The consequences of an American medical racial history have not been restituted. As a result, poor health outcomes in patients of color ensue. Ideas of race related to biology that were shaped by eugenic ideologies still exist today. The same goes for physicians’ perceptions of race. For example, many physicians believe that there are genetic differences between races, which explains racial health disparities (Bolnick 362). It is puzzling that such beliefs are prevalent decades after the completion of the Human Genome Project in 2003. Human beings are 99.9% like one another with 0.1% difference (3 million pairs) with a smaller selection of the 0.1% that provide the raw material for locating the source of difference (Wailoo et al 16). Genetic variation within racial groups is greater than the variation between racial groups because of the complexity of ancestry and human migration over thousands of years. The immense knowledge of genetics and ancestry should dismiss the concept of race. Yet, the archaic myth of race remains, making unwarranted ideas about race difficult to retract. An even more pertinent reason to have inclusive racial representation within medical textbooks and pedagogy, such practices normalize black and brown bodies within the training of all medical specialties.
Race is a social construction rather than a biological reality. Therefore, racial health disparities are not a direct result of skin color but are grounded in an American social caste system based on skin color that either creates benefits or liabilities. The social determinants of health (i.e. healthy food access, access to healthcare, pollution levels, affordable housing, etc.) inform us of the unique lived experiences and health outcomes among racial populations. Consequently, stereotypes and categorizations distort the perceptions of similarities and differences between racial groups. Even the most well-intentioned physicians interpret others by their own perceptions which influence medical outcomes. Humans are innately biased. It is an inevitable trait of the human condition. Theory and research on clinical decision-making suggest that ambiguities in the physician’s understanding and awareness of their biases may result in racial health disparities. For example, “multiple studies have shown that the underrepresentation of minorities in medical education including course slides, pre-clinical lecture material, case studies, and textbooks impedes racial equity in the practice of medicine” (Massie et al 90). It is important to understand when the training of doctors does not didactically incorporate solidarity and the importance of including people of color, it contributes to the perpetual cycle of implicit bias and racial inequity.
Yet, the stain of our racial history is not fatalistic and can improve with thoughtful solutions. First, medical communities and publishers can establish an image repository with numerous skin pigmentation, gender representation, and other characteristics. It should have a creative common license with easy access to racially diverse images with multiple skin tones, colors, and hues (Martin et al 1005). Second, publishers need to partner with black artists to create such content. For instance, Hillary Wilson, a medical illustrator based in Durham, North Carolina, is gaining popularity for creating skin tones, which can be used to assist in accurate symptoms, diagnosis, and prognosis currently not easily accessible. In addition, Chidiebere Ibe, a Nigerian medical student, and medical illustrator at Kyiv Medical University in Ukraine went viral on social media creating an illustration of a Black pregnant woman carrying a fetus (Yancey-Bragg, “Patients in medical illustrations”). Chidiebere Ibe’s work will be published in the second edition of Mind the Gap: A clinical handbook of signs and symptoms in Black and Brown Skin published by St. George’s, University of London. Third, incorporate racial inclusion by being more mindful of how racial and ethnic populations and patients are depicted. Lastly, include diversity in medical materials like posters and informational pamphlets found in doctors’ offices and health care centers (Louie 42). These ideas are a good start, but there is much more work to do to correct the underrepresentation of people of color in medical textbooks and other medical literature.
There is a collective history of racism in medical spaces. This historical medical reality is the foundational reason communities of color have many challenges today. Yet, we do not have to let history repeat itself. Including people of color in medical training literature is a crucial step moving forward. Such actions will normalize and value black and brown people as human beings. This inclusion can contribute to more accurate diagnoses and prognoses. Ultimately, alleviating racial health disparities and building trust with doctors and the patients of color they serve.
Bolnick, Deborah A. “Combating racial health disparities through medical education: The need for anthropological and genetic perspectives in medical training.” Human Biology 87.4 (2015): 361-371.
Louie P, Wilkes R. Representations of race and skin tone in medical textbook imagery. Social Science & Medicine. 2018;202: 42.
Martin, Glenna C., et al. “Equitable imagery in the preclinical medical school curriculum: findings from one medical school.” Academic Medicine 91.7 (2016): 1002-1006.
Massie, Jonathan P., et al. “A picture of modern medicine: race and visual representation in medical literature.” Journal of the National Medical Association 113.1 (2021): 88-94.
Wailoo, Keith, Alondra Nelson, and Catherine Lee, eds. Genetics and the unsettled past: The collision of DNA, race, and history. Rutgers University Press, 2012.
Yancey-Bragg, N. “Patients in medical illustrations are usually white. Meet the Black artists trying to change that.” USA Today. Retrieved from: https://www. usatoday. com/story/news/nation/2021/12/18/black-artist-brings-diversitymedical-textbook-illustrations/8892939002 (2021) (Accessed January 23, 2023).