Under-representation of darker skin in medical illustrations is unhealthy

March 10, 2022

Collage by Exposure using original graphic by OpenClipart-Vectors from Pixabay

Losing patients? Aya Pfeufer calls for more diversity to address implicit bias in healthcare provision

Have you ever seen medical pictures and diagrams illustrating black people? I hadn’t until very recently.

When I used Google search engine and typed up medical illustrations I found people of lighter complexions being used. It made me feel shocked by the lack of diversity.

The lack of representation of black people in medical textbooks was brought to light when a Nigerian medical student, Chidiebere Sunday Ibe, 25 went viral in December last year after posting a black mother and foetus, which he drew himself, on social media platforms Instagram and Twitter.

In a matter of weeks his post accumulated over 88,000 likes and, as a result, has sparked a lot of discussions on why the lack of representation of black people can be so detrimental and affect the way black patients are treated and diagnosed for illnesses compared to white patients.

Chidiebere is a freshman student at Ukraine’s Kyiv Medical University and picked up the pastime of drawing. He self-taught himself during lockdown and has created many medical illustrations, including black mothers breast-feeding children and has been actively advocating for medical inclusion and equality.

Chidiebere believes that, “Textbooks are essential to medical training. They walk medical trainees through conditions they will encounter during their practice. The skin is an important organ that protects us and can signal when something is wrong in our body. Yet, most medical illustrations are based on the Caucasian skin. This lack of diversity has important implications for medical trainees and their future patients because many conditions and signs look different based on the patient’s skin colour.”

Chidiebere’s illustrations symbolise a wider message: medical and structural racism in three levels: internalised, institutional and interpersonal.

Internalised racism is a type of oppression in which we accept racial hierarchy and stereotypes involving black people.

Examples of institutionalised racism is the skin whitening industry, which sells products to make people’s skin lighter in tone, as it is culturally considered to be ‘more desirable’, and also the idea that race correlates with social status and which class you belong to.

In the healthcare industry, racial bias and discriminations may reduce the quality of treatment and access for black people

Interpersonal racism is a form of racism that occurs between individuals, which affects the way they communicate with others.  It involves bias, prejudgement or discrimination towards black people and can come in the form of hate crimes, racial profiling and barriers deliberately set up to prevent a black person from getting a job or more.

In the healthcare industry, racial bias and discriminations may reduce the quality of treatment and access for black people.

Racial biases may include the internalised belief that black people feel less pain, can tolerate pain more or have less nerve endings. These stereotypes from medical professionals and physicians can be seen as early as the 18th century, in a more extreme form, where they used these ‘accepted conclusions’ within the medical industry as a reason to conduct forced medical experiments on the bodies of enslaved people, which were often terrorising and very painful, because operations took place without anaesthesia.

For example, James Marion Sims, an American physician in the field of surgery, also known as the ‘father of modern gynaecology’, used multiple powerless enslaved black women for his medical research and to develop different surgery methods to repair complications that arose during childbirth. Only after perfecting his procedures, did he offer surgery to European white women, with anaesthesia.

Ongoing bias training could be integrated into the medical curriculum to spot implicit biases, to ensure patients are treated equally and provided with the same service regardless of race and gender

According to a recent health study, Black women in the United States experience maternal mortality three to four times more often than white women. In Massachusetts, Black women were approximately twice as likely as white women to experience pregnancy-associated mortality, with a large percentage of these deaths reported to be preventable. This shows that there is still a lot more work to be done to reduce this disparity.

To address this problem, we need to address the implicit bias that medical professions have, such as viewing black people more negatively or taking them less seriously when these patients raise an issue regarding their health.

Ongoing bias training could be integrated into the medical curriculum to spot implicit biases, to ensure patients are treated equally and provided with the same service regardless of race and gender.

We should also encourage and push for more medical illustrations of ethnic minorities in publications and medical textbooks.