The issue of racism has been thrust back into the spotlight in recent weeks with the murder of George Floyd and the widespread protests that ensued. Many have been outraged by the story of Mr Floyd and many other Black individuals who have been unjustly killed by police in the USA. Protests have swept though the USA and the UK calling for greater attention to and action on widespread inherent racism. Many people of colour will have their own stories of racist encounters, as unfortunately I do, too. Whether it be racist slurs outside of a nightclub, racial profiling at airports, or one of the other numerous encounters that I have experienced, I find these situations deeply uncomfortable and hurtful. And unfortunately racism continues to exist at a structural level. This blog post will touch on some of the many challenges that we continue to face as people of the BAME community.

Healthcare is racist, too

Kawasaki disease is a serious illness affected children under five years old and is caused by inflammation of the blood vessels. It presents with high fever, swelling of the lymph nodes and a rash. Severe complication rates can be seen in 25% of untreated patients and mortality reaches 1% if left untreated. In medical school, the rash is described as having a classical appearance, with textbooks showing something similar to the picture below-right. However, what most textbooks fail to describe is the rash in darker skin tones. The same is true of most other rashes and skin conditions; medical textbooks fail to show the appearance of serious skin conditions in dark skin tones. Instead they focus on the appearance of skin conditions on the background of light skin tones, where contrast is improved and the rash is easier to describe. As you can see below the “classic” Kawasaki disease rash is almost impossible to see on darker skin. For clinicians unaware of the differences between presentations in patients of different skin colours, this may delay diagnosis and lead to complications or death for patients with darker skin tones.

Brown Skin Matters on Twitter: "This picture demonstrates how ...
Medical textbooks and lectures often miss the differences of disease presentation between skin tones. Kawasaki disease affects children and the “classic” rash appearances differ significantly between skin tones. Image: Change.org.

Recently, there have been growing reports of death and poor outcomes from COVID-19 disproportionately affecting Black, Asian and minority ethnic (BAME) individuals. A recent report from Public Health England found that those from black ethnic groups were twice as likely to be diagnosed with COVID-19 than those from white ethnic groups. More striking still was that people of Chinese, Indian, Pakistani, other Asian, Caribbean, and other black ethnicity had between a 10% to 50% higher risk of death from COVID-19 than individuals of white ethnicities. The report describes at the length the issue of BAME communities disproportionately affected by COVID-19. However despite over 1000 organisations submitting evidence and recommendations to the government report, there were no recommendations published in the report to help protect these at-risk communities. This highlights that ethnic minorities are often at risk of poorer outcomes in medicine. Despite the UK government recognising the issue, more still needs to be done to utilise this knowledge for the welfare of BAME individuals. There needs to be greater consideration of race and minority ethnic groups in policy. Promoting individuals from ethnic minorities into positions of power, to advocate for the issues effecting their communities, would go some way towards tackling this issue.

During my first week of medical work experience I was shadowing in a clinic with a plastic surgeon who happened to be Indian. In between patient consultations the surgeon and I would chat about medicine as a career. Towards the end of the clinic he quietly told me in Hindi that as a person of colour, if I wanted to be within a position of power in the NHS, I would need to work twice as hard and be twice as good as my white colleagues to achieve my goals. It is a story that I have told very few individuals. I didn’t believe the surgeon at first; I didn’t understand the concept of institutional racism perhaps. However looking at the latest NHS Workforce Race Equality Standard, published by the UK government, it shows that there are fewer opportunities for Black, Asian and minority ethnic (BAME) individuals than for those from white ethnic backgrounds. White applicants were 1.46 times more likely to be accepted for a job compared to BAME applicants. This is reflected in very senior positions as despite 13% of the UK population being of BAME ethnicity, only 8.4% of NHS board members are of BAME origin. Despite progress in recent years, institutional and structural racism continues to persist even within our beloved NHS.

Racism still exists within the commercial sector

Though statistics can help us understand organisational racism, they do not tell the whole story. Walmart, the world’s third largest supermarket, recently stopped locking up beauty products for Black skin tones. The items were previously locked behind a glass case and the customer was required to ask for a customer service assistant to retrieve the product. This was not required for beauty products aimed at lighter skin tones.

The world’s third largest supermarket chain recently stopped locking beauty products for Black people in stores after a lawsuit. Note that beauty products for lighter skin tones were not locked. Read the New York Times article here.

A mobile application called FaceApp was developed to beautify selfies of users. The app used a machine learning neural network to create rules to “beautify” the selfie. The algorithm used the company’s training set of “beautiful” faces to pick out similarities between the images in the training set and build a series of rules which it associated with beauty. The target selfie would then be transformed using the learnt rules. This included removing wrinkles and tending towards lighter skin tones. The app CEO apologised for the fundamental bias in the training set that caused the algorithm to use light skin tones to classify beauty. This app was harmful in its suggestion that dark skin tones were less beautiful than light skin tones.

FaceApp used a racially biased training set in machine learning which tended towards lightening dark skin tones in order to “beautify” them. Read the TechCrunch article here.

Thoughts

Stories of racism will continue to occur until institutional racism is tackled. I will do my part to try to hold business and policy leaders accountable for their actions. The issue exists on a global scale and therefore the solution involves us all. We all must stand up to racism and only then can we begin to tackle this issue.

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