In recent years, conversations surrounding every industry on the planet have steered towards diversity. Education, entertainment, politics, and even science. But we all know that science is an objective and straightforward set of disciplines, right? Why does it matter who the scientist really is?
In an ideal world, no matter what race, gender, or socioeconomic group a doctor is from, they should be able to perform their job to the same degree, and receive the same level of patient satisfaction. Unfortunately, we don’t live in that ideal world. So what really is the link between diversity, racial diversity specifically, and patient care?
At a teaching level, a distinction needs to be made in the way that conditions present themselves in people of different races. A pertinent example of this is in dermatology. A 2011 survey of dermatologists revealed that 47% of them felt that their training did not adequately prepare them to treat African American patients (1). In a personal effort to solve the problem, a handbook called “Mind the Gap” was created by a medical student, Malone Mukwende, from St George’s, University of London. It raises awareness about how symptoms present differently on darker skin for more than 20 conditions. As seen below, a condition as common as hives presents very differently on pale and dark skin. But if you were to Google “hives”, the only photos that would come up are of white skin. Medical students, in their textbooks, are also exposed to similarly homogenous content. You can access the book here at https://www.blackandbrownskin.co.uk/.
At a clinical level, health issues affect various segments of the population differently. For example, sickle-cell disease is more prominent in people of African, African- American or Mediterranean descent. It is important for medical professionals to recognise these differences before providing customised care for their patients. Furthermore, the attitudes towards the healthcare system also differ by race. In a study conducted in 2007 by students of the University of Pennsylvania, the mean level of distrust in the healthcare system among the Black and Hispanic subjects was significantly higher than that reported by the White test subjects (2). Another important factor that enhances the healthcare experience is cultural competence, i.e. the ability to collaborate effectively with individuals from different cultures, something that can only be developed in a diverse environment.
Statistics prove that a diverse physician workforce can help obtain better outcomes for patients and save more lives. One of the reasons for this is that as patients, before they can heed the advice of a doctor, need to trust the doctor. As discussed in our other article, The Myth of Black Pain Tolerance, racial biases are quite widespread in the medical field, which has bred mistrust in the medical system as a whole. As a result of people feeling sidelined by doctors of different races, patients tend to seek out doctors who are of the same race as them (racial concordance), and often report higher satisfaction rates when this occurs (3). This trend is observed among White, Black, and Hispanic people in the United States, in a study conducted by the Department of Veteran Affairs. Therefore, if people seem to prefer racially concordant physicians, it makes sense that the workforce should be diverse enough to cater to those needs. Unfortunately, while 31.5% of the US population is made up of Black, Hispanic, and Native American people, only 6% of practicing doctors are from these communities (4). Without bridging this gap, the trust that minority communities have in the medical system will remain low, because they do not see their best interests reflected in the doctors that are entrusted with their care.
Finally, let’s discuss the need for diversity in research and development. Continuing with our example of dermatology, it’s important to note that one of the most important steps in a skincare routine is sunscreen. Sunscreen prevents ageing, pigmentation, sunburns, and even skin cancer. Yet, despite being such an important part of daily skincare, it is not formulated with skin of colour in mind.
The sunscreen industry has been criticised worldwide for a lack of skin tone inclusivity because most sunscreens leave what is called a “white cast” on coloured skin. This is because mineral sunscreens work by using opaque sunlight blockers such as zinc oxide and titanium oxide that reflect the sun’s rays away from the skin. However, being white in colour, they leave brown skin looking ashy and sick.
It’s a pretty easy fix: make the sunscreens tinted and include a variety of shades to suit skin types. Strides certainly have been made to enhance representation in the industry. However, these strides have come a bit too late, as an indelible mark has already been left on communities of colour. InStyle magazine’s month-long State Of Skin study of 1,800 women found that “Black women were the least likely to use SPF products" (5). This is known as The Sunscreen Gap, and it’s a problem that has been created due to a lack of attention from the medical community on the effects of sun damage on darker skin.
It’s a common misconception that Black people, and people of colour in general, can not get skin cancer. Although studies have proven that skin cancer is less prevalent in the Black community than in the White community, when it does occur among people of colour, it tends to be diagnosed at a later, and more advanced stage, at which treatment and recovery become long and difficult. Black people are 4 times more likely to be diagnosed with advanced-stage melanoma and the mortality rate is 1.5 times higher than White people with a similar diagnosis (6).
Through this example, we can clearly see that two factors are at play with respect to research. Firstly, since there are not enough researchers who are from minority ethnic communities, these communities are often forgotten in product development itself, which can contribute to low usage rates. At the same time, research is not conducted on people of colour to actually find out how these products work for them, and what a gap in usage will lead to. This lack of research leads to the fostering of dangerous medical myths that feed into the cycle of negligence from both healthcare workers and patients themselves. Fortunately, there are organizations like the Skin of Colour Society, which actively gives research grants to dermatologists to study extensively on people with darker skin tones. If this is replicated throughout the medical field, and more diverse samples are obtained for research, these disparities can slowly be eliminated in the future.
Maybe one day we will live in a perfect world. One where human beings simply do not have biases. One where professors can easily teach about a variety of people, and students are exposed to diversity from the start of their education. One where doctors can provide the exact same level of care to every patient, and patients can feel equally comfortable with all doctors. One where researchers will automatically keep the entire population in mind when conducting studies and developing products. But until we reach that perfect society, we have to include everybody in the fight that it takes to get there. Before every patient is comfortable with every doctor, we need to slowly restore faith in the healthcare system by calling for more minority professionals within it. Before Black people feel perfectly safe taking part in experiments and studies, we need to recruit more Black researchers to show the participants that people are looking out for them. Before we can enjoy a perfect system, we have to rebuild the broken one.
Written by Ishita Sharma
1. Buster, K. J., Stevens, E. I., & Elmets, C. A. (2013, August 13). Dermatologic health disparities. US National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742002/#R44
2. Armstrong, K., Ravenell, K. L., McMurphy, S., & Putt, M. (2007, July). Racial/Ethnic Differences in Physician Distrust in the United States. US National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913079/
3. Saha, S., Komaromy, M., Koepsell, T. D., & Bindman, A. B. (1999, May 10). Patient-physician racial concordance and the perceived quality and use of health care. US National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/10326942/
4. Robins, D. (2016, August 16). Doctor’s Take: Being a Minority in Medicine. AbcNews. https://abcnews.go.com/Health/doctors-minority-medicine/story?id=41419014
5. Greaves, K. (2019, December 4). Black Women Are Still Not Wearing Sunscreen Every Day — and the Result Could Be Fatal. In Style. https://www.instyle.com/beauty/black-women-wearing-sunscreen
6.Antonio, F. S. (2020, May 15). Misconceptions About Melanoma. https://foxsanantonio.com/news/local/misconceptions-about-melanoma
7. Olds, G. R. (2018, July 31). Diversity in Medicine Saves Lives. Real Clear Education. https://www.realcleareducation.com/articles/2018/07/31/diversity_in_medicine_saves_lives_110290.html
8. Börve, A. (2017, August 10). First Derm Set to Bridge the Racial Health Gap. First Derm. https://www.firstderm.com/skin-color-racial-health-gap/
9. Onyejiaka, T. (2019, September 27). The Sunscreen Gap: Do Black People Need Sunscreen?Healthline.https://www.healthline.com/health/black-people-need-sunscreen#How-did-this-sunscreen-gap-come-about
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