Inclusivity in Medical Textbooks and Healthcare

Health disparities have a long history in America, and part of the disparities is caused by the under-recognition of diseases for people with darker skin. Researcher Patricia Louie says: “If doctors associate certain skin tones with a particular racial group — for example if doctors read a skin tone as a light patient — this might result in the marginalization of patients with darker skin tones or racial minorities.”

For example, Lyme disease is a bacterial infection often carried by ticks and can cause a rash with a characteristic bulls-eye shape. However, this rash is often recognizable on those with white skin, and medical students are often not taught how to recognize the symptom in patients with dark skin. Even Googling Lyme disease bulls-eye rash will take you to hundreds of images that depict the characteristic red rash on white skin. As a result of this under-recognition, African Americans are 10% more likely than Whites/Caucasians to show late manifestations of Lyme disease such as neurological or cardiac problems.

This raises the question: How do we prevent these kinds of problems from happening in the future? The answer to that is to promote inclusivity in medical textbooks so that medical students, who are going to be our future physicians, will be more prepared to recognize diseases and conditions in their dark-skinned patients. But firstly, what does it mean to be inclusive in a textbook? It means providing a wide variety of examples in medical texts of conditions manifesting themselves in people of different skin colors. Many of the current medical textbooks have a range of examples that are limited on paper but not in real life.

There was a study conducted by Social Science & Medicine in 2018 where four medical textbooks were analyzed. The textbooks were Atlas of Human Anatomy, Bates' Guide to Physical Examinations and History Taking, Clinically Oriented Anatomy and Gray's Anatomy for Students. After looking over the 4,146 images found from the textbooks, the researchers discovered that light skin was 75% more likely to be represented over any other race. There was no imagery present for diseases that commonly affect BIPOC. The imagery of six common cancers for people of color or dark skin tones was nearly non-existent in the textbooks, which is problematic because this contributes to the mortality rates for some cancers (including breast, cervical, lung, colon, and skin) in Black people, which are higher on average for them because they are often diagnosed at later stages of the disease. The study mentions some research that says 52% of Black people receive an initial diagnosis of an advanced stage of skin cancer compared with 16% of White people. "The research shows that even though Black people are less likely to get skin cancer than White people, they're more likely to die when diagnosed," Louie said. Additionally, the study found that textbooks had significantly more diversity between races than between skin tones.

How can aspiring medical students make a difference when preparing for medical school in terms of inclusivity of all skin types in their curriculum? How can we better educate those already in medical school or who are working in the medical field? What steps can we take to get publishers to release more inclusive versions of medical textbooks to allow their users to be more informed? These are all questions pre-med students should ask themselves as they’re getting ready to enter the healthcare field as our future physicians. If medical students want to pursue more effective action, they can pressure medical textbook publishers into producing more textbooks containing more images of darker-skinned people and how diseases are presented on darker skin tones because they are necessary for equality of care for racial minorities and darker-skinned people. Race-based inequities pervade the healthcare system in the United States, but it doesn’t have to continue if we better educate our medical students using more inclusive material.