McKinnon and colleagues deserve a great deal of credit in authoring one of the few articles that address black–white racial disparities in preterm birth in Canada.1 Despite the absolute disparities being smaller after adjusting for other variables, the relative risk ratios were very similar, as were the risk differences, between black Canadians and black Americans. These findings go against the authors’ hypothesis that there would be lower preterm rates in Canada than in the United States, because of Canada’s better history with black people and its universal health care system. However, McKinnon and colleagues may not have been aware that Canada has an exclusionary history toward black people and is perhaps not as egalitarian as they believed. In fact, before the civil rights movements of the 1960s, Canada’s immigration policy could be described as racist.2 To illustrate this troubling part of Canada’s past is a statement from the 1958 director of the immigration branch of the Department of Citizenship and Immigration in 1958:2
It is not by accident that coloured British subjects other than negligible numbers from United Kingdom are excluded from Canada. ... They do not assimilate readily and pretty much vegetate to a low standard of living. Despite what has been said to the contrary, many cannot adapt themselves to our climatic conditions.
McKinnon and colleagues’ hypothesis on racial history in Canada may be misinformed. However, their article is definitely a step in the right direction toward improving equality, because it shows inequality in the beginnings of life.