As discussed in the other three parts to the “Race in Science” series, there exists structural discrimination against people of color in modern American healthcare. But why does this happen (other than the legacy of racism)? Are there other, more specific contributing factors that reinforce this perpetual bigotry?
To start, we’ll examine medical textbooks, the foundation for training and raising each generation of doctors, and thus a highly influential portion of each physician’s career. While obviously medical textbooks cannot possibly prepare a future doctor for every patient and diagnosis they encounter, these fundamental texts have a glaring issue: racial diversity.
Medical Textbooks and Diverse Representation
As many studies have indicated, most images and diagrams found in published medical textbooks only show light-skinned body parts. Why does the skin tone of a medical model even matter?
Well, there are many conditions and diseases as explained by medical textbooks that do differ in their identification or treatment based on race. For instance, some common cancers for people of color are nearly invisible in these textbooks, which manifest in the real world: though Black Americans are less likely to be affected by skin cancer, they are still more likely to die after diagnosis due to mistreatment. Mortality rates for several other cancers (breast, cervical, colon, and lung, to name a few) are also much higher for these minorities.
The representations in textbooks matter because they affect a doctor’s mindset on medicine which is reflected in health care inequities.
In the context of skin cancer, doctors must be equipped with the skills to examine the melanoma level of a patient's nails, hands, and feet; however, the effects of skin cancer can look different on various races, which physicians may not be prepared to diagnose.
Other conditions also suffer from the lack of racial diversity: jaundice, a condition due to the excessive breakdown of red blood cells or liver disease, leaves white skin with a yellowish tint, but naturally looks quite different on a patient with darker skin. Dermatology is another field heavily affected by this medical bias. Even in South Africa, where almost 80% of residents consider themselves to be Black, most medical students learn from textbooks that exclusively teach with diagrams of white bodies.
Why does this matter?
The only implications of skin color in medical textbooks are a handful of conditions, right? So why does this issue even matter? Well, this massive disparity and lack of visual representation have other repercussions and meanings.
For one, the fact that only a certain skin tone is portrayed in medicine reflects the trend that a majority of medical textbooks are written by white scientists. While of course this is not inherently the cause of any inequity, this might contribute to the greater health care discrimination against people of color: medical textbooks are written from the lived experiences and points of view of their authors, and thus may inadvertently perpetuate racial biases.
Additionally, the absence of medical diversity is more than just skin deep. The example of South African textbooks reveals the way in which science is historically synonymous with ‘whiteness,’ a point made especially poignant by the fact that the United States spent much of its history without a single black doctor. This intimate relationship between the glory of science as a field in opposition to people of color is not new and introduces a topic for an entirely new article.
Progress...in progress
Many are proposing solutions to the inequities so blatantly displayed in medical textbooks. Malone Mukwende (pictured below) and other artists have made books and manuals that depict various health conditions--from chickenpox, ulcers, to eczema--on a plethora of skin tones. While the lack of diverse representation is only a small portion of racism medicine, addressing a contributor at the fundamental level is undeniably key.
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