Layal Liverpool has a PhD in virology and immunology, and has worked as a reporter for New Scientist and Nature. In her new book Systemic: How Racism is Making Us Ill, she unearths the shocking facts about health threats to people of colour.
What was the impetus for the book?
The idea came about in 2021. A year earlier, Covid had hit and I had just moved from medical research to working as a science journalist. My editor asked the question, is the coronavirus racist?
We were seeing racial and ethnic health gaps when it comes to Covid. So in the UK, for example, people belonging to Black and Asian ethnic groups were experiencing worse outcomes.
So I started investigating and it opened up a whole box of things. What I realised is that racism really is a public health crisis. We see across the board, from infectious diseases to cardiovascular disease, cancer and mental health conditions, that people belonging to marginalised racial and ethnic groups tend to experience worse outcomes.
I mean definitely that’s a bad thing, but it was also empowering to realise, because when we recognise it’s racism that is contributing to those disparities, we realise we can do something about it – which for me was really motivating.
What’s the message or impression you’d like to leave with people once they’ve read the book?
I would love for people to think about racism in the same way they think about other things that are widely accepted to be harmful for our health – such as smoking or eating unhealthy food.
Scientific racism underpins lots of beliefs that doctors hold today. Ideas about Black people having less sensitive nerve endings or thicker skin. Why do these ideas persist? It seems astonishing.
It was quite shocking but there was a history behind some of these ideas, that they had a purpose at the time. To give an example, the idea that Black people’s lungs are different or weaker than white people’s. In the US there was a physician and slaveholder who made the argument that Black people’s lungs are weaker and that they’re healthier when enslaved, so they benefit from slavery.
It’s very clear that at that time there was a motivation to justify the oppression of Black people, and science came to back up those ideas which have been passed down. It gets grandfathered in and we lose that ability to question.
The medical establishment is supposed to be full of some of the brightest and most caring people in society – and their knowledge is based on testing and revising evidence. Yet it seems ingrained with racist ideas resulting in negative outcomes for vast sections of the population.
They are some of the most caring people, and a lot of people are very unhappy about the situation and want to challenge it.
In recent years, thankfully, people have felt more empowered to do so. It’s great that we’re listening to medical students. And it’s great to have flatter hierarchies where people can challenge their superiors and question things.
The book is called Systemic because that’s what a lot of these problems are. It’s about guidelines, practices that are passed down rather than individual doctors. Of course there might be individual bad actors, but if we really want to tackle racial and ethnic health inequalities, we need to look at the systems, the structures that underpin medicine and our whole society.
How should doctors consider race? You’re arguing for anti-racist medicine not colour-blind medicine? Can you tease out the distinction?
I’m thinking a lot about this. We don’t want to perpetuate or reify these biological ideas about race built on pseudo-scientific notions.
But at the same time, race is very real. I experience it in the world as a Black woman. I know that how I’m perceived or believed is affected by how I appear, how people racialise me. So that is a very real experience.
You often hear that race is a social construct. It’s something fluid, that changes in time and place. I’m racialised differently in Ghana, where my parents are from, compared with here in the UK or if I went to Brazil or South Africa. That shows you it’s not really scientific – if it’s a variable that changes so much, but is still something that affects my lived experience. It affects how I’m perceived when I go to the doctor.
In the book you tell the story of how Serena Williams almost died giving birth. Doctors ignored her request for a scan for blood clots – a condition for which she takes medication. You make the point that if a wealthy, relatively privileged Black woman in a well resourced hospital is ignored, it doesn’t bode well for everyone else.
Serena Williams said that doctors aren’t listening to us. And that was such a theme across different people I interviewed, that of not feeling listened to, feeling doubted or disbelieved in a medical setting, but also maybe just in life.
I find that interesting, that Serena felt she had to diagnose herself. I wonder if that’s also an aspect for Black women, for people of colour feeling that lack of trust in the healthcare setting. There was a doctor, Carol Ighofose, who I interviewed who had a heart attack, and she was very much diagnosing herself and trying to persuade the paramedics that she was having a heart attack. I found that so shocking and an example of Black women being doubted or not believed when they’re experiencing health issues.
What advice would you give somebody who feels that the health advice or diagnosis they are getting is informed by racism?
The responsibility shouldn’t be on us to have to advocate for ourselves in healthcare, but people who belong to marginalised groups often feel the need to do so.
I would hope that the book can also empower them to do that. At the same time, I hope we can empower doctors and healthcare workers to be able to educate themselves – for example about how conditions appear on diverse skin tones. I think we reach a stage where doctors can feel more confident, and we’re at a point where there’s more awareness that there is a problem.
Systemic: How Racism Is Making Us Ill by Layal Liverpool is published by Bloomsbury (£22). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
