about sex or gender that imply binaries, and ensuring writing is inclusive of 2SLGBTQ+ patients and does not assume heterosexual relationships.
We have also added disclaimers where appropriate, specifically in instances where our content is based on clinical research studies and non-inclusive language might be used to maintain accuracy with what is reported in the clinical literature.
CPS content is also available in French, how are you approaching gender-inclusivity with your French content?
Since French is a gendered language, the use of gender-inclusive language is more complex than in English and requires a careful approach. We have consulted current references on the subject and have identified a number of neutral and inclusive formulations that we adapt on a case-by-case basis.
What are the next steps?
While our clinical team has worked hard to address a number of key issues already, this is a continuous process we are engaged in to improve our therapeutic content. We’ve developed some new approaches that will continue to shape the content we publish going forward, like the language style guide I mentioned. For example, we have actively recruited health-care practitioners with diverse backgrounds who are reviewing and providing input on our content.