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A refusal to consider the experiences of Black, Afro-Indigenous and Indigenous Peoples in healthcare settings has predated the global COVID-19 pandemic. The history and development of medicine are founded on anti-Black racism and, as a result, systemic anti-Black racism is a feature of healthcare settings and the delivery of services. Globally, anti-Blackness is a barrier to meaningful and substantively effective health equity and, yet, contemporary practices of equity and inclusion do not effectively address anti-Black racism. Focusing on the needs of Black and Indigenous Peoples would create equitable healthcare that would serve everyone's needs.

This is a reflection from three Black South African doctors - two women and a man. We studied at the institution that we are currently working in, which is a former white university that was not permitted to train Black medical students by the apartheid government. We experienced the segregation in healthcare and witnessed how our communities did not have access to it. The COVID-19 pandemic unearthed major challenges and asymmetries, particularly for the Black race and poor countries. For countries such as South Africa, it brought back memories of the apartheid past with the history of segregation and discrimination.

Racial inequities exacerbated by the COVID-19 pandemic highlight how systemic anti-Black racism negatively impacts health. Anti-Black racism pervades the healthcare system, ranging from race-based corrections embedded in clinical algorithms to bias among healthcare providers. Systemic racism takes a physiological toll, causing illness and early mortality among Black people in the US and sending ripple effects across Black communities. The erasure of Black history is a common tool of racism that serves to impede progress toward racial justice. Structural changes, such as policies and laws that centre the lived experiences of Black people and directly address anti-Blackness racism, are essential for achieving health equity.

Throughout the COVID-19 pandemic, there have been numerous examples of how systemic racism and racist stereotypes stigmatized those who contracted and transmitted the virus. This systemic racism predates the pandemic, and is itself endemic in healthcare service, delivery and education as evidenced by the treatment of Black students, residents and doctors. While public health officials, healthcare providers and medical schools may claim to be colour-blind, the documented experiences of Black and Indigenous people and people of colour - particularly those who are queer or trans - demonstrate otherwise. In this paper, the author focuses on the experiences that Black people have in healthcare settings and reflects on what has been revealed during the COVID-19 pandemic, including how systemic historical, contemporary and ongoing anti-Black racism continues to negatively impact health outcomes.

Dryden (2023) highlights how the COVID-19 pandemic anchored on anti-Black racism within the Canadian healthcare system to cause disproportionate suffering and death among Black people. We extend this argument by situating both COVID-19 and healthcare within broader racialized landscapes- the weather of anti-Blackness in the US - and argue that from sports and education to healthcare, Black bodies are weathering precisely because of intentional interconnected systems of oppression grounded in white supremacy, racial capitalism and patriarchy. Because oppression does not exist in a vacuum, health equity and liberation require us to engender new lexicons that decisively expose racism to (1) evaluate data differently, relationally and more critically through different disciplinary lenses and (2) centre the liberation of those at the intersection of multiple systems of oppression, such as Black women; Black queer and transgender people; Black people with disabilities; and unhoused, unemployed, uninsured and incarcerated Black people.

Canada is often held out by scholars as the exception to a disheartening global pattern that suggests that high levels of racial diversity in a society are incompatible with support for generous social policies (Banting et al. 2006). The explanation for this pattern is that it is a real phenomenon (rather than an artefactual one) and it can be chalked up to racist motivations that cause powerful racial groups (whites and those non-white people who ally with whites) from endorsing policies that will benefit Black and other non-white groups (Alesina et al. 2001). One of the social policies that we are most often lauded for maintaining is the Canada Health Act (1985), which mandates that the vast majority of physician and hospital services are accessible free of charge. The prevailing discourse in Canada has been that the Canada Health Act (1985) ensures equal access to healthcare among all Canadians. In addition, polling data suggest that the vast majority of Canadians believe racism is a terrible thing (Bricker and Chhim 2020). However, cases such as that of Joyce Echaquan (Nerestant 2021) who died at a hospital in Saint-Charles-Borromée, QC, as nurses looked on and mocked and demeaned her with their words, or Leonard Rodriques (Allen 2020) who was turned away from an emergency room in Toronto during the COVID-19 pandemic and died shortly after, call into serious question the narratives of an egalitarian and benevolent system, in the context of a society that publicly endorses anti-racism.

In response to the arguments put forward by Dryden (2023), this paper discusses the disproportionate toll of the COVID-19 pandemic on racially marginalized communities - particularly, Black healthcare workers. There were numerous reports in the media that Black people were being treated poorly by healthcare providers and that Black healthcare workers felt poorly protected compared to their white counterparts. This paper argues that the National Health Service has been maintained through a system of racial capitalism. The author proposes that to address racial health inequity a more in-depth understanding of our shared colonial history is required.