White people in white coats: How racism works in world medicine

THE SECOND WAVE OF BLACK LIVES MATTER – sparked by new high-profile cases of police brutality against African Americans – has been joined by people from all walks of life . Yesterday we wrote about the protest of athletes who are boycotting big tournaments. At the same time, social networks around the world were flooded with messages under the tags # WhiteCoats4BlackLives . More than 40 medical organizations have issued statements against racism, the largest being the American Medical Association. We understand why the world started talking about racial discrimination in medical science.

Danielle Morgan, an African American professor at Santa Clara University , was dancing in her room on Saturday morning, August 22 , when she was interrupted by a knock on the door. Outside, her brother, Carlos Fuentes, was visiting her on campus after eight months of separation due to the pandemic. Next to him was a campus police officer who followed Carlos to his sister’s house and demanded that she show her ID and vouch for his brother.

“I asked, in what is the problem, and he said that my brother was” suspicious, “and they thought that he may have been homeless, – wrote Morgan in his twitter. “ I asked why I would show ID at my own home. He replied: “The university owns the building, you still have to prove that the house you are in actually belongs to you.”

The incident, Morgan said, caused health problems and psychological trauma for both her and her brother and is currently under investigation by the administration.

Paradoxically, the healthcare system is traditionally more diverse than in other areas: on the one hand, it is difficult for developed economies to satisfy staff shortages only at the expense of graduates of local medical universities. On the other – not weakens the flow of medical expatriates from poor countries where medical career very difficult disproportionate burden, inadequate wages, and technological and scientific limitations. Ethnic minority students make up, for example, 40 % of medical students in the UK, nearly double that of universities as a whole.

At the same time , many problems of systemic racism extend to medicine. People of African and Asian descent continue to find it more difficult to enroll in universities, receive degrees and awards, high positions, and have difficulty applying for grants. And this is not to mention the everyday racism that forces doctors to leave their homes. African-American Uche Blackstock told about the fact that the difficult decision to leave a teaching position at the Academic Medical Center, where she worked for more than nine years: she was afraid of retaliation for his remarks about racism and sexism in its establishment, the atmosphere in which became, in her words, toxic and oppressive.


It is enough to read the stories that many have shared under the hashtag #BlackInIvory to understand that being a scientist of non-European appearance is much more difficult. #BlackInIvory – literally “ivory black” – means that you have to give 110 % to even consider your candidacy in relation to the implementation of opportunities, where others are only required to express their interest.

More than 25 years ago, The British Medical Journal (BMJ) published a controversial article on racial discrimination in medicine, which showed that British doctors with English names are twice as likely to be shortlisted for senior internship positions than doctors with foreign names. … There was intense controversy around this article, the authors were accused of fraud, and they were threatened with professional reprisals by the General Medical Council (GMC). But these actions prompted sociologists to conduct new research. They revealed a differentiated attitude towards doctors from among ethnic minorities, showed that candidates from this group, all other things being equal, are less likely to be admitted to a medical institute compared to their colleagues – representatives of the Caucasian race. The research team’s work was later partially acknowledged, but their confrontation with GMC is still ongoing .

A BMJ study found that ethnic discrimination is rampant in medical schools that they are unable to control. Respondents report, for example, humiliation during hospital practice in a very racially homogeneous part of the UK.

“I was on a ward tour when a student asked a counselor what the patient meant using a certain idiom. The doctor replied in front of everyone that this is why it is so important for foreigners to know local expressions. The student was very offended. She was not a foreigner, she simply did not know this expression, ”said one of the trainees.

Ololade Obadare, a third-year student at Nottingham Medical School, says that she and many of her classmates feel frustrated when they complain about racial incidents: “When you have complained three, four, five times and nothing has been done, there comes a point where you just give up. ”

Uche Blackstock left a teaching position at an academic medical center, where she worked for more than nine years: she was afraid of retaliation for her statements about racism and sexism in her institution.

Only half of the medical schools of the respondents BMJ collects data on the complaints of students on racism (of forty and thirty-two medical schools responded to the BMJ request, with a 2010 , they recorded only eleven complaints about biased attitude by teachers, insults from other students). The number of complaints documented by universities in the UK in general, too small: for according to the 2019 year the universities of the country registered 560 complaints of racism for three and a half years, although declared filing such complaints, 60 thousand students. Rebecca Hilsenroth, executive director of the UK Equality and Human Rights Commission, said the numbers show that some universities are simply ” oblivious to the issue of racism.” The result was released Charter for medical high school “On the prevention and the effective suppression of harassment on the basis of race” – with requirements to monitor the ability of victims to talk about it, reliable reporting and processing complaints, to ensure equality, diversity and inclusion in the learning environment.

Racism in medical schools has become a subject of special attention as early as 2016 , the year because of serious racist incident in the School of Medicine, Cardiff University, 32 students were suspended from classes and required independent verification. One of the students made a blackface and went up to the pulpit with a huge dildo, pretending to be his African American lecturer, while the other students did not skimp on racist, sexist and homophobic jokes.

Four years later, cadre research in the medical environment shows that the medical elite – whether they are people in leadership positions in higher medical schools or the health care system – remain predominantly white and male. Ethnic minority medical students continue to face excessive disciplinary action, fail exams three times more often , and are almost twice as likely to be denied employment after college (43% versus 23%). In 2017 , the base payment for consulting physicians from ethnic minorities was at 4.9% less than that of white consultants, which is equivalent to 4644 pounds (about 460 thousand) in the year.

Medical practice

Medicine has promoted fairness and diversity for many years . But needless to say that many people still consider “normal” white doctor cisgender heterosexual men without disabilities. Anyone who does not fit into this picture can be conditionally referred to as “others”, and it turns out that more and more doctors comply with the law on “diversity” in force in a number of countries. But will this “diversity” be real diversity?

The truth is the fact that, while doctors from ethnic minority groups may experience discrimination, it does not always look the same. For example, immigrants are sometimes subject to special government programs and benefits. For example , in Canada, students from South and East Asia are widely represented in medical education programs , while black medical students make up a very small proportion, and indigenous students are even smaller.

Originally, the concept of “diversity” referred to certain racial groups, but over the years its meaning has expanded. The Canadian Federation of Medical Students defines diversity broadly to include diversity in culture, ethnicity, gender, sexual orientation, physical ability, geography, religion, and socioeconomic status. But in the Canadian Medical Association’s report on Gender Equality and Diversity in the Medical Profession in Canada, only one paragraph addresses racial diversity. There is little coverage of racial stereotypes or under-representation of certain groups that fall under the banner of diversity. In other words, vague language allows you to achieve “diversity” without even going back to its original intent – to eliminate racial inequality.

Ethnic minority medical students face excessive disciplinary action, are three times more likely to fail exams, and almost twice as likely to be denied post-college employment

In the United Kingdom, doctors of European descent continue to occupy higher positions (46 % were consultants, compared with 33.4 % of Chinese and 30.6 % African). And this despite the fact that the number of doctors of Chinese origin in the UK health system (NHS) is much greater. The researchers found similar results among nurses and visiting workers: European-looking people were predominantly represented in groups with higher pay.

The 1960s and 1970s saw a sharp increase in the number of health workers in the UK due to migration from the Indian subcontinent. In this case, the time was considered not to be questioned, and acceptable, if a doctor from among the ethnic majority will apply for a job, immigrants from ethnic minorities not to be included in the short list of candidates.

Dr. Ranma Matthew says that after his father, who came to the UK to work as a doctor, received a Royal College of Surgeons Fellowship, colleagues told him that he would never become a consultant there and that it would be better for him to return “home . ” By that time, Ranma’s parents had already built their lives in the UK. Despite his disappointment, his father took a job as a consultant 100 miles (over 160 kilometers) from home, traveling back and forth for over fifteen years. At the same time, Ranma’s mother had to give up her dream of becoming a consultant, because it was impractical for both parents to travel around the country.

And now the NHS continues to depend heavily on the contributions of migrant doctors. In 2019 year, 28.4 % of physicians working in hospitals and public services in England, reported a non-UK citizenship. Likewise, 20.1 % of general practitioners in England are qualified outside the UK.

Ranma’s mother had to give up her dream of becoming a consultant because it was impractical for both parents to travel around the country.

It is assumed that medical socialization is designed to strengthen the identity of the “doctor”, eliminating differences, and each member of the profession is destined to become a ” neutral doctor .” “Rigorous training makes all of us, regardless of age, ethnicity, or other factors, become almost identical people,” writes one of the participants in the survey on medical education.

However, in a modern multi-ethnic society, it is not enough just to say that a doctor is “neutral”; social programs are needed, thanks to which students of medical universities of different origins will be able to acquire this medical identity. At the same time, invisible at first glance, the privileges of doctors – representatives of the ethnic majority (the so-called white privileges in white coat, “white privileges in a white coat”) still exist in any country.

From an early age, a person realizes that people of his race and nationality can become doctors. His success in studies in medical school is not clouded by doubts that the achievements are connected with abilities. He has no difficulty in finding professors – role models. On the contrary, he gets a daily reminder of the fact that his medical knowledge is based on discoveries made by people like him. He does not reveal that some of these discoveries were made as a result of inhuman experiments on people of his origin. He has the ability to get medical education in the mother tongue and in the future to use it in a professional environment.

The privilege is , and in the general sense of security: on the way to the hospital and back to the doctor is not afraid of being stopped or unfairly detained because of his origin. When a patient enters the office, he will not consider the doctor a representative of the nursing staff because of the color of his skin. No patient will ever tell such a doctor that he wants to be treated by a “normal” (= white) doctor because he does not trust him. It is worth whether to say that at the doctor’s titular nationality will not have the situation in Russia, where his patient would be “difficult to pronounce the name of the doctor, because it is” non-Russian “.”


It is common to use the concept of equity when discussing discrimination in the health of people from different backgrounds. It is impossible to create full equity in health: for example, members of the same population may die at a younger age due to genetic differences. But if a part of the population has a lower life expectancy due to lack of access to medicines and medical care, the situation turns out to be precisely unfair.

The so-called horizontal justice, that is, equal treatment of individuals or groups in the same circumstances, in the health care system has not yet been achieved even in advanced economies. According to data for 2019 year in the UK women of African descent in five times more likely to die during childbirth time in comparison with women of European descent, and women of Asian ethnic groups – in twice as often. In the United States, there is a similar disparity in maternal mortality rates: African American, Native American, and Alaskan Native women die from pregnancy- related causes three times more often than white American women .

The gap was initially thought to be related to a difference in the incidence of chronic disease. However, surveys have shown that this is also linked to structural racism in health care. Women from ethnic minorities face widespread racism when seeking medical care and access to it, their symptoms and complaints often ignored. Serena Williams, a tennis player from the United States, talked about the fact that doctors from ethnic minorities are more often “not heard”, she referred to her own experience of pulmonary embolism in the postpartum period.

Ethnic minority women face pervasive racism when seeking and accessing health care, and their symptoms and complaints are more often ignored

There are also symmetrical differences in infant mortality among newborns. Children and adolescents from poor, predominantly African American and Latin American areas spend significantly more days in hospital due to a variety of acute and chronic illnesses than children from more affluent, predominantly white areas. Poor doctors’ ability to “hear” their African and Asian patients, poor confidence in their complaints, and inadequate medical care contribute to an ethnic gap in morbidity and mortality in cardiovascular disease and diabetes mellitus.

Unsurprisingly, the impact of the COVIS-19 pandemic also turned out to be stronger for African Americans: amid extreme poverty, food insecurity, inequality in distance education, there was a staggering death rate. Thus, in Chicago, more than 50 % of COVIZ-19 cases and almost 70 % of deaths from COVIZ-19 are associated with people of African descent, although they make up only 30 % of the population. In New York, the epicenter of the pandemic, this disproportionate burden was reiterated for ethnic minorities, especially African Americans, and Hispanics , which account for 28 % and 34 % of deaths, respectively (population representation: 22 % and 29 % respectively).

Vertical equality – the principle according to which patients should be treated differently depending on their level of needs, and differences in the quality of health of different ethnic groups should be taken into account in prevention and treatment – in world medicine, too, unfortunately, is not always implemented . By the way, the situation is the same in Russia: despite the fact that ethnic health characteristics are generally well studied, in practice they are not systematically taken into account. The standard medical history collection does not include clarification of the patient’s origin. But it can play a role both in the establishment of a diagnosis due to genetic characteristics or nutrition of ancestors, and in the selection of treatment due to the specifics of the work of enzyme systems with which medicines interact. We also know little about the effects of various drugs on ethnic minorities because they are less likely to be included in clinical trials.

Elderly people from ethnic minorities are one of the most isolated social groups in society, as reflected in international studies that show higher rates of mental and physical illness among older people from ethnic minorities compared to the ethnic majority.

Biomedical science

In addition to the fact that people of different backgrounds may be left out of clinical trials, the history of biomedical science contains examples of other racial abuse. So HeLa cells, thanks to which many medical discoveries and therapies were developed that have saved hundreds of thousands of lives, were taken from the body of African-American Henrietta Lacks without her consent. Lax cells were the first to exist and actively multiply in the laboratory, outside the body, and were recognized as “immortal”: unlike ordinary cells, they did not die after several divisions, but multiplied endlessly. Henrietta Lacks herself was buried without a gravestone in the family cemetery near the hut left over from the days of slavery.

In Tuskegee’s experiments, African American men were artificially infected with syphilis, ostensibly as part of their voluntary participation in the experiment, but they were not informed of their status and did not receive any treatment. The Sims vaginal speculum was created as a result of horrific surgeries performed on enslaved African women without anesthesia.

I would like to say that all these horrors remained only in history, but, unfortunately, this is not the case. Only recently has it been discovered that medical algorithms discriminate against people of non-European descent. Facial recognition systems, which are widely used by law enforcement and border officials , have consistently been unable to match people of Asian and African American descent with their photographs.

local_offerevent_note March 22, 2021

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