Small Changes Big Impact

EDI, race, and authenticity in medicine with Dr. Onye Nnorom

June 10, 2020 University of Toronto - Department of Family & Community Medicine Season 1 Episode 29
Small Changes Big Impact
EDI, race, and authenticity in medicine with Dr. Onye Nnorom
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Small Changes Big Impact
EDI, race, and authenticity in medicine with Dr. Onye Nnorom
Jun 10, 2020 Season 1 Episode 29
University of Toronto - Department of Family & Community Medicine

In studio today, we have Dr. Onye Nnorom. She's the new lead for Equity, Diversity and Inclusion in the Department of Family and Community Medicine. She is the Black health theme lead for the University of Toronto medical school, family doctor and public health specialist, and assistant professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health. Today's episode focuses on inclusion and authenticity. 

This episode was recorded on March 9, 2020, but its release was delayed due to the COVID lockdown. 

Show Notes Transcript

In studio today, we have Dr. Onye Nnorom. She's the new lead for Equity, Diversity and Inclusion in the Department of Family and Community Medicine. She is the Black health theme lead for the University of Toronto medical school, family doctor and public health specialist, and assistant professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health. Today's episode focuses on inclusion and authenticity. 

This episode was recorded on March 9, 2020, but its release was delayed due to the COVID lockdown. 

Dr. Rezmovitz:

Dear listeners, the release of this episode was delayed due to the COVID lockdown. Please be mindful we sat down to have this conversation with Dr. Onye Nnorom on March 9, 2020. I hope you enjoy the show. Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. In studio today, Dr. Onye Nnorom. She's the new lead for Equity, Diversity and Inclusion in the Department of Family and Community Medicine. She is the Black health theme lead for the University of Toronto medical school, family doctor and public health specialist, and assistant professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health. Today's episode focuses on inclusion and authenticity. I hope you enjoy the show.

Dr. Nnorom:

Thank you for having me.

Dr. Rezmovitz:

No problem. So I think first off, I would really like to hear you tell me about the role that you have at the DFCM right now, the Department of Family Community Medicine. Talk to me about equity, diversity, and inclusivity or inclusion. Sorry.

Dr. Nnorom:

No, it's all good. I'm happy to talk about it because I'm so excited for this opportunity. So I'll kind of abbreviate sometimes and use the acronym EDI. We love acronyms in medicine, but that's equity, diversity and inclusion. So what my role is is to provide recommendations to the leadership in this Department of Family and Community Medicine around on those topics. But first I'm just going to pause and say, let's level the playing field and what do I even mean? What do we mean by equity, diversity and inclusion? So one of the ways I like to describe it is what's often used in the literature as an analogy for these things. So you think about a party, right? So you go to a party, diversity is all the different people who are there. And so, our department is actually quite diverse - there's all different types of people here. But when you think about , equity - equity is who has not been invited or who has been invited but could not come to the party. And so when you're thinking about equity, you might think of groups that are not represented very well, particularly historically within the Department of Family and Community Medicine. So , we could think about Black, Indigenous , Filipino communities, perhaps those who are differently abled - there's particular groups that you're less likely to see compared to their proportion in the general population. So equity is taking extra steps. So if it was a party, you say, 'how come these people can't come? Oh, they've been positioned further out where they can't access the party .' So just for them, we're going to have a bus to make sure that they're represented here at the party. So that's equity. It's doing things a little bit differently because you recognize that there have been unfair practices or unfair barriers to particular groups into how they can't or have not been really able to enter that party. Inclusivity - that's a whole other level. That means the environment at the party. You now start to say to different people - all the different groups - I want you to help with creating - what is the playlist? What is the music we're all going to dance to? It's not going to be only the traditional way that we've always done what we've done, but now we're going to try to make everybody comfortable. So you bring a song from your life and perspective, your own authentic vision. We bring that all together and then we're all going to learn how to dance together. So inclusivity is really making it comfortable for all of those people to come in and as their authentic selves from different backgrounds - even if they had already been at the party. So when I think about that in the Department of Family and Community Medicine, it's definitely building on the diversity that already exists. We already have half of the faculty in DFCM are women or more than half. So that has changed over time and it used to be male dominated. And then now we have to think about who has been missing and then how can we make it a more comfortable environment for everybody so that we can work towards excellence and better care for our patients.

Dr. Rezmovitz:

Well, this is going to be pretty easy today because we're just gonna walk down the path. And so obviously, what are your ideas as the lead for EDI and how to make it more equitable? Because I can tell you there's a party happening April 24th, it's the DFCM Conference. There'll be a lot of diversity. But the question is how can we - and you don't have to use that example, but I just wanted to promote the DFCM conference over and over again. And so - April 24th - and so -

Dr. Nnorom:

Very subtle.

Dr. Rezmovitz:

Very. Oh, we use a very, very keen subtleties here that people hopefully won't - April 24th, DFCM Conference. Get your tickets now. No, for real. So down the pathway here is, so we've got EDI, right? And so you're the lead, and you said - and I love the analogy because the DFCM is a party and I would - like how are we going to curate this playlist and make sure that everybody gets a chance to participate? So I would love to hear what your thoughts are on which areas you're going to tackle first or address or which projects you think need to address this area -use using these strategies right now.

Dr. Nnorom:

Right. So I mean - I'm very new to the role and so I think my biggest task is actually to listen and learn first. So I'm coming in with a lot of curiosity. I do know that there has been some data collected in which we know like Black, indigenous and Filipino are underrepresented in the faculty and the DFCM, but there are so much more. I know that there has been data on the voice of the resident voice of the faculty, voice of the staff. So that was a survey of, you know, people's experiences that was collected by the Faculty of Medicine and distilled to the leadership, but I wasn't at the table when that was provided. But also I'm curious about what is going on. Like there's lots of people doing work throughout the Department of Family and Community Medicine, both those who are in community and those were at academic centers. So for instance, I will be giving a talk at the at the conference on April 24th. So I will be there, but I really want to hear about what great work people are already doing. I want to know what is in the surveys that we already have and then how - is there opportunity to collect a little bit better data? Because I think before we start changing things, change the playlist, send buses out to have that equity lens, it really is important that that is well-informed. And that comes from not just reading survey results - although that's important - but I need to speak to people, speak to leaders, speak to equity champions. And I'll also be developing a committee. So it's not just me running around making decisions, but I'll have a whole committee of people who are champions at different sites - so an EDI committee to decide, okay, what are the first steps that make the most sense? Now in the long run? Like the North star - like what I'd like to see definitely is those groups that have been historically underrepresented, being better represented within the department. So using that equity lens, having a better sense of what our diversity looks like and how that can grow over time. This is Toronto. And including the greater Toronto area, but very, very diverse. And then inclusivity, I mean, that's really everyone. So I was involved in the - Faculty of Medicine has a strict - like the academic plan talks about excellence and equities. So that's a pillar of our academic plan. And so I was involved with my co-chair [inaudible] here at U of T to create an action plan around equity in the Faculty of Medicine. And so we engage in a vision process where we thought about what would the Faculty of Medicine look like if everybody was able to come with their full, authentic selves, feel welcome, and bring their contributions and their innovations based on their life experience without feeling like they're going to be excluded or threatened, but actually bring all of those experiences, right? So that's what inclusion would look to me and the Department of Family and Community Medicine - whether you've had a lower income background or high socioeconomic status, whether you are Black or white or Indigenous or South Asian - you're an immigrant as a physician or your parents were, or you've lived here for several generations - all of your different life experiences really determine the kind of ideas, innovations, problem solving that you come with. So to me, that is what the inclusion is.

Dr. Rezmovitz:

Values.

Dr. Nnorom:

It's those values, it's practices, it's ideas. And then how do we create that environment so that we're better serving the diverse population that we have as patients . So for me, that's kind of like long- term North star . But right at the beginning it's about, I'm coming in with curiosity and excitement and I just want to talk to people and I want to look at some data.

Dr. Rezmovitz:

So it sounds like a gap analysis needs to be done to see if there is a gap, where the gap is, and then how we're going to address the gap. In order to get to your North star though, I think you're going to need thousands of hours of psychotherapy for people to become their authentic self. Just being honest.

Dr. Nnorom:

Yes. And I have a good therapist myself. I think it really is -

Dr. Rezmovitz:

It's important.

Dr. Nnorom:

Yeah it is important to do that self-awareness piece and getting over the barriers that we create for ourselves and for others.

Dr. Rezmovitz:

I actually recently listened to your podcast and you had a guest on and talked about the authentic principle?

Dr. Nnorom:

Yes Ritu Bhasin.

Dr. Rezmovitz:

Yeah. And she - I couldn't help but think that what if - and this is how my brain works because I lead a pretty authentic self. I am who I am and that's it . That's what I try for. But what if somebody doesn't want to lead their authentic self? And so I think that's - listening to the podcast , I was like there was a lot of telling people to be authentic. What if they don't want to be authentic? And I'm not trying to - I'm just playing devil's advocate here for a second because they don't even know, right? That's the problem. I think that we have this fractured community right now , where people are afraid. I think that there's so much fear about doing the right thing, doing the wrong thing. Am I going to step on somebody's toes? And so this all ties into equity, diversity and inclusion is how do you bridge that fear? Because I don't think anyone's intention is to be exclusive or not inclusive. I don't think anyone's intention is to not create equity. But I think the hardest thing that people have to wrap around this is that they're so ignorant and not as a bad way - I'm just using the word - like they're uninformed about how to even address these issues because they're not even aware that somebody - they don't even think about these things. It's like clearing off the stairs so that the kids can go up to school, but if the guy would've just cleared off the ramp, then everybody would've been able to get into school. Do you know what I mean?

Dr. Nnorom:

Right.

Dr. Rezmovitz:

You know, you do the ramp first and make sure everyone can get in, including those with disabilities [inaudible].

Dr. Nnorom:

Strollers.

Dr. Rezmovitz:

Strollers. Right. Actually , last point here - Judith Heumann - do you know Judith Heumann? She wrote a book recently. She was onTrevor Noah's The Daily Show, and she was a activist for people with disabilities in the 60s. They did a rally. They had 50 people with wheelchairs and they stopped Times Square, I think in the 60s. And her new book called "Being Heumann" - which is not available at the DFCM Conference on April 24th - is it talks about how we don't even think about these things, but she got the elevator in the Washington DC subway system. And so everybody who uses this - people with strollers - don't even realize that that fight was fought by people with disabilities who fought for their own rights, their own human rights. And so we have to do this somehow in a way that brings everyone up together, supports people. And so that's what I would love to see. It's a long diatribe or monologue of me saying I support what you're doing.

Dr. Nnorom:

Thank you. And I think you raised some really great points. So one is okay, first was around authenticity. So I think there are some pieces to unpack there. So in the podcast, "Race, Health and Happiness", which you can find on racehealthandhappiness.com - oh, sorry, I just said it wrong at racehealthhappiness.com - that's where you can find the podcast. That's where I interview people to find out how they have overcome in what I would call a racialized world. So although not everybody is fully self aware - that's a common thing. We all strive to become more or some people run away from it, but we don't necessarily all have natural self awareness. But for groups that have experienced historical - what I'd call historical oppression - so I'll use systemic racism and as an example. So where either laws or policies or cultural practices in an institution had been set up in a way that might not have been intentional or might not be intentional right now to exclude certain groups , have historically excluded certain groups, right? So one then grows up in a situation where you're part of the non- dominant group and you have to pretend - like you have to pretend more than your average person to fit in. Um, your values might be different. You might have come from a community where there are more community values, but where you sit in class and people are like for end of life care or making decisions, it is up to that one patient, you know, perhaps the family is in the room or not in the room, but it's not a collective decision. But you might come from a culture where that is the case, but feel uncomfortable in the classroom or at work kind of, you know, that, that you've had that or that perspective. So the trick that she's talking about authenticity is really where you live in a society where the way your own identity, not just as an individual, but your whole collective group that wears a particular label has to kind of contort itself to fit in, can be extremely stressful.

Dr. Rezmovitz:

It is .

Dr. Nnorom:

Yeah. And so - for instance, again for black women it's everything from the way one might do one's hair, for black men the way they might stand or present - I know professional black men who are speakers at different events - so they're professional speakers, but they think about, "okay, I have to like hunch myself. I have to put my voice at a certain level so that I am not intimidating to certain subpopulations of our population that have all these stereotypes about black men. I have to really work hard - not just at my speech, at my work, but also actually work to seem non threatening because I don't want to trigger a stereotype."

Dr. Rezmovitz:

Trust me. I've been there.

Dr. Nnorom:

Right? So that's an extra layer. Right? And so where one has those extra layers that society doesn't allow you to be your authentic self, then that's really what she's speaking to. Right?

Dr. Rezmovitz:

Totally.

Dr. Nnorom:

And what's fun is -

Dr. Rezmovitz:

It creates conflict.

Dr. Nnorom:

It creates conflict - particularly when you're from a demographic where you don't have the power because I think if you are from - let's say you're from like a higher income background or you're the dominant group - so here the dominant race would be white Canadian - you could decide, "you know what, I just want to go somewhere else. I don't feel comfortable here." But if the whole society is structured in a particular way, you might not have that benefit. Especially if you want to help your community or have impacts . You need to stay in those places, in spaces that might make you feel uncomfortable. So she has a book and it's really cool because - and I think this applies to everybody. It's a fun way of thinking of it. So in her book around authenticity -, we didn't get into that on the podcast on Race, Health and Happiness, but she talks about the adaptive self, the authentic self and the performative self. And I think this is helpful for everyone. I love it. So the authentic self is a bit of an illusion because the way you're going to be authentic with like your parents is not the same way you're going to be authentic with like your friends or when you're in clinic, right? It's you, but it's a modified version of you. The performative self is where you're really pretending to be somebody that you're not because you feel like you have to do that. And then there's the space in between. That's the adaptive self. And I think for it , particularly for a young person growing up, but even for somebody who hasn't thought about their own authenticity, she describes it as a playful place where you figure out how much you can kind of push the envelope and move towards your authentic self or it's changing environments or doing that, but have fun in that space because it will change with age, with context and everything else. So it's actually a playful space and it really depends on the person. So for some people it's not a big conflict. They're not ready. They're not there. It's a journey. So I think that probably is a nice way to think about it. It's not this stressful thing where you have to figure out authenticity. It's just a playful space where you kind of figure it out over your lifetime. And then speaking about what you had said around inclusivity - again, like I think that that's part of it. Like that her analogy around the adaptive self is really around trying to figure what that means as an individual. But if we're thinking about environments and trying to make a department or clinic or anything like that safe, then it's going to be work for everyone to say - particularly the leadership to make the environment which you call a psychologically safe space. That means you can say something or do something and then if people don't like it, they correct you in a way that isn't shaming. Right?

Dr. Rezmovitz:

Yeah. No , I agree with you. We've had this talk on the podcast here before about the differences between a safe space and a brave space. So the brave space includes the safe space because you can't have a brave space without a safe space.

Dr. Nnorom:

Right.

Dr. Rezmovitz:

And so by telling people that this is a safe space, it actually is counterintuitive because people then may question is this a safe space? But by showing people and not telling people that it's a safe space, right? Creating a brave space where people can feel that they can speak up and that people trust that this is coming from a place of good intentions, not something not to trust, something to fear, then you won't end up with the same conflict that you would by telling people this is a safe place because as soon as you do that, there are people who are like, is it a safe space? Can I do that? So that's kind of thing that I've been focusing on with the workshops and research that I've been doing. There's you may want to check out a very interesting theorist. His name is Pierre Bourdieu. He's a French theorist. He came up with the social capitalist theory.

Dr. Nnorom:

Yes, yes. I read about him.

Dr. Rezmovitz:

And so everything that you're talking about adaptive, performative - so it comes down to, you have an individual and they have worth, they have value, right? And their values are - they take on their own values by existing in this world, but for most of their formative life, those values are projected onto them.

Dr. Nnorom:

That's right.

Dr. Rezmovitz:

And so those main values or the capital that is inside each individual is based on the three big ones, which is financial, social and cultural. And so then we adopt these as we either align with the projected values or we distance ourselves from those projected values and create our own values, which is where you play with stuff. And so you're either labeled a disruptor because you don't align with the cultural values of the system that you're in. But it turns out you're a key stakeholder in every system, right? But like you said, I go to work and I'm a respected physician at at work. I mean for the most part. But then I go home and I'm respected for different things at home. It is not for the work that I do. Right? Socially, I'm at the bottom of the totem pole, right? Everything's just changed. All the values have changed. And so to assume that you can apply the same person in every single context and expect the exact same outcomes is crazy because the context has changed, the values of each system has changed. And so it's going to be really difficult to create the North star - get to the North star, I think because we have to examine every , uh , system every context to try to bring people up, and to create inclusion, equity and make sure there's diversity in each one. You got a strong - you have a lot to work with. You're so lucky.

Dr. Nnorom:

But you know what? I do feel really lucky because I feel like the things that are happening in my life right now - like we mentioned, I'm the Black Health Theme Lead. So I teach in the medical school about Black health and I really anchor it on how anti-Black racism in our society is a driver of like health inequities, right? For me to be speaking about issues of racism and oppression and also how we can overcome it as a society - so both in the context of the podcast, Race, Health and Happiness, but also particularly here in the Faculty of Medicine at the University of Toronto. I feel incredibly blessed. So even though it's a tall order, I love this work because I h ave been doing this type of work since I was probably eight or nine years old. So I was the kid - so like after I experienced racism on the playground and in the classroom right where I had a very, very lovely teacher who made assumptions about my intellectual ability - I don't think she thought really two seconds about it - it wasn't even intentional, but, giving me straight Ds, whereas I had been a B student in grade one. So that devastated me. And my mom came in and asked a bunch of questions and was my advocate. And then by grade three I was having straight A's and the rest is history. But that was, a critical moment for me where a teacher just made assumptions - didn't even flag anything - but you know, about my ability, which I presume was about my race because that's shown in the literature to commonly happen. But basically at a very young age, I started to observe things due to race. And so my coping mechanism was to read and be like an advocate around racism. So like other kids have like show and tell. So if you p icture like 10 year olds show a nd t ell whatever, where they went on vacation, I was like, this is Nelson Mandela, this i s the African national Congress flag. I've got it like in crayon - like that was my way of coping, right? And so to then end up in medicine and then realize that different forms of oppression, like racism affect people's health, and then I can be somebody - along with many others - who is creating awareness around this and advocating around this and then able to use that experience to understand other people's experiences. Right? So, I mean, I'm a w oman, s o already I kind of understand issues of systemic hetero - of sexism, but to understand hetero sexism and homophobia and people whose lives I have not walked through, but I can understand that, and working with different champions, "okay, how do we overcome this," to me is like, it's - you know that saying that like luck is where preparation meets opportunity.

Dr. Rezmovitz:

I haven't heard it but -

Dr. Nnorom:

Okay. But people say that luck is where preparation meets opportunity. But I feel like for me it's more than luck, it's a blessing because this is almost like my life's work intersecting with medicine. And then I have this opportunity not only to do it, but to engage others who have this passion as well. So it's not easily undone. There's an Indigenous saying that if it takes two days to walk into a forest, it takes two days to come out. So this - the different forms of barriers and impressions and different contexts and systems can't be completely undone - you know what I mean - in a couple years or anything like that. But we all as a society have to move towards that. So that's one thing. So I've got that curiosity. The other curiosity that I have now more recently is around - well, what if I had been born in a different skin, in which case that I didn't have this point of reference of seeing like oppression - of seeing, you know, as a kid I saw like all of the - I'm half Nigerian so lots of the community had degrees they went to McGill but couldn't get jobs. And you know, there's studies showing that at that time in Montreal, even if you're a Black person with a graduate degree, your odds of getting a job were the same as a non Black high school dropout. Right. But I didn't have that study at that time, I just saw it. So I can understand where people express their own feelings of exclusion, right. Where you have like a whole society, I'm in a community feeling excluded for opportunities. But I'm like, what if I had been brought up in a context where I didn't see that? Like, what if like - you know, at six years old I was called the N word, so that that was done. You know, I had that label. But like what if I was just a person?

Dr. Rezmovitz:

When you say "just a person" what do you mean?

Dr. Nnorom:

Like I didn't have the label black girl or black person. I was very conscious of that. So like as a teenager, you walk into a store, we all knew we can't touch our school bags. Because if one of us touches o ur school bags, they're g onna think we stole. So as you kind of go in - like we didn't even think of it at the level like "that's terrible that that store person did that." We would say, "Oh my gosh, this girl - how does she not know not to touch her bag if she walks into the store? We're black kids. T hey're g oing t o think we stole. Don't touch y our bag."

Dr. Rezmovitz:

So you own it.

Dr. Nnorom:

Yeah. You kind of own it - the stereotypes .

Dr. Rezmovitz:

Instead of it being systemic.

Dr. Nnorom:

Yeah. Because that's like the internalization, right? But where I speak to people - first of all, either they could be of actually any background, but they grew up in their context as the dominant group. So let's say somebody who grew up in Ghana, right? And they're black. They were part of the dominant tribe. They grew up feeling like a person. They didn't wear a label. I would assume for maybe - maybe not now, but in the past, like a young white boy probably grew up not - constantly thinking of himself as a white boy. I'm entering the space as a white boy. I have to speak up in class as a white boy. But for me, because that happened at such an early age of my formative development and happens to so many people who are visible minorities, then it becomes like internalized. Right? But I'm like - and so I understand different groups in under that lens. But what if I hadn't had that lens? Like, what would it be like? So I'm really curious to speak to people who really aren't into equity, diversity, inclusion - really don't feel like this is a big deal. Or who think that it's a bad idea. I'm genuinely curious now. Whereas before I think it was more defensive when I was younger. Now I'm curious about that because that's somebody who's walked a different path and has not seen the things that I've seen.

Dr. Rezmovitz:

So it's really interesting the way that you frame that . I agree with you - I think you want both points of view. I think you can learn from both.

Dr. Nnorom:

Exactly.

Dr. Rezmovitz:

So - and the reason I think it's really interesting is because this came up in the last few years for me is because how I'm perceived and how I perceive myself are in conflict. You see, I'm a tall white male according to the perceived narrative. And yet recently I - over the last few years, I took a course - the Indigenous cultural safety course.

Dr. Nnorom:

Yeah. The [inaudible]

Dr. Rezmovitz:

Yeah. It's amazing. And you have to hit a radio button at the beginning to identify your race and your gender in order to engage in the dialogue .

Dr. Nnorom:

Yeah.

Dr. Rezmovitz:

And I didn't identify with any of the races that they put up there as the radio buttons. And it's like one second. So I had to go investigate. And the reason is, is because growing up and being prejudiced against for being Jewish and being and having been victim of anti-semitism and being a child of children of four Holocaust survivors , and hearing the stories, I'm not white. I don't identify with white. I don't identify with a regular white person and the experiences of growing up in Canada. I'm a first generation Canadian whose grandparents survived mass genocide, whose children have listened and have been traumatized with the intergenerational trauma that comes through that and then subsequently traumatize yourself also. But you listen to this stuff over and over again and at no point do you identify with white. And so then I have to go and realize that there's complete conflict in my perceived narrative and my own narrative and go, what the hell? And so you start doing some reading and investigation and curious and be like, really? And so all the things that you talked about earlier, I lower my chair because I'm a tall white male so that the learners will be more on par with me. I've been doing this - I've been yelled at for being the person who lowered the chair and I said, "you know, yeah, your chair is lowered, but I have to actually raise my chair every time after you because you're five foot three and I'm six foot three and so we both are doing it. It's not like I'm not doing it to you."

Dr. Nnorom:

Right, right.

Dr. Rezmovitz:

The fact that Mount Sinai exists as a hospital in Toronto is because of the pervasive anti-semitism that existed that didn't allow Jewish doctors to be interns. And so they could never practice. Right? So like all these things that are out there, right? Is because of systemic racism, antisemitism, it's prejudice. And so, I didn't know how to come to terms with the fact that my racial identity and my racial expression were completely different. Thank God Jewish isn't - I was told. And so that's what I was told. It's an ethnicity and a culture. And so coming to terms with being white - have you ever heard this before from somebody? Coming to terms with being white and the afforded privileges that come with being white? It's not that it wasn't aware of it 20 years ago. I mean, because of the prejudice that starts when you're very young, you start realizing that you're different. You're standing on a street with your friends because of a fire - what do you call it ? A fire alarm, not the fire -

Dr. Nnorom:

The fire drill?

Dr. Rezmovitz:

The drill! The drill - because of the fire drill and someone starts yelling out, "you dirty Jews." You know, you're 12 years old. Just what did we do? Nothing. Right? You see it over and over again. You have the same fears and triggers that your parents have that have been passed down to you.

Dr. Nnorom:

Yes.

Dr. Rezmovitz:

Because you're engaged in this cultural maelstrom basically. Like you don't see another point of view until you start experiencing it yourself and make that decision, "wait a minute, how am I going to respond to this? Do I need to respond the same way that my parents responded or do I make up my own mind and choose to be different?" And I don't think a lot of people are making that choice. I think it happens so quickly subconsciously that because of the values that you engage in are from the culture and the people that you value - your parents, for the most part here - it happens subconsciously. So you're not even aware that these differences exist. Unless of course you were lucky enough to have been prejudiced against and see the world for what it really is and see both sides. And I know it sounds crazy that I'm saying lucky enough to be prejudiced against -

Dr. Nnorom:

No, but I understand what you mean. An experience that allows you to understand others.

Dr. Rezmovitz:

That's right. And so that is happening in the city - in Toronto more than we - it's happening all over the world - more than we actually acknowledge. And so it's really hard to live in a world where you are prejudiced against, but that you have no control over it because of the systemic - what's the word? Prejudice.

Dr. Nnorom:

Yeah. Yeah.

Dr. Rezmovitz:

And so how do we have to beat that?

Dr. Nnorom:

That's it. And that takes time because again, with that - it takes two days, like these types of systemic exclusion, oppression , discrimination happened . Like, you know what I mean, over centuries. And even as you mentioned, like for the Jewish population - the Jewish population wasn't considered white. Italians weren't - like all of these are our social constructs that usually follow along with like politics and you know, whatever the context is at the time.

Dr. Rezmovitz:

It was Black, dogs, and Jews, right?

Dr. Nnorom:

Yeah. Right. So that changes based on the political context. So race, of course, is a social construct and it's a very political and a politically loaded issue, but you talk about some other things. So that's the process of racialization. So actually under the anti-racism directorate - so that's like for the province of Ontario, the group that - the part of government that looks at systemic racism , antisemitism and anti-Muslim sentiments are considered part of the anti-racism directorates work because they argue that those are religious groups that have been racialized. Right? And so you talk about really what you're talking about where you are standing there and the fire drill - that is a moment where you become like racialized. You become part of a category, whether you liked it or not or volunteered for it or not where that happens to you. The other thing that you touched on was privilege, right? So for each group, we have different privileges - like if you grew up rich or you grew up poor or what have you. But the common thing about privileges that we don't always reflect on our own - we think about the privileges we don't have. So that is the exercise also that I'm curious about where you said listening to both sides, because I think there is a choice to overcome, but if you are differently abled or if you are, let's say trans and - you know what I mean, like certain groups - and then you add that to like other identities or lower income or Black like that - all that intersectionality where you belong to like multiple groups but it's not as much of a choice. Then there's a lot of work to be done of course to release yourself of those labels. But then there's a lot of work to be done by those who are more privileged to say we need to knock down these barriers because again, particularly at a young age - like you said, like 12 - it becomes internalized. And then there's also what you described, the intergenerational trauma - information that's passed down to really keep you safe as far as grandparents and others are concerned but can create its own trauma or make you scared to engage with others who might not look like you or be like you because of that danger. So these are all the things that we need to begin to unpack - thinking about our own privilege, thinking about the society and how things need to be changed and also at an individual level. So that's, that was part of the impetus behind the podcast - again, Race, Health and Happiness - it's how do we stay well in a racialized world because it's when you realize, okay, as you know, particularly a visible minority, we know that poverty is racialized i n Canada - l ike a racialized person makes 75 cents for every dollar that a non racialized person makes. That's not g onna change overnight. But you can't just allow that to take away all of your joy. Like we are human beings, right? So we need to be able to find joys. So like for me personally, like I wake up every morning, I'm like, "okay, where is the joy today? Like, I'm going to go find it." Like it doesn't even have to find me. I'm going to find it today.

Dr. Rezmovitz:

It is an active process. You know, waiting as a construct - waiting for joy to happen, waiting for all these things - actually creates fear. It's based in fear, it's anxiety. And so actively focusing on gratitude and actively focusing on finding the joy will actually improve your overall mental health. And yet not enough people do it. They're like, "well, I'll just wait and see." And it's based on fear. Most people are afraid, I'm finding. Most people really just are not willing to take risks because it's not safe to them. They're afraid. They're afraid of isolation, which we know leads to more mental health issues.

Dr. Nnorom:

It does.

Dr. Rezmovitz:

They're afraid of being the final - see I read this book and - probably one of the best books I've ever read in my life. It's called "How Come Every Time I Get Stabbed in the Back My Fingerprints Are on the Knife?"

Dr. Nnorom:

Oh yeah. That's -

Dr. Rezmovitz:

It's amazing.

Dr. Nnorom:

I haven't read it, but that's a great title.

Dr. Rezmovitz:

It's amazing. It's about organizational development, but at the end - so what is the - everyone - one of the biggest fears that people have - and he calls it in the book called anaclitic depression - is the fear of separation. And what is the greatest separation that one can experience in our lifetime. Do you know what the greatest separation is?

Dr. Nnorom:

Birth?

Dr. Rezmovitz:

Death.

Dr. Nnorom:

Oh yeah.

Dr. Rezmovitz:

Death. Death. I have to look at how birth is the greatest separation -

Dr. Nnorom:

Well some people look at it as a trauma, as you leave, like the environment where you're most comfortable and now you have to fend for yourself and you're really alone. So yeah.

Dr. Rezmovitz:

It could be.

Dr. Nnorom:

Like an epic disappointment when you leave the womb.

Dr. Rezmovitz:

Yeah, and so we constantly looking for - how to improve our epic disappointment. When you were fed, you're warm, you're carried around. I know this is -

Dr. Nnorom:

All automated in there.

Dr. Rezmovitz:

The greatest separation generally is death. People are afraid of dying because they leave this world. But the - right under that, is isolation from your community - from whatever group that you belong to.

Dr. Nnorom:

Yes. Exclusion. Very painful.

Dr. Rezmovitz:

It is. And so we need to find a way to improve - at least in the Department of Family and Community Medicine - ways to reduce anaclitic depression, ways to reduce separation, ways to include people and support them because that will improve everyone's mental health . When you feel - when you belong - when you feel like you belong instead of trying to -

Dr. Nnorom:

To fit in.

Dr. Rezmovitz:

To fit in. Right. Because fitting in - there's conflict in that. Do I fit in? Do I not fit in? It's fear. But when you belong there's ease. And the reason is there's alignment. And when you have alignment, right after that comes ease. That's when you put the effort in to support that alignment. Not trying to effort, effort, effort all the time. Trying to create something like fitting in. Well , I'm always trying to fit in. I'm trying to fit in. You're going to have conflict and question and doubt and fear. And so when you say that you go looking for joy, I think it is amazing that you are active participant in improving your own mental health.

Dr. Nnorom:

No, absolutely. I'll tell you actually I didn't just, you know - I was trying to figure out the answers and for me - I'll let the listeners know cause I do recommend this. Yale University has a free online course called The Science of Well-Being. And it's a course - it's like an - so it's free. It's online.

Dr. Rezmovitz:

Is it on Coursera?

Dr. Nnorom:

Yeah, it's Coursera. Anyways, but it's really awesome because it has you kind of engage in the practices that are kind of common sense, but you don't necessarily do them all the time. So, meditation, gratitude, speaking to strangers - I started like speaking to strangers on the subway .

Dr. Rezmovitz:

Really?

Dr. Nnorom:

Yeah, you'd be surprised. Like people totally want to talk if you actually talk to them.

:

So my father - I'm going to out my father. He actually listens to these podcasts. But my father - and I don't know if this was a defining moment in my life, but we'd go on family vacations and he would tell people by the pool that he was psychiatrist and they would just talk to him. And it's so wrong. So wrong. But it was hilarious because he had no - he wasn't bound by confidentiality because he wasn't a psychiatrist. And then he would tell us what they said.

Dr. Nnorom:

Wait, he wasn't a psychiatrist .

Dr. Rezmovitz:

No, he wasn't. He's not a psychiatrist. And so he would tell people - it's totally - listen.

Dr. Nnorom:

[inaudible] ethics standpoint, but okay.

Dr. Rezmovitz:

Oh yeah. Well he doesn't have the ethics because he's not a psychiatrist . Right . But he as a child of survivors, had to survive. And so he had to figure out what brought him joy. You know what brought him joy? Listening to other people tell him intimate things. And while he figured out for himself at a time when we didn't have the same rules and regulations that we have now, right. That it was like, "Oh, I'll just tell people I'm a psychiatrist." It's crazy. If you tell someone you're a psychiatrist, they will - or doctor - they start telling you problems and stuff. So I don't recommend doing that.

Dr. Nnorom:

Yeah.

Dr. Rezmovitz:

But what I'm telling you is, I learned that very easily to go and just speak with people at an early age. It was quite joyous to do that.

Dr. Nnorom:

Yes, yes. Speak to people , smile at people, have gratitude journals. So all of these things they actually like make you do in the course . And so -

Dr. Rezmovitz:

Face the wrong way in the elevator. Have you done that one yet?

Dr. Nnorom:

No, but I turn towards everybody and just say hi. Yeah .

Dr. Rezmovitz:

Everyone always faces the doors.

Dr. Nnorom:

Yes, yes.

Dr. Rezmovitz:

Walk in and just face the back and everyone - first of all, it disrupts everybody's thinking - what is going on. Okay. But then say, hi, I'm here to greet you today. I've been sent by the university or wherever you are and whatever to to greet everyone in the elevator. And you'd be like, Oh, hi. It's so crazy. You can make up certain stories that allow you to face the other way. But it's fun. Well, I enjoy it, I can't speak for everyone.

Dr. Nnorom:

So I don't necessarily make up a story, but I just say hi and people or smile. People actually - I mean it's normally if you smile at people, they usually will smile back with some exception. I mean, I'm of course as a woman, sometimes it can be misinterpreted. So you choose your moments somehow and when you're going to smile. But overall, engaging in those practices I felt like really - and the usual getting enough sleep, exercise, whatever. But I found that beneficial. And so yeah, that's what I encourage like my students and listeners to do. It's really finding joy, finding gratitude. I wake up every morning and I say, thank you, because there's a million reasons why I wouldn't necessarily wake up the next day, right? Like anything can happen, right? Like you just walk into the street, bus, whatever. Like somebody throws something out of a window, which seems to be happening in Toronto every now and then. So I'm just grateful. And so I want to be able to share that with people and say, you know - again, with the podcast, it's a story of overcoming, right? Because we face challenges. There are unique challenges to those who face systemic barriers. But nonetheless, we are fundamentally human beings. So we need to like find those moments, share those moments, have connection. And the nice thing about living in Toronto particularly or you know, in Canada in general, is that if you don't find community with people who are just like you , you can find other communities. Like there's so many other different people. And so I actually am most comfortable in settings where everybody is different because that's how I grew up. That's how , you know, in Montreal and class and everything. So I don't actually seek - or I'm not the most comfortable in situations where everybody thinks like I do or it looks like I do or whatever. And that's a beautiful advantage to have in Toronto. And again, coming back to the diversity, right? So it enriches our situations. It gives more options for finding community and connection. So I feel like if people are worried about that, you can still find there's so many opportunities if you don't like give up and just - because that's a common thing, right? To be like, "Oh, it's not worth it." Or I tried, people say "I tried everything" right? Probably didn't try everything. So seeking that, and - earlier we talked about t herapists when I can't - when things get too much -yes. You know, it's like you hurt your arm or something. You need physio. Like you know, so I'll do that as well too. I'll get s upport. I'll be uplifted and then I'll actively pursue. Yeah. Gratitude, joy, all of those things daily.

Dr. Rezmovitz:

That's awesome. We're coming - our time is coming to an end and so we always like to end with if I had only known. Tell us something. Tell - if you could tell your earlier self - you're probably like - I'm guessing sitting across the table from you - about 26, 27.

Speaker 2:

That is lovely. A lovely lie. But I just turned 39.

Dr. Rezmovitz:

Oh my God.

Dr. Nnorom:

Two weeks ago.

Dr. Rezmovitz:

Wow. That's old.

Dr. Nnorom:

Right?

Dr. Rezmovitz:

So old.

Dr. Nnorom:

Well when I was younger I thought that was like epically old.

Dr. Rezmovitz:

I know. It was. Modern medicine has changed, right? Because 60 is now 70, right?. W e're aging well - better. So if I h a d o nly known or something that you'd like to tell the medical students or some piece of wisdom. Let's impart wisdom on the listeners today and we'll leave them with that.

Dr. Nnorom:

So I think overall, no matter what we go through, like odds are there's going to be a better day. Like as long as we are here, as long as you're alive, there is hope. So where there is life, there is hope. And for me, the thing that has pulled me through and that I continue to do, is in moments of pain, when I get through them I reflect, and then I turn that into purpose. It's like how can I help others? How can I make sure that this doesn't happen to me again? But like turning pain into purpose ends up being the driver. So sometimes when something is happening I'm like, "wow, you know, once this is done I'm gonna really try to create change." So I think, yeah, once there is life, there is hope. And where you face challenges, then you know, please turn that pain into purpose. Let that drive you to help others, so turn it into a positive.

Dr. Rezmovitz:

That's amazing. I look forward to working with you in the future, and thank you so much for coming on today.

Dr. Nnorom:

Thank you for having me.

Dr. Rezmovitz:

Have a great day.

Dr. Nnorom:

You too.

Dr. Rezmovitz:

This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva, and the whole podcast committee. Thanks for tuning in. See you next time.