Health, race and medical racism
Race is not a biological category; racism creates biological consequences
The provision of healthcare has always been catered to white patients. Illness is measured using parameters suitable to white skin in comparison non-white skin; “Is the patient pale?” a question that is often used as a marker of illness excludes those who do not always appear ‘pale’. Medicine has perpetuated the longstanding inequalities regarding healthcare within society. Prejudices embedded in medical education are harmful; they alienate patients who need help, rise to poorer outcomes for some and widens social inequality. Racial bias is pervasive in healthcare; there have been countless accounts of healthcare staff experiencing discrimination at the hands of their patients, employers and colleagues. Medical education further emphasises these biases by adhering to out-dated medical education curriculums.
Black and ethnic minority patients are disproportionately affected by disease. The NHS has identified that black and ethnic minority patients experience high rates of chronic diseases such as cancer, and heart disease, and experience more premature deaths. The average life expectancy of a Black man is 4.4 years lower than that of a White man, 72.2 years and 76.6 years respectively. The House of Commons and House of Lord’s Joint Committee on Human Right’s Black people, racism and human rights report highlights that Black women are five times more at risk of dying during child-birth, causes of which are linked more to social determinants of health than biology.
There is no universal definition of race in a scientific context. There are 2 main views of race: an essentialist view where race is seen as groups of people that certain share innate, inherited biological traits, and the non-essentialist view that sees race to be social construct embedded in a historical, political and economic context. Despite, these 2 distinct views, modern scientific evidence criticises the concept of race as a biological trait. Biological justifications of race encourage racist thinking, for example, medical books on the cultural response to pain, states that black people may have “higher pain intensity” and “believe in prayer and laying hands to heal pain” and Muslims consider pain as “a test of faith”. Such claims on people’s attitudes to health leads to inequalities in healthcare and ultimately leads to premature deaths in non-white communities. Black people are 22% less likely to be prescribed pain medication. Race changes and has no genetic basis, therefore is cannot be a biological concept. But racism does lead to biological consequences.
There has been a longstanding history of medical and research abuse of Black people. Most notable is the Tuskegee syphilis study and it is often associated with medical mistrust amongst the Black community. However, there are many examples of experimental abuse on Black that extends over four centuries. The Immortal Life of Henrietta Lacks by Rebecca Skloot explores the life of the woman behind the HeLa cells. Henrietta Lacks’ cancerous cells were taken by doctors without her consent and have and still contribute to ground-breaking medical research. Her cells were even recently used in the research of a COVID-19 vaccination. Additionally, a study on the genetic cause of aggressive behaviour was performed on Black boys. The researchers used financial incentives to persuade parents to register their sons in the study, whereby the participants were withdrawn from medication including asthma medication, they were put on a low protein diet, withheld water, had overnight stays without parental consent and were given drugs with high serotonin levels that were associated with aggressive behaviour. Due to these unethical experiments, many Black and ethnic minority individuals fear entering medical research programmes. There is a belief that the research may reinforce negative stereotype and or expose them to unnecessary risks. Some have also voiced that they are particularly fearful of genetic research as DNA collected may be used to implicate innocent people in criminal cases.
History shows, non-white mistrust in medical is very valid, but the stark reality is that despite the unfair practices, medical and racial injustice, the medical education still fails to include Black and Brown people in their curriculum. Most research focuses on Eurocentric conditions. Research is widely focused on so called ‘White disorders’ such as Cystic Fibrosis in comparison to ‘Black diseases’ like Sickle Cell. Cystic Fibrosis receives more funding for research and has also received four drug approvals whereas Sickle Cell only has 1 drug approval. There has been a recent call to decolonise medical education and pioneers like Malone Mukwende have taken front seats at taking action to include darker skin in medicine. Mind the Gap: a handbook of clinical signs on black and brown skin was created by a current third year medical student in London after witnessing that his education does not cater to people who look like him. The handbook and website, https://www.blackandbrownskin.co.uk, collects dermatological conditions on darker skin that can be used to properly diagnose patients in clinical settings. This is a major step in reducing health inequalities and racism in medicine.
Racism as a social determinant of health affects individuals at all stages of the Dahlgren and Whitehead model. It affects people’s socio-economic, cultural and environmental conditions, social and community networks and their individual lifestyle factors. Race and racism is known to be associate with lower socio-economic status, low educational attainment, structural barriers to improvements in all aspects of life and individual factors like stress.
