The Urgent Need for Change in Racial Inequalities in Healthcare

The Urgent Need for Change in Racial Inequalities in Healthcare

Through our Writer Spotlight Series, we strive to cultivate a positive representation for young women by engaging in insightful dialogues with various writers and illustrators. In this edition, we present the illuminating conversation we had with author Layal Liverpool, delving into the themes and factual behind her captivating book, Systemic: How Racism Is Making Us Ill.

Welcome back Layal! Congratulations on your debut book Systemic: How Racism Is Making Us Ill. What was the motivation for writing this book?

I recently became a mum, my son is four and a half months now. I was ‌aware going through pregnancy‌ that we are in a world where here in the UK, for example, there are significant racial inequalities in maternal health. So Black women like me are four times more likely to die during pregnancy and childbirth. There was a recent survey, from the grassroots organisation Five X More, which found that 43% of Black and Black mixed women reported experiencing discrimination in their maternity care. 

I am a science journalist. I also have a background working in medical research. So this was something I felt compelled to investigate further. Even though I knew a lot about this, I was shocked by some of what I discovered in my research, that this is not only a problem in the UK but also in the US, in countries all over the world. People who are discriminated against based on race, ethnicity and caste in India experience significantly worse health outcomes, not only during maternity but also across various health conditions, including infections such as COVID.

In the book, I also argue that this is a terrible situation for everyone. Racism is a worldwide public health crisis. It affects medicine and science. It also makes our healthcare systems definitely unfair, but also inefficient. This is a waste of time and money. It makes medical research also less effective for everyone. So it's something I am ‌motivated to change. This book is like my small way to contribute towards that change, which is already happening. Thanks to a lot of amazing people! The goal with the book is to gather all of that, all that resource, which can validate our experiences of discrimination, but also to be used as a starting point to discuss and make changes.

Systemic: How Racism Is Making Us Ill.

Systemic: How Racism Is Making Us Ill.
Available to buy here 


Did you draw on any personal experiences or stories from others that highlight the real-world impact of systemic racism in healthcare?

For me, that is probably the most important thing in the book. I mean, I think, obviously, data and statistics are ‌important. This is something that is affecting all of us‌ in our day-to-day lives and experiences. 

So when I was a teenager, I also experienced a skin condition which I kind of struggled to get diagnosed for years until eventually I saw a doctor. It was here in London, and this doctor had darker skin, similar to me. He explained to me that I had eczema, which probably people have heard of as it is a common skin condition. 

He thought that the reason various doctors I'd previously might have missed was because they are not familiar with diagnosing conditions on diverse skin tones, and especially brown skin like mine. While I was researching the book, this was a theme that came up and I met a young British Nigerian woman named Kanayo, who had a similar experience of being misdiagnosed, however this was a life-threatening situation. So she almost died due to what she believes was also a failure of health care workers to recognise the condition on her brown skin. She went to her local A&E 3 times in London. The last time she arrived, she collapsed and had to be resuscitated.

Only then did they realise she had this condition called Stevens Johnson Syndrome, and which turned out to be a reaction to a drug that she was on. After her sharing her concerns about the effects she was experiencing while taking these drugs. She felt that there was no recognition of the fact that this was not what she normally looked like. She was experiencing swelling and other problems, which led to her feeling discriminated against. 

There is one international survey of medical professionals, and only 5% said that they felt confident diagnosing conditions across diverse skin tones, which to me was surprisingly low. We also looked at different parts of the world. And even in Africa, the figure was only 29% and Africa is the most diverse continent in the world. We would hope that we can recognise conditions across all skin tones.

What role does data play in your book, and can you share any surprising or particularly impactful statistics that affect racial health disparities?

Definitely being a scientist, data and statistics are ‌important to me. So when I was writing the book, I tried to connect personal stories with relevant data and statistics to just show how statistical inequalities affect people as well. I think collecting data on race and ethnicity in relation to health can be helpful to monitor, but also to address, racial health disparities.

A few years back I was reporting on COVID,very early on during the COVID epidemic in the UK, when I was covering this issue, as a journalist, data was showing that 34% of critically ill COVID patients were from Black, Asian, or other ethnic minority backgrounds, even though‌ we make up just 14% of the population in England and Wales. There were similar disparities in the US in other countries, like Brazil and Australia, patterns of inequality based on race or ethnicity. 

Then later on, when vaccines became available, there were also racial and ethnic inequalities in vaccination coverage. Though I felt there was also a lot of blame on Black people not taking the vaccine or not trusting the healthcare system. Got me thinking, no wonder people do not trust the healthcare system, after uncovering these statistics, stories and inequalities in my book. Those who are in medical research or in the medical establishment should be earning trust, we should be humbled and think about the history of racism in medicine, and kind of understand that people do have a mistrust or scepticism of health authorities because of that history, also, including racism in medicine itself. So I think that is a very valid thing for people to feel. I think it's important that doctors just take that extra minute or two to just answer people's questions. Treat people as humans and, and make sure that everyone understands what is happening. Medicine, it can be very complicated.

What do you hope readers will remember most about Systemic: How Racism Is Making Us Ill after they have finished reading it?

I would hope that readers will feel hopeful. Just recognising that racism causes so much unfairness and health means that we can start to tackle this problem. I think you can not fix a problem if you do not. First, acknowledge that it exists. Awareness is so important to me. I think for young Black children who read Sadé Magazine, realising that there's nothing wrong with us or our skin or our background, it is not race that causes us to have health problems. 

It is living in a racist society, which is harmful to our health. So I ‌think that it's racism that should be prioritised as the public health problem. There's nothing wrong‌ with those of us who are feeling discriminated against. It is a problem that we can all play a role in fixing. 

I think we all are affected by one another's health. We all live in communities. And we saw that with COVID. I think racism and racial health inequalities kind of form these cracks in our society, which can act as holes through which problems can creep in like we saw with COVID and that those problems affect all of us.

What is your long-term vision for a healthcare system free of systemic racism, and what steps do individuals or institutions need to take to achieve it?

I still think that we all will be advocating for ourselves and for each other. I think that's great. And I hope more people can join that. Thankfully, there are many ‌brilliant people, and also organisations who are sounding the alarm about the problem, and also working towards positive changes. They are showing us that this problem is not impossible to fix. We can teach doctors to recognise health conditions on diverse skin tones. Skin is important. It is not just about skin conditions. Our skin is often a kind of early warning system for illness ‌that might be happening in our body. We should take seriously the ability of doctors to recognise conditions. 

There is a lot we can do to help‌ we can improve representation in medical textbooks. People are working on this. There was a study in the US, which found that 75% of the images in widely used medical textbooks showed health conditions on lighter skin tones, and just 5% showed it on the darker skin tones. Almost 80% of the participants in genetic studies are of European descent, just 2% are of recent African descent, which is a big problem. Of course, we all want to be represented in studies, we have that right. But ‌having more diversity in genetic studies has been found to be beneficial to improve the chances for scientific discovery. So again, this is good for everyone. It means findings will apply to more of us; we have more chances of making discoveries of new treatments that will benefit all of us.

We can all take control of our health journeys, and just demand fair treatment, whatever our backgrounds. Many people want to know what they can do. Okay, maybe we will not eliminate racism tomorrow. So what can I do? I hope that this book also can just validate people, so they feel like, “Hey, okay, what I experienced, maybe this is a problem”. Now maybe they will feel more able to speak up. Beyond that we can join campaigns for clean air, clean water, I discuss this a bit in the book, healthcare that's free from discrimination. There is a lot of evidence also that living environments and racial inequalities in living environments and access to even just healthy foods or green spaces, which have been shown to benefit health that is not equally distributed based on race either. So I think all of those things, improving society ‌it's good for everyone again, but it will also help to tackle these racial health gaps.

Systemic: How Racism Is Making Us Ill.
Available to buy here 


About the Author 
Layal journalism has spanned diverse science topics, including technology, physics, the environment and health, focusing particularly on inequalities in science, health and medicine. Her writing has appeared in Nature, New Scientist, WIRED, the Guardian, and elsewhere, and she has worked on staff as a reporter for both Nature and New Scientist.

Before moving into journalism, Layal worked as a biomedical researcher at University College London and the University of Oxford in the UK. She has a PhD in virology and immunology from the University of Oxford.


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