Divided: Racism, Medicine and Why We Need to Decolonise Healthcare

"It’s global in the sense that it’s about racism and given what the Empire and slavery did, it was a transatlantic question and beyond. But the cases she looks at very often are contemporary cases within the British health service. What she’s looking at is the unacknowledged racism and racial pseudoscience that underpins quite a lot of modern medicine in terms of its histories, the categories used, and the horrific experiments that were performed on people of African descent in the Caribbean under conditions of slavery that then allowed various individuals to claim scientific discoveries. If people had known the bases of these, and how they treated the people that they were experimenting on, it would be as appalling as anything we heard from the 1940s in Europe. There’s a sense in which this has been an unacknowledged history, and it’s entered into modern medicine in all sorts of disturbing ways. Bogus racial classifications still endure. For instance, she says more research needs to be done, but there is suggestive evidence from the United States that in A&E wards, children who come in who are African American will receive less powerful painkillers than white children, based upon a completely fallacious and prejudiced notion that people of African descent have a higher pain threshold. This has also applied to women in childbirth and elsewhere. A powerful idea here is that just because the conditions of the worst racial discrimination and slavery have disappeared, it doesn’t mean their legacies don’t live on. They live on in some very surprising places in modern medicine. Another example she talks about is lung function. She couldn’t understand why, when people went into an NHS hospital, they had to fill in a grid with race classifications based upon racist pseudoscience of the 18th and 19th centuries. It made no allowance for people who were of mixed race and suggested a nonsensical relationship between skin color and the condition of your lungs. Because it’s there in the forms, it seems to have a reality. She wants to question that. It’s a very impassioned book. She is trying to create an awareness of things we should not take for granted—like the shaping of medical instruments for the ideal white male body, rather than for female bodies, or for bodies of people who aren’t white males. She isn’t trying to indict modern medicine. She is a doctor, and her parents were involved in medicine as well. But she says that one has to be very careful. One of the things that brought this out clearly was the COVID-19 pandemic, when the outcomes were different for different ethnic groups. Why was that? She says everyone was searching around for genetic reasons, but the genetic aspects were very, very suspect. The book begins with an indictment of eugenics, whose practitioners had a respected place in British academia until remarkably recently,. So much so that there were institutions at her college named after famous eugenicists who were also racists. That’s beginning to disappear as people become more aware. So there’s a strong element in her book of alerting people, of awakening them. The book is based on strong scholarship and original research. That’s one of the reasons we thought it was a good contender."

"Sowemimo is great in that she really unpicks that on quite a granular level. She looks at our medical education: how the education of doctors is deeply rooted in a very white, patriarchal and westernised capitalist system, and the harms that can perpetuate. She’s incredibly insightful at analysing the power dynamics that are inherent in medicine. She looks at what we call implicitly racist (although it’s often quite explicitly racist) ideas around people’s tolerance of pain, the stereotype of the angry black women and the problem of black patients being seen as more challenging and difficult. Unfortunately, these are things that I’ve encountered in the maternity system as well, so although Divided isn’t explicitly a book about pregnancy and birth, because in the UK both sit within this medical model, I thought it was important to include on my list. Yes, in fact that issue is really timely because in April the UK’s National Institute for Health and Care Excellence released its latest draft guidelines for care in labour and birth. One of the new recommendations was that anyone with a BMI over 25 should be thoroughly and constantly briefed about the increased risks to them throughout pregnancy and birth, and may be more actively encouraged to accept certain interventions because of that. We know that BMI itself has a deeply flawed history , especially as it relates to non-white bodies, so policies like this can be discriminatory to the minoritised populations who are already at increased risk of morbidity and mortality in pregnancy."