COVID-19 has thrown a stark light on inequalities in healthcare. What are the challenges that we face and how can we tackle these to move towards a more diverse and inclusive society, that is fit for the future?
Essay by Adaeze Chikwe
The COVID-19 pandemic was a harrowing time for many worldwide, and we are still seeing the devastating effects of the pandemic to this very day. It was this chaotic and catastrophic environment that highlighted the already present health inequalities in society.
One aspect of COVID-19 that was brought to our attention is how the virus seemed to disproportionately affect non-white communities, both in terms of number of deaths as well as the number of hospitalisations(1). A virus that everyone felt was lurking around every corner seemed to take on a more murderous and vindictive energy for many non-white people who didn’t know which family member or friend this silent killer would choose as their next victim.
These racial health inequalities highlighted by the pandemic have multiple roots, to name but a few: Discrepancies in how medical students are taught to treat white vs. non-white patients; the lack of availability of materials (including on the NHS website) that show dermatological manifestations of diseases on darker skin; and medical equipment not providing accurate measurements on darker skin, as research done in the US on pulse oximeters demonstrates(2).
In this essay I will be focusing on the discrepancies in medical school teaching and how we as medical students can tackle them to lesson the burden of racial health inequalities in our future practice.
At medical schools up and down the UK, the teaching, like many things in our society, is centred around the white experience. An example of this is not being shown how hypoxia presents in those with darker skin. If those in healthcare and at home were taught and armed with this knowledge from the outset, it is possible that the mortality rate of COVID-19 in non-white communities may have been different.
So what can we can do at our medical schools to promote anti-racism and inclusive teaching?
- Find out who are in a position of power that can make changes to the curriculum in your medical school
This may involve contacting the degree programme director or someone in a similar position. If this proves difficult contacting the office in charge of medical students and asking them who are the best people to get into contact with would be worth a try.
- Find places in the curriculum where the non-white experience can be added, such as in case studies
Often in case-based teaching a vast majority of the patients used are white, and the people of colour that are used in cases play into stereotypes such as immigrants who are unable to speak English. If this is the case in your medical school you can get into contact with the person in charge of organising these cases and discuss making them more diverse and inclusive.
- Organise focus groups
Getting together a group of students and discussing where you feel changes can be made is a great way to bounce ideas off of each other and hear from different perspectives that may highlight issues you might not have considered.
- Push for the inclusion of discussions about systemic racism in the curriculum
It is vital to acknowledge the mental and physical trauma that systemic oppression causes on non-white bodies. The term ‘weathering’ coined in a study by Arline Geronimus is used to describe the continuous stress of racial trauma experienced by non-white people leading to health deterioration much earlier on in their lives compared to their white counterparts (3). This can be seen in maternal mortality rates where black women have more than five times the risk of dying in pregnancy or up to six weeks postpartum compared to white women(4).
We are not taught about the reasons why there are these discrepancies, such as racial biases in pain perception and inaccuracies in treatment recommendations(5). This means medical students continue to be unaware of their subconscious biases and carry these into the workplace once qualified, therefore allowing these health inequalities to persist.
- Approach lecturers directly if you see they have not included non-white skin tones in their teaching
It may feel daunting to approach a staff member to mention this but there is no need to feel anxious about doing so. As long as you do so politely, many lecturers are open to feedback and constructive criticism, and you would be surprised as to how many lecturers are thankful that you pointed out an often unintentional oversight!
To conclude, the burden of health inequalities may be reduced by inclusive and diverse medical education. We are often told that as medical students we have to wait to become change-makers, to hope that things will change with time or to wait until we become consultants to be able to carry out real change. However, by working together we ourselves can be the change we want to see in healthcare.