Why racism is a public health crisis

Racial bias in science and medicine harms people’s health, writes Layal Liverpool in his new book Systemic: How Racism Is Making Us Ill. She tells David Robson about the litany of health care disparities she’s discovered.

When Layal Liverpool was a teenager in the Netherlands, she began to notice small spots of pigmentation on her face and arms. He was prescribed antibiotics and antifungal medications, but to no avail. She thought it was a very rare and incurable disease.

It wasn’t until she met a dermatologist in the UK who also had darker skin that she discovered the real cause was eczema. He suggested that the other doctors she saw – who were mostly white – simply didn’t know how this condition could appear on brown skin, leading to a misdiagnosis.

After working as a biomedical researcher, Liverpool is now a science journalist and her first book Systemic: how racism makes us sick examines the health gap between people from marginalized ethnic groups and their white counterparts, and ways to close it. She spoke to fellow science writer David Robson about what she discovered.

What inspired you to write this book?

I recently became a mother and in the UK black women like me are four times more likely die during pregnancy and childbirth compared to white women. There are similar statistics in many other places, and as a science journalist with a background in medical research, I felt compelled to look into them.

I thought I knew a lot about this subject, but I was actually quite shocked by what I discovered. I found that marginalized racial and ethnic groups in many countries around the world experience much worse health outcomes in many areas beyond motherhood – including infectious diseases, cardiovascular disease, cancer and mental health problems . I would call racism a public health crisis. This makes our healthcare systems unfair, but also inefficient: it wastes time, money and resources.

You cite research showing that medical students often have completely false beliefs about biological differences between people of different ethnicities. What are some examples of these misconceptions?

Early in the book, I look at this belief that black people’s skin is thicker than white people’s or that their nerve endings are less sensitive – so black people feel pain differently. Around half of medical students in the United States believed some of these false ideas.

This is just one example, and in other areas, myths have even been translated into medical advice. For example, there used to be guidelines for adjusting kidney test results based on a patient’s race, based on the idea that black people’s kidneys work differently than white people’s. This appears to come from a small study, which was then cited by other studies, and which was eventually incorporated into guidelines. research showing that this has negative consequences on health.

We can also see race-based medicine in lung function testing. We can go back to doctor and slave owner in the United States named Samuel Cartwright, who had this idea that black people’s lungs were weaker and therefore they benefited from their slavery. This has sort of become ingrained in practice, and when I spoke about it in 2021, it was still present in international guidelines that suggest we need to adjust for race when measuring lung capacity. But last year, as I was editing the final version of the book, I learned that the American Thoracic Society and the European Respiratory Society had stroke adjustment removed of their joint recommendations. They explicitly stated that race is a social construct and has no biological basis. It would have been great if it had happened sooner, but I’m just happy that it’s happening and that there are these discussions.

How does racism influence mental health?

Racism can also influence diagnoses. There is evidence that depression is underdiagnosed and undertreated among marginalized groups, while schizophrenia, in some cases, is overdiagnosed in blacks in the United Kingdom and the United States. So there may be certain stereotypes and perceptions that affect how practitioners interpret people of color and the conditions that might affect them, which is problematic.

Finally, in many countries, people of color find that their experiences of racismand its effects on their well-being, are not taken seriously by mental health practitioners. This can reduce people’s willingness to seek care to talk about the problems they are facing, when they are vulnerable and need support.

Our mental state can also influence our physical health. What is the link between racism and diseases like cardiovascular disease and Alzheimer’s disease?

Cardiovascular disease is the biggest cause of death worldwide and a huge public health problem – and evidence shows that racism also plays a role. There are everyday stresses you feel, like walking into a store and being followed, due to stereotypes that black people are more likely to steal – you might feel like your heart rate is elevated and you’re stressed . And experiencing racism on a daily basis throughout your life can have a sort of chronic effect on your nervous and cardiovascular systems. Black people in the United States, for example, are more likely to have hypertension – high blood pressure – which is a major risk factor for cardiovascular disease. Chronic stress and trauma can also be linked to age. cognitive decline And dementia.

Is there room for optimism?

In writing this book, I met many people who care about these issues and are working to solve them. For example, there is a local organization called Five more X’s who campaigns for the health of black mothers in the UK. They conducted a study showing that 43% of black and brown women reported experiencing discrimination in their maternity care. And they made recommendations for pregnant Black people on how to advocate for themselves in health care. They have also provided training for healthcare professionals who want to tackle this issue and ensure patients from all backgrounds feel comfortable when accessing maternity care.

Many scientists work hard to remove bias from their medical research. And doctors have begun to address the systemic forms of racism and race-based medical practices that we talked about at the beginning of our conversation. I would like to see a broader awareness across medicine, but it is already happening in some areas, which is amazing.