Angelina Jolie recently opened up about her daughter Zahara’s surgery and unveiled the racial bias inherent in the healthcare field.
She revealed that her daughter, who is black, faced bias due to institutionalised racism after undergoing an operation. Doctors asked if her daughter’s skin had ‘turned pink’. In case it isn’t clear, very dark skin does not have the ability to turn pink.
Now, I wouldn’t go as far as calling the doctor ‘racist’ but it certainly highlights the ignorance in the medical field when it comes to different demographics.
In Angelina’s case, she was speaking to medical student and writer Malone Mukwendein in an interview with Time magazine. Malone had previously exposed institutionalised racism in medicine and revealed that almost all of the images and data used in teaching were based on white skin.
Now I’m pretty neutral and indifferent when it comes to Angelina Jolie, but she has highlighted an ongoing and problematic issue of racial bias in the medical field.
And judging by the triggered and defensive comments that many people made in response to what she said, we still have a long way to go before some of the stereotypes and bigoted assumptions are banished from the field of medicine and elsewhere.
What are some of those assumptions, you may ask?
Like the ones below:
“I thought black people wanted equality?”
The most common (and arguably the dumbest) response to the issue Angelina raised is “but…but…I thought all races were equal? Is Angelina saying that black people are not equal if they have different medical needs to whites?”
Sigh.
No. She isn’t. If I have different medical needs from you, does that make me less of an equal under the law?
What about disabled people? People with different medical conditions? Are they less of a human under the law, and therefore not included in equality laws?
As a matter of fact, are tall people superior to shorter people because they have different body types? Women often have different medical needs from men. Perhaps they are not equal?
That can’t seriously be what some people think, can it?
Yes, we all bleed red, but it doesn’t negate our medical needs…or differences. And the truth is, not all diseases show up in the same way in people of different races.
Of course a rash won’t look the same on black skin as it does white. It doesn’t take a rocket scientist to work that out. Diseases may do the same damage but present differently.
Any competent medical doctor can tell you that. Hell, I’m not even a healthcare professional, and even I know that. But apparently, some medics still struggle with the basics.
But this isn’t just about skincare. At times, this bigotry can be life-threatening.
Inequalities in Healthcare
Research from the Centers for Disease Control (CDC) showed that black women in America are three to four times more likely to die from pregnancy-related causes than white women.
The picture in the UK is equally bleak.
According to the MBRRACE-UK report, black women are still four times more likely than white women to die in pregnancy or childbirth in the UK, and women from Asian ethnic backgrounds face twice the risk.
The reason for this is a combination of poverty, bad housing, incorrect prescriptions, and medical bias leading to healthcare professionals missing signs of illness. The confusion over a rash appearing on dark skin is just one small example of how this happens.
A separate report published in December by the joint committee on human rights highlighted the lack of an NHS target to end racial disparities and urged the government to introduce one.
“Black People Can’t Feel Pain”
Half of white medical trainees believe that black people cannot feel pain.
A shocking study published in the Proceedings of the National Academies of Science found that 40% of first- and second-year medical students endorsed the belief that “black people’s skin is thicker than white people’s.”
What’s more, false ideas about black peoples’ experience of pain can lead to disturbing treatment disparities. In the 2016 study, for example, trainees who believed that black people are not as sensitive to pain as white people were less likely to prescribe pain killers, even for things like childbirth and surgery.
A 2012 study found that even black children were often denied pain killers following surgery due to racist assumptions about their ability to feel pain.
What’s more, a meta-analysis of 20 years of studies covering many sources of pain in numerous settings found that black/African American patients were 22% less likely than white patients to receive any pain medication.
The table below highlights some of the most prevalent stereotypes that white medical students have about black patients:
A 2000 study out of Emory University found that at a hospital emergency department in Atlanta, 74% of white patients with bone fractures received painkillers compared with 50% of black patients.
Unbelievably, this untrue stereotype about black people having ‘thicker, pain-killing nerve endings’ was disseminated in medical textbooks as late as the year 2000.
Now this idea that black people can’t feel pain is not rooted in scientific fact. It goes all the way back to slavery when celebrated medical figureheads like J Marion Sims (the ‘father of gynaecology) would experiment on enslaved black women with the justification that “they can’t feel it anyway”.
This dumb assumption also has its roots in segregation and eugenics where white doctors would announce that their black patients were incapable of feeling the same things that white people do.
While some medical conditions (like sickle cell anaemia) are proven to be more prevalent in black people than white, when unscientific and unproven assumptions bleed into medical training, it is a perversion of medical practices where white medics are essentially telling their black patients that they are merely imagining the pain that all humans feel.
This has also led to horrifying situations where black patients have been reported to the police for requesting pain medications that doctors assumed they didn’t need. There’s something very disturbing about a doctor outright ignoring the symptoms you are describing because other white doctors told them that you as a human are incapable of feeling pain.
Essentially, this puts already sick black patients in a position where they are having to explain their humanity to sceptical non-black doctors.
“Racial differences should have no bearing on the treatment you would receive”
Normally, I’d agree, especially given what I said just above. Of course, your skin colour should not impact whether you are likely to receive medical treatment or not.
However, this is very different from highlighting the fact that many medical diagnoses and conditions are not spotted early enough in black people because all of the literature is based upon how signs and symptoms show up in white people.
This can be clearly demonstrated by a BMJ study that found that racial disparities in healthcare led to black patients being at a higher risk of complications for diabetes due to lack of treatment and not catching it early.
Higher insulin resistance in black people often means that diabetes is often not even recognized until it starts to cause symptoms.
Racial Disparities During The Pandemic
The racial disparities in healthcare even impact black and brown nurses and doctors. Mary Agyeiwaa Agyapong, was pressured to return to work even after being ill from Covid-19. This did not only endanger her life but her baby’s life and that of her patients.
The inquest in Bedfordshire heard Ms Agyapong was signed off on 12 March 2020, initially for back problems, and died on 12 April.
She was admitted to hospital with breathing problems on 5 April and discharged the same day.
Furthermore, Dr William Manning, who assessed the nurse on her admission, said he “suspected she had Covid-19” but sent her home as she did not require oxygen therapy.
He even admitted that she wasn’t happy to be sent home, but he sent her home anyway despite the fact she was seriously ill.
However, that is not the only example of black healthcare workers being sidelined by the very system they tried to work in.
A similar case occurred in America when a Black physician died of COVID-19 after alleging she was mistreated by doctors and nurses at a medical facility because of the colour of her skin. The CEO and President of that hospital said that the now-deceased patient may have been “intimidating” purely because of her medical knowledge. So even a dying black patient is considered a threat due to the fact that they too have medical expertise.
Furthermore, a news investigation published in April found that black people in coronavirus hot spots are twice as likely to die from the illness than their white counterparts.
What’s The Solution?
The solution is to eradicate institutional bias in medicine. But how can you eradicate a problem which many claim does not exist?
Then there are those that conflate being the same with equality.
The truth is none of us are the same, regardless of whether we share the same race or gender. But we don’t treat people with dignity because they are the same as us. We treat people with dignity because they are human.
And yet whenever the question of racial inequality and medical treatment comes up, the same tired old defensive arguments come crawling to the surface.
Angelina Jolie raised an important point about how the images and treatments taught to young medical students are based on white skin, when it is clear to anybody that is capable of thinking that different skin tones will present rashes differently.
Screaming about how much you despise Angelina or how we all bleed red does not negate what should be obvious, medical facts.
But this isn’t just about skin rashes. This is about the wider problem of racism and bigotry in the medical field. But this brings me to the last tedious objection that I always hear when writing about racism:
“I’m Tired of Snowflakes Whining About Racism”
This might surprise you to hear me say this but I half agree. I’m tired of the woke ‘dear white people’ articles I often see right here on Medium. I’m tired of people getting offended over the smallest things or any perceived slight.
Like the outrage at IKEA for trying to celebrate Juneteenth by offering a meal of fried chicken, watermelon, mac and cheese and collard greens (sounds delicious by the way). It angered some bedwetters because it was deemed too stereotypical.
When the waters are muddied by dumb examples like that, it leads to racism fatigue where serious bigotry in the medical field or the unprovoked killing of unarmed black men gets a response of “here we go again”.
But if you are sick to the back teeth of hearing about racism, imagine how you’d feel if you were experiencing it? It’s kind of invisible when it doesn’t affect you.
Yes there are examples of people all over the place getting offended at absolutely nothing. Those people annoy me too. But when we’re referring to institutional racism that can in some cases make the difference between life and death, then here we go again takes on a whole new meaning.
The Way Forward
I believe the way forward is through education. Yeah it’s great that Angelina spoke out against it, but one celebrity is not enough to change the tidal wave of bias that still plagues our hospital corridors.
Things don’t change until the next generation of doctors, nurses, teachers, police officers, local representatives and ordinary folk learn to see the elephant in the room. When you have multiple studies, infinite examples and even the wealthy being affected by the same problem, at some point it’s time to say, enough is enough.
The great news is, the NHS and other medical institutions around the world are already making moves to be more inclusive and diverse. But until the racial disparities are no longer present in the death rates, the diagnoses and the treatment plans, then it is clear we still have a long way to go.
