When Lyal Liverul was a teenager in the Netherlands, she started noticing tiny spots of pigment loss on her face and hands.
She was prescribed antibiotics and antifungal drugs, but they did not help.
She assumed that it was a very rare and incurable condition.
It wasn't until she went to a dermatologist in the United Kingdom (UK), who was also darker-skinned, that she learned the real cause was eczema.
He suggested that the other doctors she went to, who were mostly white, simply didn't know how the condition could occur in darker skin, leading to a misdiagnosis.
A former biomedical researcher, Liverpool is now a science journalist, and her first book, “Systematic problem: How racism makes us sick" explores the disparities in quality, access and health care received by members of marginalized ethnic groups and whites, and ways in which these could be remedied.
In a conversation with a colleague, science journalist David Robson, she tells what she discovered.
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Why did you write the book?
I recently became a mum, and in the UK, black women like me are four times more likely to die during pregnancy and childbirth than white women.
Many other countries have similar statistics, and as a science journalist with a background in medical research I felt I had to look into it.
I thought I knew a lot about this subject, but I was still quite amazed at what I discovered.
I found that in addition to motherhood, marginalized racial and ethnic groups in many countries around the world have far worse health outcomes for many other health problems, including infectious and cardiovascular disease, cancer, and mental health.
I would describe racism as a public health crisis.
This is why our healthcare system is unfair, but also inefficient: it wastes time and wastes money and resources.
You cite research showing that medical students often have completely wrong beliefs about the biological differences between people of different ethnicities. What are some examples of these common misconceptions?
At the beginning of the book, I talk about the belief that black people's skin is thicker than white people's skin, or that their nerve endings are less sensitive, which is why black people experience pain differently.
About half of medical students in the United States (US) had some of these prejudices.
This is just one example, and in other areas of medicine, myths have even been translated into guides.
For example, there used to be guidelines that kidney function test results should be adjusted for a patient's race, based on the belief that black kidneys work differently than white kidneys.
This appears to have been the conclusion of a small study, which was then cited by other studies and eventually included in the guidelines, and there is research showing that such an approach has negative health consequences.
I first wrote about it for [scientific journal] New Scientist, and after I contacted the UK's National Institute for Health and Clinical Excellence and provided them with research showing these consequences, they removed the race section and updated their guidelines.
Now changes are being made to international recommendations as well.
Race-based medicine is also used in lung function testing.
It originates from Samuel Cartwright, a doctor and slave owner in the USA, who believed that the lungs of blacks were weaker and therefore slavery was beneficial for them.
It somehow took root in practice, and when I reported on it in 2021, international guidelines still contained the recommendation that lung capacity measurements should be adjusted for race.
But last year, while I was editing the final version of the book, I learned that the American Lung Association and the European Respiratory Society had removed from their joint recommendations the guideline that trials should be adjusted for race.
They specifically said that race is a social construct and has no basis in biology.
It would have been great if it had happened earlier, but I am happy that it is happening at all and that such discussions are taking place.
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How does racism affect mental health?
There are many inequalities that need to be taken more seriously.
For example, blacks are more likely to be involuntarily committed to psychiatric institutions than whites.
In cases of outbursts caused by mental disorders, the police in the US are more likely to kill a black person than a white person.
Research suggests that a possible reason is that blacks are seen as more of a threat and more dangerous.
Racism can also influence the diagnosis.
There is evidence that depression in marginalized groups is under-diagnosed and therefore under-treated, and that in some cases schizophrenia is under-diagnosed in black people in the UK and USA.
So there are some stereotypes and perceptions that affect the way doctors treat people of color and the conditions that can affect them, which is a problem.
Also, people of color in many countries say that mental health professionals do not take their exposure to racism and the impact of such experiences on their well-being seriously.
The consequence of such a relationship is that when people are vulnerable and need support, they hesitate to seek help and talk about the problems they face.
Our mental state can also affect our physical health. What is the connection between racism and diseases such as cardiovascular disease and Alzheimer's disease?
Cardiovascular disease is the world's biggest killer and a major public health problem, and evidence shows that racism plays a role.
There are stresses that you experience on a daily basis, such as being followed when you go to the store because of the belief that black people are more likely to steal - you may feel your heart racing and anxiety.
And daily exposure to racism throughout your life can have some sort of chronic effect on your nervous and cardiovascular systems.
For example, in the US, blacks are more likely to have hypertension - high blood pressure - which is a major risk factor for cardiovascular disease.
Chronic stress and trauma can also be linked to cognitive decline and dementia that are characteristic of aging.
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While writing the book, I met many people who consider these problems important and work to solve them.
For example, there is an organization called Five X More which campaigns for the health of black mothers in the UK.
They conducted research that showed that 43 percent of black and mixed-race women reported discrimination in institutions that provide health care to pregnant women and mothers in labor.
They then made recommendations for pregnant black people to exercise their rights in health care facilities.
They also offered training for health workers who want these problems to be solved and to ensure and provide equal health care to all people, regardless of their racial origin, during pregnancy, during and after childbirth.
Many scientists are removing racial bias from their medical research.
And doctors have begun to address the systemic forms of racism and the race-based medical practices we discussed at the beginning of our conversation.
I wish there were more overarching discussions, but they are already happening in individual areas of medicine, which is great.
Watch the video:
Laila Liverpool's book "The Systemic Problem: How Racism Makes Us Sick" was published by Bloomsbury Publishing (UK) and Astra Publishing House (USA).
David Robson is an award-winning science writer. His latest book, The Laws of Connection: 13 Social Strategies That Will Change Your Life, is published by Canongate (UK) and Pegasus Books (US and Canada). His Twitter account is @d_a_robson, and @davidarobson on Instagram and Threads.
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