We need more illustrations of people of color in medical textbooks


“We need more people with color illustrations in our medical textbooks! I only see us in the infectious disease, STD and HIV sections.”

I (Dr Eseosa Ighodaro) tweeted this, along with an illustration of a cross section of a brain on a black man, in November 2021. I didn’t really expect the response he received: the Tweeter went viral, capturing worldwide attention with over 2,000,000 million impressions on Twitter and 100,000 likes on various other social media platforms including Facebook, Instagram and TikTok. The post sparked important conversations from community members around the world.

Emmanuel Garcia, MA, MPhil, psychologist and researcher who identifies as Black, Indigenous, Latinx commented, “I looked at hundreds of brain pictures and never thought ‘my brain.’ Little did I know that I could feel an emotional connection in addition to being intellectually stimulated. Savage !”

O’Hara Jiménez, a member of the community, commented: “I was in the office of an ophthalmologist today whose clientele is mainly Vietnamese, and the poster of the eye and all its parts was a [W]hitting a blue-eyed person. I was wondering if there were even other choices?”

Ubenthira Patgunarajah, MD, physician in Sri Lanka, noted“I’m from Sri Lanka and India. It’s so strong because even though I’m from a country with brown people, the banners inside the hospital or the brochures never included the brown people. I always wondered why!”

Lack of diversity in medical education materials

Currently, the representation of white tones greatly exceeds that of the representation of black tones in medical education manuals and online resources.

Many studies offer evidence for this question. Patricia Louie, PhD, MA, and Rima Wilkes, PhD, MA, to analyse 4,146 photographs and found that light skin tones are overrepresented in medical textbooks and darker skin tones are underrepresented. Glenna Martin, MD, MPH, and colleagues saw again 4,033 images were shown to medical trainees at their institution and revealed that white individuals and male characters were predominantly depicted in teaching materials. Jonathan P. Massie, MD, and colleagues found that plastic surgery educational resources overrepresented white people compared to other skin colors.

The origins of this problem are deeply rooted in the historical mistreatment and systemic oppression of black people. The history of medicine in the United States has its foundation in medical racism. Many pro-slavery white doctors have published several so-called scientific papers to justify inferiority and the disease-prone black body. Even more recently, clinicians involved in the Tuskegee Study, funded by the US Public Health Service Syphilis Study in 1932, suppose that African Americans were susceptible to venereal disease due to the color of their skin. The list of examples continues. With these medical backgrounds, it’s no surprise that medical textbooks disproportionately describe black bodies in chapters on sexually transmitted diseases compared to other sections.

The implications of portraying predominantly lighter-skinned white individuals with Eurocentric features in medical images support the persuasive concept of white supremacy. This perpetuates the belief that the white male body is “the standard” against which all other bodies should be compared. This leads to inequality in medical education and further perpetuates harmful stereotypes of black individuals. Therefore, this issue plays a role in the inappropriate diagnosis and management of black people’s health. Moreover, medical care becomes subjective, discriminatory and filled with speculative assumptions based on stereotypes.

The exclusivity of medical illustration is an example of injustice in the medical training program. This practice prevents black interns and health care providers from visualizing themselves in medicine. It also deprives non-black interns and healthcare providers of the opportunity to properly care for black people. A plethora of examples exist in dermatology, plastic surgeryand other fields of medicine.

What can be done to solve the problem?

Unfortunately, very little is currently being done to address this issue. Due to the viral tweet, representatives from hospitals, medical associations and academic centers contacted me (Dr Ighodaro) for collaboration. I work with these groups through Ziengbe, my non-profit health advocacy organization, to create medical illustrations about black skin tones. But this work alone is not enough – other individuals, health systems and organizations must join the cause.

We encourage the Association of Medical Illustrators to further encourage, create best practices, and set the standard for the inclusion of black tones in medical textbooks. We urge medical training institutions to accredit the requirement to use various images in medical curricula. We encourage medical illustrators and publishers to create educational materials on various skin tones, including blacks. We urge readers to share articles that use images of various skin tones.

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

Dr. Eseosa Ighodaro is an award-winning neurologist, neuroscientist, and health disparities researcher at the Mayo Clinic in Rochester, Minnesota. She is also the founder and president of Ziengbe, a non-profit 501c3 health advocacy organization. Claudia A. Salazar, BA, is a doctoral candidate in neuroscience at the Medical University of South Carolina in Charleston, South Carolina. Mackenzie A. Jones, BS, is a graduate of Baylor University, a multifaceted national and international medical trainee, and researcher on systemic health disparities, inequalities, and the social determinants of health.

The views expressed herein are not representative of Mayo Clinic, the Medical University of South Carolina, or Baylor University. Comments should not be used as medical advice. For educational purposes only.


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