Navigating Backlash: Decolonizing and Intersectional Approaches to Equity in Medical Education

Despite greater attention to inequity as a pressing societal issue in the wake of racial justice mobilizations, the COVID pandemic, and global polycrises, commitments to address equity remain unfulfilled and experience pushback in ways that delegitimize equity as a concept and value. Medical education is a useful case to examine this turn, as it continues to be perceived as upholding expertise, evidence, and neutrality while being engrained in deeply inequitable and colonial institutions. Drawing on doctoral research involving interviews with 32 people working to integrate equity in medical and health education in Canada and internationally, I make three arguments. First, the concept of backlash can misname the problem. Resistance to equity in medicine is structurally rooted and long predates the present moment. The increased efforts around inclusion of equity in recent years were largely peripheral or added on, often as special diversity foci set apart from the ‘core’ of medical education. This shallowness has partly fueled the backlash while obscuring opportunities for structural change. Second, the backlash frame can hide what equity work requires. Fixating on whether equity is advancing or retreating, and what needs to be dismantled or maintained, can obscure the fundamentals of equity work. These include reflexivity as a continuous and relational practice, relationship as the medium through which change occurs, and love, hope, and care as a guiding pulse for action rather than sentiment. All participants emphasized or demonstrated the power of these qualities, which reductive approaches to equity consistently strip away. Third, as bell hooks argues, the margin is a site of possibility. Resistance is not only what equity work meets but what equity work is: agentic, motivated, and sustained through relationships and communities that the backlash cannot easily reverse. Much of this work proceeds without the label of equity at all, under other names and vocabularies, which is partly what makes it durable. Looking at these issues through intersectional and decolonizing approaches, which I take to be synergistic and necessary for real change at present, I argue for greater attention to the relational conditions, long articulated across diverse traditions, through which equity work thrives.