Representation matters in healthcare | Black History Month 2023

In late 2021, a medical illustration of a fetus in utero went viral online. While most people can expect to have seen at least one of these illustrations in their lifetime, this one stood out because the mother and fetus had black skin. Reactions online all had a similar tone: “I’ve never seen anything like this before.”

Nigerian illustrator and medical student Chidiebere Ibe thought the same thing as he was drawing it. As he went through his medical education, he noticed the lack of diversity in illustrations and set out to implement change. Seeing yourself represented in education materials breaks down social barriers, and in medicine it has even bigger impacts. People with different skin tones – and therefore different evolutionary biology – experience illnesses and conditions differently. Without seeing conditions represented on different skin tones, and without comprehensive and deliberately inclusive education, the likelihood of delayed or incorrect diagnoses is increased.

As we celebrate Black History Month at Brant Community Healthcare System, we wanted to take a deeper look at the impact that representation in the medical field has on our patients and our communities.

Mistakes are made because of clinical misinterpretations. In one example, it has come to light in recent years that the widely-used estimated glomerular filtration rate (eGFR) test, used to calculate how well a patient’s kidneys are functioning by measuring creatinine, has been erroneously keeping some Black patients off the transplant list. Black people in the original studies that developed the test may have had nonbiological exposures, such as diet or medication that affected creatinine levels. Instead of investigating, researchers drew the conclusion that Black people had more “muscle mass” and therefore a higher level of creatinine. This deduction, not substantiated by rigorous scientific evidence, has led to the eGFR test reporting kidney function as much as 16% higher for Black patients compared with all other racial groups.

The eGFR test is now under review and new policies are in place to protect Black patients from those kinds of mistakes.¹

This is just one example of a lack of diversity leading to negative outcomes. Many of the indicators for skin conditions are recorded and taught on white or light-coloured skin, meaning conditions such as Psoriasis, Impetigo, and melanoma, among others, are more difficult to accurately diagnose on Black skin. Indicators like cellulitis (redness), brown spots, and dryness present differently. The more illustrations we see like Ibe’s, the higher the awareness of diversity and inclusion will be – and this will ultimately lead to better healthcare for all. Education is always preceded by awareness.

Our thanks to Dr. Fikre Germa for sharing resources and his thoughts with us on this important topic.

¹Hassanein M. Widely used test kept Black people from getting kidney transplants sooner. Now that's changing. USA Today. February 8, 2023. Accessed February 10, 2023. https://ca.style.yahoo.com/widely-used-test-kept-black-110005993.html?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAEhtDXHMAR7GEmxiDxvKd7bMd_oIZo2tyUWWZIgoGVt7jGx6xJQSOMqYUS1CQHC61ce1PoKOvtq_ZWWc-IW328o3yl6EX8cRdUu2t6bvxdsnHgQMWBCh-NTrDKk0W_ICwwJEmeSonDu9XjQ25vzJE5V8KFQwtBEFIWdGnmzj5HOC