Why we need to decolonise healthcare

We take it for granted that several aspects of sexual and reproductive health can be solved with medicine—syphilis is now vastly treatable, while the contraceptive pill soothes perimenopausal symptoms—but for some, these interventions are symbolic of the historic injustices and inequalities that continue to impact healthcare today.

The Tuskegee experiments are a case in point. In 1932, a US government-funded study called “Tuskegee Study of Untreated Syphilis in the Negro Male” recruited 600 African American men in Alabama to study the life cycle of a syphilis infection. 

The men were told that they would receive free medical care for what the doctors called “bad blood”, but this was not to be.

Even when penicillin became the standard treatment for syphilis in 1947, the researchers chose to deny their participants medicine and instead track the progression of syphilis until all the men had died and autopsies could be performed. 

None of the men were told the name of the experiment, nor the fatal consequences of their condition. By the time the study was leaked by the Associated Press in 1972, 128 participants had died from syphilis or related health conditions. 40 spouses and 19 children were also diagnosed with the disease.

Credit: USAID/South Africa, CC BY-NC 2.0, via Flickr. Despite the known interaction between HIV and COVID-19, South Africa struggled to get vaccines, due to Western hoarding

Some might call events like this ancient history, but in her new book Divided: Racism, Medicine and Why We Need to Decolonise Healthcare, Dr Annabel Sowemimo argues that colonial attitudes in medicine—such as the habit of testing drugs on marginalised groups, while withholding vital treatments—continue to be endemic, and have contributed to a lack of trust in healthcare. 

“When you do research, particularly qualitative studies where you go and talk to people about their health and their behaviours, people bring this level of distrust up. It has to come from somewhere,” she says. 

Such exploitative attitudes showed up recently during the pandemic, when the Parisian doctor Jean-Paul Mira suggested that COVID-19 vaccine trials should be carried out in Africa.

“If I could be provocative, shouldn’t we do this study in Africa where there are no masks, treatment, or intensive care, a little bit like we did in certain AIDS studies or with prostitutes?” he told the French TV channel LCI (Mira has since apologised for his comments).

“That had a really visceral reaction,” Sowemimo recalls. “The whole of African Twitter and the diasporic Twitter ignited and was like, ‘This is something that we've seen time and time again, and we're not prepared for this to happen.’ 

“But it did happen. There were vaccine trials in South Africa, then South Africa couldn't get vaccines, despite South Africa having one of the highest rates of HIV in the world. We know that Covid-19 and HIV interact well. If you were not on antiretrovirals and undetectable, they did cause people to have worse Covid-19 outcomes.”

The level of mistrust felt by marginalised groups in the UK towards medicine was laid bare during the pandemic, when a poll by the Royal Society of Public Health found that only 57 per cent of ethnic minority respondents intended to take the vaccine, compared with 79 per cent of white participants.

Part of this is because of how the medical industry is perceived in certain communities, according to Sowemimo. “Medicine as a profession is seen as very paternalistic and middle class. If people don't know any doctors, they automatically are a bit suspicious if they don't see themselves in the profession,” she says. 

“Even when they do see themselves, sometimes people see medicine as interacting with the state. And there is quite clear evidence of that, like passing records to the Home Office about people's immigration status or complying with the police in investigations.” 

But the problem with some people’s interactions with medicine goes much deeper than its perceived ties with the elite and political classes.

“On a more micro interpersonal level, you’ve got how people feel they get listened to in consultations,” says Sowemimo, citing the maternal mortality rate in the UK, which is four times higher for Black women.

Black women also find it more difficult to get endometriosis diagnosed. While it takes an average of between eight and twelve years for women to get a diagnosis, Black women are 50 per cent less likely to be diagnosed than white women—and those that do manage it have to fight for an additional two and a half years.

There is evidence to suggest that when Black women express pain, they are not taken seriously—racial stereotypes could be causing medical staff to assume that Black women have a higher pain tolerance. 

“When you look at the little research that has been done on this issue—despite the huge statistics, there should be more, right?—people are saying, ‘I feel silenced. I feel like when I assert myself, people don't listen to me’,” says Sowemimo. 

Pulse oximeters are known to be less accurate when used on skin with higher melanin levels, which could have have affected healthcare during the Covid-19 pandemic

The tragic consequence of a medical institution that centres whiteness, and neglects to interrogate how racism continues to influence it, is inevitably poorer health outcomes for the demographics that have been excluded. 

Sowemimo remembers a conference that she attended before the pandemic, where a colleague raised the problem with pulse oximeters, which give less accurate readings when used with darker skin pigmentation. 

“The first study that suggested that this device was not going to be as accurate was about 15 years ago, and then we went into a respiratory pandemic and people were saying, ‘Hey there, I think we should probably flag this’,” she says. 

“The conversation did not really go anywhere until two years later, where we had really robust data about disproportionate deaths, which is shocking. I think, if this was to affect other demographics, then we would have a much quicker response.”

Sowemimo founded the campaign, Decolonising Contraception, in 2018, which has now grown into the charity, Reproductive Justice Initiative.

Through these projects, Sowemimo is both raising awareness about lingering colonial attitudes in medicine, and nurturing outreach that helps to connect marginalised groups with the healthcare that they need. 

Her book is a natural progression of that work. Drawing from her career in the UK’s medical industry, and insights from colleagues in several medical fields, Sowemimo explores how racism continues to impact things like medical research, mental health, reproductive justice and the development of future technologies.

What does she consider to be the first step towards reconciling modern medicine with the groups that still feel marginalised today? 

“It's really about opening the gateway to conversations,” she says. “In this country, in some ways, we're much further forward in having conversations that revolve around sexism. In having conversations around certain issues, I feel automatically it makes people feel listened to, and then that trust builds.”

Divided: Racism, Medicine and Why We Need to Decolonise Healthcare by Dr Annabel Sowemino is out now (£20, Wellcome Trust)

Read more: The role of critical race theory in healing BIPOC generational trauma

Read more: Why climate activism needs to decolonise

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