Are ‘whitewashed’ medical textbooks putting black lives at risk?

In light of the recent Black Lives Matter protests, many institutions are working towards tackling issues of racial inequality. The healthcare industry is one sector in particular where inequality needs to be seriously dealt with. If not, it could present dangers to the black population who seek treatment and medical care.

It starts with the teaching of future medics. From the first day of medical school, universities assign textbooks which feature predominantly white faces. Not only is this blatant discrimination, but it fails to prepare students to treat diverse populations. More still needs to be done to fully decolonise curriculums and diversify the work force. 

The first study into medical textbook diversity

In 2018, University of Washington assistant sociology professor Patricia Louie, and her co-author Rima Wilkes, published the first study into racial diversity in medical textbooks. In this study, Louie and Wilkes analysed over 4000 images of skin from four widely-used textbooks. They found that in Atlas of Human Anatomy, less than 1% of images featured dark skin. The highest proportion, still a measly 8%, was found in Bates’ Guide to Physical Examination & History Taking. 

Not only is the lack of representation a discriminatory problem, but it also presents serious potential threats to the health of non-white communities. Consider this issue and take a look at figures regarding skin cancer-stage diagnosis. 52% of black people receive a diagnosis when the cancer is already at an advanced stage, compared with 16% of white people. This prevalence of late-stage diagnoses could partially be a result of the lack of black imagery in textbooks, resulting in medical professionals that are under-prepared to diagnose cancer on dark skin. Ultimately, this may contribute to why black people are more likely to die from skin cancer, even though skin cancer is more prevalent in white populations.

The white-centred language of the NHS

Racial inequality is also evident in the language medical professionals use. All it takes is a quick look on the NHS website to see how conditions are described from a white-centred viewpoint. A rash caused by eczema is referred to as ‘red’ or ‘pink’. ‘Blue lips’ are considered a common symptom of pneumonia, while ‘orange tinged skin’ is representative of jaundice. All of which are accurate descriptions but only when discussing symptoms present on light skin.

This issue has only increased in significance, and risk, with the development of COVID-19. Medical professionals ask potential COVID-19 patients whether their skin has gone ‘pale’ or their lips have turned ‘blue’. Both are key symptoms in light-skinned patients, but are less prevalent on darker skin and therefore less relevant for diagnosis. The NHS gives seemingly no consideration to these differences.

How can non-white people be expected to recognise their symptoms, when their only point of reference is images and descriptions for white people? How are medical professionals expected to effectively diagnose a diverse population based on symptoms they’ve only seen on white people? This under-representation could cause severe misdiagnoses which could lead to untreated conditions worsening and other serious health consequences. 

Working towards diversifying medical education

Fortunately, the movement to diversify medical education is gaining traction. An ongoing Change.org petition calling for better BAME representation in clinical teaching has already attracted upwards of 205,000 signatures. There have also been concerted efforts to change medical education resources, in particular the work of Malone Mukwende. 

Malone Mukwende, a black medical student at St George’s, has made headlines for his creation of a handbook that shows symptoms on a range of skin tones. According to a press release by St George’s, after recognising a lack of racial diversity in his textbooks, Mukwende formed a student-staff partnership. This partnership aims to examine and improve clinical teaching on black and brown skin tones. The handbook, named Mind the Gap, is now available online. Eight UK medical schools have since added it to their recommended reading lists. 

However, Mukwende struggled to source images of darker skin. He contacted the British Association of Dermatologists who provided little help, as they also lacked images featuring non-white skin. Consequently, Mukwende is currently developing a live database, where the public can submit their own photos of different conditions. This database should represent the diversity present in Britain, and therefore improve patient care for all BAME people. 

This issue is just one of many regarding the discrimination of non-white groups. Any form of injustice or prejudice puts lives at risk, but especially when it comes to medical care.