Dermatologists, doctors who specialize in skin diseases, therefore know a lot about white skin. As a result, people with darker skin are sometimes not helped properly.
“As a result, diagnoses are missed or made later,” says dermatologist Jim Zeegelaar of the Flevoziekenhuis. “A lot of research has been done into it. Especially from America, of course, but that has actually been demonstrated.” It is not known how often things go wrong.
Different on dark skin
Eczema, sunburn or skin cancer, these are well-known skin problems. But on dark skin that can look very different than on white skin.
Most of the research comes from the United States. It has been shown there, for example, that people with a skin color are more often diagnosed with skin cancer (too) late. Because this is less likely to be recognized on dark skin.
Another skin condition, rosacae, can soon be missed. The red rash is more difficult to see on dark skin. And reference books don’t always show pictures of what that looks like on colored skin.
“Much medical knowledge is based on the often dominant norm of the white straight man,” says the Council for Public Health and Society. “People who fall outside this standard can therefore receive less good care, because there is insufficient knowledge about the health complaints they experience.”
“It means that these people run the risk that the complaints they have are not recognized, or that no suitable treatment is available. This is not only the case with dermatological complaints, but also applies, for example, to sickle cell disease (a hereditary blood disorder that is common in prevents people of color), “said the RVS.
“There is too little knowledge about dark skin in the Dutch healthcare system. That already starts in the training,” says dermatologist Jim Zeegelaar. “Actually, there is hardly any attention for colored skin in the training for dermatology, but also before that.”
Research shows that 18 percent of the images in dermatology textbooks are of colored skin. Zeegelaar: “Even in the most important books, such as this book that I have in front of me, you see that less than 20 percent of the pictures are dark skinned.”
So did Stacey. Her daughter developed skin complaints when she was one year old. She got spots all over her body and it got worse and worse. “She was very itchy, crying all the time, she was scratching everything.”
According to her dermatologist, it was severe eczema. And so it was treated that way. “Then you have to think of quite intense ointments: skin-thinning, carcinogenic.”
Until, after a long search, she came to a dermatologist with knowledge of dark skin. “He looked at my daughter and the first thing he said was, ‘This isn’t eczema! This is just extremely dry skin and those patches are caused by using the wrong products.”
Stacey doesn’t blame the doctor because he simply didn’t know enough about black skin. “But more knowledge would have saved a lot of suffering.”
Knowledge lags behind
The Dutch Association for Dermatology and Venereology (NVDV) now acknowledges, at the request of RTL News, that this knowledge is lagging behind.
“There is attention for it in sub-areas, but not enough. And it has not been appointed as an overarching subject within the training,” says dermatologist Colette van Hees on behalf of the association.
‘Broaden white gaze’
That image plays out more broadly in Dutch healthcare, according to expertise center Pharos. “It is an example of the lack of attention for ethnic differences in health and care,” says Patricia Heijdenrijk, director of Pharos.
“We also see that patients do not recognize themselves in the information about diseases that is easy to find, such as commercials about the sun causing skin cancer. It is important to broaden the (unconscious) ‘white’ view, and that starts, among other things, in the training courses.”
During the corona pandemic, there were many people with skin complaints. That was one of the symptoms of the virus. But in medical research, which started right at the start of the pandemic, almost only images of white skin resulted. Of the 700 subjects, 47 had skin of color.
More knowledge needs to be gained about these knowledge gaps, says Pharos. Director Heijdenrijk: “The ‘white’ view plays a role in all kinds of areas. It is about a lack of knowledge about diseases related to ethnicity, skin color or social origin. Not recognizing yourself in medical information or feeling discriminated against leads to stress and sense of exclusion.”
‘We must close the knowledge gap’
Dermatologists association NVDV has recently set up a diversity committee that has to work on this. “By providing more training about it, by providing more education, by providing more refresher courses. And by giving it a separate place in our guidelines,” says dermatologist Van Hees of the NVDV.
Pharos and RVS also see a role for the government and the healthcare sector. RvS: “The national government has an important role in stimulating more research into the role of diversity in healthcare, and in combating racism and discrimination in practice. Employers must pay more attention to the inclusive recruitment of personnel and the active combating discrimination and racism in the organization.”
It is not clear when this problem will be solved. Van Hees: “I hope within a few years. Of course I hope sooner. Yesterday, tomorrow. But that will take time, of course.”
Have you experienced something in healthcare where you could not be helped as well because of a bicultural background or skin color? And do you want to share that story with us? This can be done via [email protected].
Would you like to know more about health differences in the Netherlands?
In 2022, a lot of research has been done into health differences and inequality in Dutch healthcare.
In March, the national expertise center Pharos published a report that shows that patients and clients with a migration background do not always receive the same treatment as those without a migration background. This is also reflected in the presentation of the program of the National Coordinator against Discrimination and Racism. The Council for Society presented an essay in which the Council warns that if insufficient attention is paid to diversity and its risks, health differences and undesirable health effects will increase. Charifa Zemouri researched discrimination in the care for Statera (scientific institute of Denk). Read the report here.
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