鶹ý

We Need More Illustrations of People of Color in Medical Textbooks

— The lack of diversity perpetuates health inequality and stereotypes

MedpageToday
A photo of a stethoscope laying on an open anatomy text book

"We need more people of color illustrations in our medical textbooks! I only ever see us in the infectious disease STD and HIV sections."

I (Dr. Eseosa Ighodaro) tweeted this out, along with an illustration depicting a cross-section of a brain on a Black man, in November 2021. I did not expect quite the response it received: the went viral, garnishing worldwide attention with over 2,000,000 million impressions on Twitter and 100,000 likes across various other social media platforms including Facebook, Instagram, and TikTok. The post ignited important conversations from community members worldwide.

Emmanuel Garcia, MA, MPhil, a psychologist and researcher who identifies as Black, Indigenous, Latinx commented, "I've looked at hundreds of brain pictures and never once thought, 'my brain.' I didn't know I could feel an emotional connection in addition to being intellectually stimulated. Wild!"

O'Hara Jiménez, a community member, commented, "I was in an eye doctor's office today whose clientele is mostly Vietnamese, and the poster of the eye and all of its parts was a [W]hite person with blue eyes. I wondered if there are even other choices?"

Ubenthira Patgunarajah, MD, a physician in Sri Lanka, , "I come from Sri Lanka and India. This is so strong because even though I come from a country with Brown people, the banners inside the hospital or pamphlets never included Brown people. I always wondered why!"

The Lack of Diversity in Med Ed Materials

Currently, White-tone representation vastly surpasses that of Black-tone representation in medical educational textbooks and online resources.

Numerous studies offer evidence for this issue. Patricia Louie, PhD, MA, and Rima Wilkes, PhD, MA, 4,146 photographs and found that lighter skin tones are overrepresented in medical textbooks and darker skin tones are underrepresented. Glenna Martin, MD, MPH, and colleagues 4,033 images showed to medical trainees at their institution and found that White individuals and male figures were predominantly represented in the educational material. Jonathan P. Massie, MD, and colleagues plastic surgery educational resources overrepresented White individuals compared to other skin tones.

The origins of this issue are deeply embedded in the historical mistreatment and systemic oppression of Black individuals. The history of medicine in the U.S. has its in . Many White pro-slavery physicians published several so-called scientific articles to justify the inferiority and disease-prone Black body. Even more recently, clinicians involved in the Tuskegee study, funded by the U.S. Public Health Service Syphilis Study in 1932, African-Americans were susceptible to venereal diseases because of the color of their skin. The list of examples goes on. With these origins in medicine, it is not surprising that medical textbooks disproportionately depict Black bodies in sexually transmitted disease chapters compared to other sections.

The consequences of primarily depicting White, lighter skinned individuals with Eurocentric features in medical images supports the persuasive concept of White supremacy. It perpetuates the belief that the White male body is "the standard" to which all other bodies should be compared. It leads to inequality in medical education and further perpetuates harmful stereotypes of Black individuals. As a result, this issue plays a role in inappropriate diagnosis and health management of Black individuals. Furthermore, medical care becomes subjective, discriminatory, and filled with speculatory assumptions based on stereotypes.

Medical illustration exclusivity is an example of injustice in the medical education curriculum. This practice prevents Black trainees and healthcare providers from visualizing themselves in medicine. It also deprives non-Black trainees and healthcare providers from being able to appropriately care for Black-skin toned individuals. A plethora of exist in , , and other areas of medicine.

What Can Be Done to Address the Problem?

Unfortunately, very little is currently being done to solve this issue. Due to the viral tweet, representatives from hospitals, medical associations, and academic centers reached out to me (Dr. Ighodaro) to collaborate. I am working with these groups through , my non-profit health advocacy organization, to create medical illustrations on Black-skin tones. But this work alone is not enough -- other individuals, health systems, and organizations need to rally behind the cause.

We encourage the Association of Medical Illustrators to further incentivize, create best practices, and set the standard for including Black tones in medical textbooks. We urge accrediting medical training institutions to mandate the utilization of diverse images within medical curriculums. We encourage medical illustrators and publishers to create educational material on diverse skin tones, including Black individuals. We urge readers to share articles that utilize images from diverse skin tones.

Together, we can eliminate medical illustration exclusivity and promote a just learning environment for medical trainees and patients.

is an award-winning neurologist, neuroscientist, and health disparities researcher at Mayo Clinic in Rochester, Minnesota. She is also founder and president of Ziengbe, a non-profit 501c3 health advocacy organization. is a neuroscience PhD student at the Medical University of South Carolina in Charleston, South Carolina. is a Baylor University Graduate, multifaceted domestic and international medical intern, and systemic health disparities, inequalities, and social determinants of health researcher.

Viewpoints expressed here are not representative of Mayo Clinic, Medical University of South Carolina, or Baylor University. Comments are not to be used as medical advice. For educational purposes only.