The racism that exists globally within healthcare systems and the medical sphere is rife. By definition, racism refers to the belief that one race is superior to another - but this broadens to include religion and ethnicity. A colonial mindset continues to enforce such hierarchical ideas and, in turn, has shaped medical research and people’s experience of modern medicine in damaging and discriminatory ways. It is known that many countries with a history of slavery and forced migration demonstrate adverse health outcomes for people of African and Asian ethnicity (1). While racially biased prejudgements about pain threshold, consent, care and communication impact the way people are denied the medical support they need and deserve.
Shocking reports from the US and UK show that Black and historically marginalised ethnic groups are at a higher risk of maternal mortality and complications after childbirth (2). These figures aren’t isolated. The prominence of severe mental illness amongst African and Caribbean origin as well as genetic disorders and chronic diseases within Black communities reflects this racially charged gap found in medicine (3). Current studies about the COVID-19 pandemic have drawn attention to the disproportionate amount of Asian, Black, Latinx people dying from the virus in high-income countries. Accompanying these devastating facts are the legal complaints filed in Morocco against French researchers who proposed using part of Africa as a ‘testing ground’ for a COVID-19 vaccine (4). Recognising examples such as this of where and why racism exists is a crucial part of rebuilding a better system that serves everyone equally. In this article, we unpick the history of medical racism to shine a light on what needs to drastically change.
History of racist practice
Looking at the past is an essential part of recognising what has shaped modern medicine. Throughout history, non-dominant racial groups, either by law or custom, have received inferior treatment in societal institutions and medical care (5). Since 1619 when the first enslaved person was taken to the US, up until the end of the 1900s, experimentation and research has been conducted on Black people, predominantly Black women, without their consent. Violent medical treatment and exploitation of bodies formed the basis of scientists’ practises, such as James Marion Sims. Sims is renowned for being the founder of gynaecology in the US. But his discoveries of the female genitalia were the result of Sims’ forced experimenting on enslaved women without anesthesia (6).
Eugenics, on the other hand was a dangerous practise embraced by many medical professionals not only in Nazi Germany, but also throughout the US in the 20th century. Coercive and compulsory sterilisation targeted Native American, African American, and Puerto Rican women (7). More than 60,000 people were denied their right to reproduce due to eugenicists applying theories about who was “fit or unfit” for human breeding (7). Black women were continually sterilised without their knowledge or consent well into the 1980s. Such acts are found to have caused deep psychological and cultural harm on women, their families and communities.
Racial Disparities in Research and Chronic Illness
It is known that the majority of clinical trials carried out in the US and UK included a disproportionate amount of white participants (8). With the historical coercion of Black and migrated populations being experimented on, one could hypothesise how the abuse of power has led to a collective distrust in prospective participants for modern medicine research. One of the best-known examples of exploitation amongst Black people in scientific research is Henrietta Lacks. Lacks was being treated for cervical cancer in 1951, before her death, when samples of her cells were found to have an unusually longer life span. Scientists used Lack’s sample to produce many more cells, coined HeLa, to investigate the behaviour of cancer (9). However, for decades, no researchers sought consent from Lacks or her family, nor were they compensated by pharmaceutical companies selling HeLa cells for thousands of dollars worldwide. Thankfully, because of the attention put on the ethics of HeLa cells and the controversy that came with it, an informed consent process has been put into place making this historial practise illegal.
Mental health diagnosis has also been seeped in a long history of systemic and destructive racism. During the 1800s, psychologists coined alleged mental illnesses such as ‘dysaethesia aethiopica’ to justify the punishment of slaves (10). Dysaethesia Aethiopica was considered to be a condition that made African-American slaves lazy and therefore subject to being beaten and put to harder work in order to “cure” them. Today it is understood to be an example of scientific racism and pseudoscience. Whereas, in more recent years, conditions such as schizophrenia have been redefined so as to become biased against Black people. It was in the 1960s that psychologists moved from identifying schizophrenia as a generally harmless condition assigned to middle class housewives, to being a brain dysfunction causing violence predominantly amongst Black men (10). This past is conflated when looking at international studies today suggesting that immigrant racial minorities receiving mental health services are assigned psychotic disorders more frequently than patients originating from the country they seek medical support in (11). This is reflected in statistics from the UK showing Black African, Black Caribbean and Black and white Caribbean mixed groups accounting for 21% of all mental health patients in hospitals, 19-39% of which were admitted involuntarily (12).
Research showed that between 1960 and 2005, the amount of chronic diseases amongst historically marginalised ethnic groups in the US quadrupled. The most common diseases included cancers, diabetes, mental illness and sickle cell anemia (13). Sickle Cell Anemia is the most common monogenic disease worldwide estimated to affect 300,000 annual births; seventy-five per cent of which occur in sub-Saharan Africa (14). In Western countries, SCA predominantly affects Black and Asian people (14).
Many people struggling with SCA will encounter psychosocial issues including anxiety, depression, and impaired quality of life (14). This is thought to be due to how painful the disease is, as well as the lack of understanding and empathy. One sickle cell carrier we spoke to explained how “every trip to the hospital, I’m met with a deep interrogation by the hospital staff. They’ll ask on a scale of 1 to 10, how bad is the pain, then question if I’m sure it hurts. Only on a few occasions have I suffered a painful episode and been greeted by doctors, nurses, or ambulance workers who have any holistic understanding of Sickle Cell Anaemia.” This person’s experience as a Black male reflects new evidence showing the racist bias medical students and professionals have in regard to pain perception and recommended treatment. It is unstood from both research and conversations amongst Black patients that their pain has been continually undermined, leading to symptoms being undiagnosed and an increase in health deterioration (15).
Racism and Reproductive Health and Childcare
Over the past year, new statistics have shown drastic racial disparities in women’s access to reproductive health, support during childbirth as well as postnatal care (16). In the UK, Black women are four times more likely than White women to die during, and up to six weeks after, childbirth (17). In America, maternal mortality amongst Non-Hispanic Black women is 3-4 times higher than white women (1). And in Brazil, death amongst women of African descent during and after childbirth is five times greater than white women (1). ‘Near misses’ define the term of women who nearly die but survive complications during pregnancy, childbirth, as well as within 42 days of terminating a pregnancy. Near misses are roughly 100 times more common than maternal mortalities (1). In the UK, they are twice as likely to happen for women of African and Afro-Caribbean descent (1).
As these statistics gain attention, conversations around the racism underlying hospital treatment and access to care are evolving. Beyond pregnancy, many women report having their level of pain undermined and feeling unheard by medical professionals. With reports showing a higher prevalence of endometriosis, uterine fibroids, and hysterectomies amongst women of historically marginalised ethnicities, it’s important to look at the level of care (18). When speaking to a woman of Afro-Carribean descent in the UK, she told us that her condition of endometriosis went undiagnosed on multiple occasions “I was having scans and nothing showed up. I was told that there wasn’t anything wrong with me, despite my pain being crippling. It made me distrust the doctors and feel ignored.” This reflects the lack of agency women are given in regards to managing and understanding their reproductive health. Such racial inequalities extend to reports showing that STI diagnosis in the UK is highest among people of Black and mixed ethnicity (19). While in the US, the majority of people accessing abortion services are Black women (20). Such statistics should be questioned regarding the care and support women are provided with regarding contraception and sexual reproduction health in relation to their race.
Steps to creating change
At present, research has shown that the medical world is predominantly serving high-income white communities the best. In this way, they are failing both the physical and mental health and well-being of humanity as a whole. The decolonisation of social constructs, institutions, and healthcare systems forms the basis for tackling racism. By recognising how the past has shaped hierarchical prejudices surrounding race, religion, and socioeconomic standing, change must be facilitated, renewing patient’s autonomy over their health. There are some brilliant projects working to improve and address the racial inequalities existing for women and reproductive health. These include decolonising contraception, Heart to Grow (for Muslim women and girls), NAZ, and FiveXMore.
It is vital that cultural differences and religious beliefs regarding contraception, abortion, and pregnancy are respected and catered for within the medical sphere. As well as better communication between patients and doctors, where accessible information and holistic care is offered. For many people, complementary and alternative medicines such as homeopathy, herbalism and crystal healing play an important role in their personal care plan. So, once again, respect and openness to people’s choices can be an essential part of moving past bigoted belief systems.
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William Goussanou COVID-19 trials at risk after Africa ‘racism’ backlash, Sco Dev Net, https://www.scidev.net/global/news/covid-19-trials-at-risk-after-africa-racism-backlash/
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Ayah Nuriddin,Graham Mooney,Alexandre I R White, Reckoning with histories of medical racism and violence in the USA, The Lancet, Elsevier, 3–9 October 2020
Alexandra Stern, Ph.D., Forced Sterilization Policies In The US Targeted Minorities And Those With Disabilities – And Lasted Into The 21st Century, Sept ‘20, https://ihpi.umich.edu/news/forced-sterilization-policies-us-targeted-minorities-and-those-disabilities-and-lasted-21st
Under-representation of minority ethnic groups in research — call for action, Sabi Redwood and Paramjit S Gill, British Journal of General Practice 2013; 63 (612): 342-343. DOI: https://doi.org/10.3399/bjgp13X668456
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The historical roots of racial disparities in the mental health system, By Tahmi Perzichilli, May 2020, article consulted April 2021 - https://ct.counseling.org/2020/05/the-historical-roots-of-racial-disparities-in-the-mental-health-system/
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