Medical texts show race imbalance, study finds
UBC researchers studying how race and skin tone are depicted in medical textbooks have found a startling lack of diversity.
And, their new study argues, that could be contributing to racial bias in treatment.
The study by UBC and the University of Toronto, published in the journal Social Science and Medicine, found dark skin tones are under-represented in a number of chapters, including those dealing with skin cancer.
UBC lead author Patricia Louie, who is now a PhD student in sociology at U of T, says the lack of diversity in medical textbooks is a serious problem.
“Proportional to the population, race is represented fairly accurately, but this diversity is undermined by the fact that the images mostly depict light skin tones,” she said.
For the study, researchers analyzed the race and skin tone of more than 4,000 human images in four medical textbooks: Atlas of Human Anatomy, Bates’ Guide to Physical Examination & History Taking, Clinically Oriented Anatomy and Gray’s Anatomy for Students.
In an interview from Toronto, Louie said they used the textbooks from the 2015 and 2016 reading list for medical students at North American universities. But the textbooks are also widely used around the world.
The study found that only one per cent of the photos in Atlas and Clinically featured dark skin, compared to about eight per cent in Bates’ Guide and about five per cent in Gray’s Anatomy.
More than 70 per cent of the individuals depicted in Clinically and 88 per cent in Gray’s had light skin tones, while Atlas featured almost no skin tone diversity.
“It seems that skin tone isn’t something they are paying attention to. The books include racial diversity but not skin tone diversity, and skin tone is important because it is central to how race is perceived,” said Louie.
The researchers argue that rates of mortality for some cancers are higher on average for black people, often due to late diagnosis. With skin cancer, the researchers say physicians need to look for melanomas on nails, hands and feet, but they found no images in the textbooks to show what melanoma would look like on different skin colours.
Louie said they also looked at the research for six commonly diagnosed cancers, and another example was that of the images used for breast cancer.
In all the textbooks, they only found two images of black women, and the rest were images of lightskinned women. She said this is alarming because research shows that black women are more likely to die from breast cancer.
Also, there was no representation of Asian, Latino or Aboriginal skin tone in any of the books, Louie added.
“The heart of this study is that textbooks may influence how doctors think about patients,” she said. “We think that this under-representation may be one way that bias enters medical care. I just think it’s not on their radar.”
UBC sociology professor and study co-author Rima Wilkes said, in a UBC news release, that the findings highlight a need to show greater diversity of skin tones in teaching tools used by medical schools.