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Dr. Kannin Osei-Tutu, MD, senior associate dean, Health Equity and Systems Transformation, at the ��֦��Ƶ’s Cumming School of Medicine, speaks with a measured thoughtfulness as he describes the complex causes of inequities in health-care and ways to address them. His calm tone reflects his role as a trusted nationwide leader in improving medical outcomes for underserved groups.

It might come as a surprise to learn that his decision to become a physician was born from a moment of profound emotion. 

At 10 years old, Osei-Tutu was flown to Vancouver after receiving an eye injury that couldn’t be treated in the small northern British Columbia community where he lived.

“The doctor that took care of me was named Dr. Harris. I’ll never forget him, because I had never been so scared at that point in my life about what was going on,” Osei-Tutu recalls. “I thought I was going to lose my sight. And yet he cared for me patiently in such a reassuring way.”

Rather than proceeding to surgery immediately, Harris took a measured, cautious approach. By the third day of observation and treatment — and ongoing explanation and reassurance for his young patient — he concluded that no surgery would be necessary.

“And that’s actually the moment I decided I wanted to go into medicine, because I had been so scared, but also made to feel so safe in that interaction,” said Osei-Tutu. “At that point in time, I decided I wanted to be able to do that for other people.”

With guidance and encouragement from his parents — including his father, a urologist who travelled to care for patients throughout northern B.C. — Osei-Tutu began his journey towards a medical career. And, although he didn’t have the words to describe it at the time, he had already witnessed people experiencing the systemic challenges that he would later spend much of his career working to dismantle.

The Many Forms of Health Inequity

“Growing up, I would see patients with differential access to care,” Osei-Tutu says. “I would see, in my community, Indigenous people who would not want to go to the hospital. I didn’t really understand why that was at the time, but I realized later on, as I began to practise medicine, that the health-care system is experienced differently by different people. Whether it’s gender, race, or socioeconomic status — it doesn’t afford the same level of safety or care to everybody, even though it should.”

Osei-Tutu — an accomplished researcher and hospitalist who now serves as senior associate dean, Health Equity and Systems Transformation, at the ��֦��Ƶ’s Cumming School of Medicine — describes some of the discrepancies that can be found in hospitals across Canada. Indigenous, Black, and other racialized patients often see slower diagnostics, delayed treatments, longer wait times and worse outcomes. They’re less likely to have their pain taken seriously and are more likely to be physically restrained if they display symptoms of physical or mental discomfort often assumed to be from withdrawal.  Black and Indigenous patients in Canada are 30-50% more likely to die after elective surgery than non-racialized patients. This is not a matter of genetic factors, says Osei-Tutu, but rather modifiable system factors

“These are not anecdotal examples,” emphasizes Osei-Tutu. “These are real, evidence-based outcomes, statistically supported and preventable occurrences that happen, unfortunately, at a much higher frequency than the average person would be aware of.”

As with any large system, the causes are complex.  

Sometimes, outcomes are worse because racialized patients, anticipating an unpleasant experience, avoid the health-care system until their symptoms become more serious, creating a vicious cycle of cause and effect. Sometimes, language barriers impose communication changes that delay treatment. In other cases, it’s unconscious bias and preconceptions on the part of the well-meaning medical practitioners themselves.

“Having biases is a natural part of being human,” says Osei-Tutu. “This doesn’t make us bad people, but it doesn’t excuse inaction or complacency either. If one is aware of our biases and chooses not to correct them, then they are actually contributing to preventable harm. And in many cases, this takes the form of care that’s not provided or treatments that aren’t offered." In health care, Osei-Tutu notes, these acts of omission can carry some of the highest morbidity and mortality.  

For Osei-Tutu, management expert W. Edwards Deming provides an apt perspective: “There’s a quote (from Deming) who says every system is perfectly designed to get the results that it gets,” he says. “So, if you want to change the outcomes, you have to change the system.”

As he’s taken on increasingly senior roles in medical leadership, Osei-Tutu has spent much of his career working to do just that.

Pathways to Change

Some solutions come from the lab. Osei-Tutu sees great potential in AI as a tool for health equity — for example, by providing real-time translation to eliminate language barriers, speed up diagnostics, reassure patients and build confidence in their treatment plans. Algorithms can analyze and predict population health data by region, knowing that underserved communities are often clustered geographically.  

“It’s very important that those communities are not left out of the digital technology revolution, because then the gaps just continue to widen,” Osei-Tutu says.

And, while Osei-Tutu’s lab is researching solutions in these areas, perhaps even more important is the work that’s focused on training, standards, and visibility.

Osei-Tutu’s attention to discrepancies in standards of care for underserved communities was awakened in 2020 following the killing of George Floyd and the rise of the Black Lives Matter movement. “That made me realize that I had to do more,” he says. “I saw when I was interacting with medical students that the things I went through 20 years before as a medical student hadn’t actually changed.”

As a racialized student in medical school or residency training program, Osei-Tutu says, “you may be second-guessed when you give an answer on an oral exam, or you’re more likely to be questioned by staff or nurses when you’re entering orders. If your competence is questioned, you may get less time in surgery, less access to cases and fewer opportunities to develop your skills.” This sometimes leads to a confirmation bias that results in racialized learners being placed in remediation — a sequence of events that can be career-ending. This isn’t overt discrimination per se, Osei-Tutu argues, but could instead be an expression of unconscious bias.

Looking to strengthen the pathways that have supported racialized physicians for generations — mentorship, advocacy, and mutual support — Osei-Tutu founded the Black Physicians Association of Alberta in 2020. It held its inaugural meeting on Jan. 18, 2021 — Martin Luther King Day in the U.S.

“As Black faculty members, we were uniquely positioned, understanding the system and having some security to effectively mentor student physicians,” Osei-Tutu says of the Association. “This group helps us take better care of our students, and to focus on wellness, research and community outreach — to make it better for the next generation.”

The Tide Rises

Slowly, but surely, change is happening. Perhaps the biggest turning point was the formal adoption of anti-racism and anti-discrimination training for physician accreditation in the nationwide CanMEDS Framework. As a strategic advisor on health equity to the CEO of the Royal College of Physicians and Surgeons of Canada, and through his involvement as chair of various committees in the accreditation field, Osei-Tutu has played a vital role in advancing this work.

Osei-Tutu says U��֦��Ƶ is a unique place to launch this kind of change and be a nationwide leader.

“There’s incredible opportunities for transformation and impact here,” he says. “In many ways the ground in ��֦��Ƶ is more fertile for transforming systems because of our spirit of innovation.”

Despite recent gains, however, progress isn’t always linear, as Osei-Tutu knows well.

Amidst rising polarization and uncertainty, he has a calm, measured message for racialized communities: “I would say that it’s probably more important, now than ever, to stay strong, to stay hopeful and optimistic while being determined to focus on shared humanity. Try not to get angry or get discouraged if there’s pushback, but rather, expect it and be ready for it.”

“And there’s an interesting thing about energy. Energy, whether it’s negative or positive, if you harness it, can always be redirected into the ways you’d like to see it move. And, while the pushback is definitely real, and in some cases it’s intentional and co-ordinated, that means the ways we respond to it also have to be thoughtful and strategic and intentional, as well.”

Osei-Tutu also emphasizes that this is a pivotal moment for allies of equity movements. “This is the true test of allyship. Are the allies going to bend and break and bow out? Or stand on what they’ve said they believe in, and hold the line and find ways to move the work forward?”

While shared humanity and compassion make up the tenets of Osei-Tutu’s physician ethos, he also explains the need for health equity in more universal terms.

“We know that when we implement these kinds of changes, patient outcomes improve,” he says. “It shouldn’t be scary to anybody that we’re trying to make the system better for everybody. A rising tide lifts all boats. We want everybody that enters the health system to feel safe and secure to the greatest possible extent. We want to take the time to understand their unique needs and circumstances, despite all the confounding pressures.”

“And that is possible. I really think it is. It’s part of our shared responsibility to create a more compassionate and equitable world.”