This year has been notable for public health crises. As a nation we have come to recognize that a disease is spreading across the country and around the world, and that innocent lives are being lost. We have come to recognize that there are vulnerable populations that are disproportionately at risk for adverse outcomes from this condition and that without interventions, the condition will continue to propagate across the country. This public health crisis we speak of is systemic racism and, like coronavirus disease (COVID-19), it has had a disproportional impact on the African American and broader skin of color communities.
The video images are all too disturbing to most, but all too familiar to some. The weaponization of race, gender, and privilege in the 9-1-1 call on Christian Cooper is astonishing and upsetting. The loss of the lives of Ahmaud Arbery, Breonna Taylor, and George Floyd due to the crime of “living while black” is not occurring more often but rather now being documented for all to see. We (hopefully) have come to a crossroads within this country. Colleagues, patients, families, and friends in the United States and around the world are letting their voices be heard: black lives matter.
The systemic and institutionalized racism that currently exists within the United States is a byproduct of slavery, disenfranchisement, and Jim Crow. Discriminatory practices are observable in many aspects of our society: poverty, housing, the criminal justice system, and health care. The National Medical Association (NMA), the largest and oldest organization representing African American physicians and their patients, was founded 125 years ago in Atlanta, GA, because black physicians were unable to join the American Medical Association due to racist policies. Today, there are differences in the medical management of black vs white patients for the same health condition, in pain management of black vs white patients, and even racial bias in health algorithms used for guiding health decisions and assessing health care costs. These challenges have become increasingly evident, as highlighted by Centers for Disease Control and Prevention data during the COVID-19 pandemic; we see poorer outcomes, lack of health care access, and higher mortality rates in patients of color, including African American and Hispanic populations.
Dermatology is not immune from racism’s reach. Within the house of medicine, dermatology remains one of the least diverse disciplines with regards to its percentage of underrepresented minorities. Cutaneous diseases that primarily affect individuals with skin of color tend to be misdiagnosed, understudied, and have fewer treatment options. In a field where visual recognition is sine qua non, how can the images of conditions such as dermatomyositis be so overwhelmingly of lighter skin tones when the condition is more common in darker skinned individuals? The color of erythema differs depending on the amount of melanin in the skin; recognition of the early signs of erythema in life-threatening diseases decreases morbidity and mortality in patients of color.
Some progress is being made in dermatology regarding skin of color. Major dermatological societies (American Academy of Dermatology, Society for Investigative Dermatology, Women’s Dermatologic Society, Association of Professors of Dermatology, Skin of Color Society [SOCS]) are addressing diversity, inclusion, and underrepresentation within dermatology as a point of emphasis, culminating in the Diversity Champion Workshop last year in Chicago, IL.
The SOCS, founded in 2004 by Dr Susan Taylor, is mission-driven to promote awareness of and excellence within the special interest area of skin of color dermatology. The Society is committed to educating health care providers and the public on dermatologic health issues related to skin of color.
The SOCS and the Dermatology Section of the NMA are two organizations within dermatology that will continue to speak out against racial injustices, address societal inequities, and work to change the vast disparities in health care impacting people of color. And more needs to be done: better representation of people of color in clinical trials; all skin types being represented in medical education (textbooks, lectures, and journal articles); more questions about black skin in our board certification examinations; and an increase in the number of dermatologists of skin of color.
It is encouraging to see and hear from so many people, from so many walks of life, that are moved by our current circumstances and are even more determined to seek equality, dignity, humanity, and respect for all. For those moved to protest, continue to do so peacefully, purposefully, and with proper protection, given the pandemic. For those less inclined to public activism, continue having (or start to have) meaningful conversations with those who you interact with every day but may not look like you. That includes your fellow dermatologists, staff members, and patients. To all, please vote!
The Pledge of Allegiance ends with the words “one nation, indivisible, with liberty and justice for all.” Let us continue to work and make progress, together, so that these words will finally ring true for us all.
Editor’s note: For more information on how the SOCS and NMA are improving the lives of minority patients and promoting the growth of physicians with skin of color, visit www.skinofcolorsociety.org and www.nmanet.org.
Dr McKinley-Grant is the president of the SOCS as well as associate professor and director of Curriculum Innovation and Development in the department of dermatology at Howard University College of Medicine in Washington, DC. Dr Desai is the immediate past president of the SOCS as well as the president and medical director for Innovative Dermatology, PA, in Plano, TX, and clinical assistant professor of dermatology at the University of Texas Southwestern in Dallas, TX. Dr Glass is the secretary/treasurer of the SOCS and assistant professor at the department of dermatology, University of Texas Southwestern Medical Center, Dallas. Dr Kindred is the chair of the Dermatology Section of the NMA and the founder and medical director of Kindred Hair & Skin Center in Columbia, MD.