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A London medical student, Malone Mukwende, was aware of gaps in knowledge and created a medical handbook to help, called “Mind The Gap”.
Malone identified the problem research had previously reported on. A lack of images of dermatological conditions shown on black, or brown skin during medical training, a starting point for less effective treatment.
Studies in Canada, the US and other parts of Europe have confirmed that disparities exist. This is not simply a UK problem but the UK population with non white skin is approaching 15%, around 10 million people.
A number greater than the population of Scotland and Wales combined and as deserving of equal care as those countries. So is progress being made?
Stimulating Change
We have highlighted the need for skin colour awareness in dermatology before, as have professional bodies. This has gradually had an impact, although sometimes triggers can be needed to heighten thought and action.
International protest groups raised concerns, the Covid pandemic more so, with ethnicity and worse outcomes closely linked. Investigation is ongoing but reasons include socioeconomic and health status, along with unseen medical bias.
Whilst racism exists within medicine, this was not found to be the core problem. Publication of skin condition images related to Covid showed us what was, yet again the vast majority were on fair skin.
Innate bias had restricted shared knowledge and worse health outcomes can follow. A tipping point may however have been reached.
Current Initiatives
The BMA have recently conducted research into racism within medicine and are working with other foundations to improve ethnic representation amongst medical staff. As importantly, they have acknowledged gaps in patient care.
Beyond looking at changing their own documentation, they have funded projects such as All Skin Tones. An initiative from doctors to develop unbiased education materials, to be distributed to healthcare professionals and patients.
The British Association of Dermatologists are working to increase educational facilities on skin of colour and holding training days. Their Lexicon Group have created a new, evidence based scale for describing differences in skin colour.
Medical colleges are moving faster to amend study materials than before. Dedicated resources are being made available online, such as the Skin Deep project, or the skin of colour resource at the University of Nottingham.
Looking Forwards
The impact of more representative literature should not be underestimated, to build knowledge and confidence in medical staff. There are also subliminal effects from this, part of shifting perceived norms.
Most health professionals accept that justice and equality should be part of the care they offer. Ideally without thinking too much about this at the point of care, where they should have the confidence and wish to just treat people.
Nobody can pretend that steps to date will instantly cure the problem, although they are helpful parts of creating a fairer future. Learning objectives are changing, diagnosis and treatment will ultimately improve.
Our clinic is pleased to offer knowledge based dermatology for darker skin but we will be just as pleased when this is standard practice.