Layal Liverpool: ‘Racism is a public health crisis – and we can do something about it’

LAyal Liverpool has a PhD in virology and immunology, and has worked as a reporter New scientist And Nature. In her new book Systemic: How Racism Makes Us Sickshe reveals the shocking facts about health threats to people of color.

What was the occasions for the book?
The idea came about in 2021. A year earlier, Covid had hit and I had just switched from medical research to working as a science journalist. My editor asked the question: Is the coronavirus racist?

We saw racial and ethnic health disparities when it comes to Covid. For example, in Britain, people belonging to black and Asian ethnic groups experienced worse outcomes.

So I started researching it and it opened up a whole box of things. What I realized is that racism is actually a public health crisis. Across the board, from infectious diseases to cardiovascular disease, cancer and mental health issues, we see that people belonging to marginalized racial and ethnic groups tend to experience worse outcomes.

I mean sure that’s a bad thing, but it was also empowering to realize because when we recognize that it’s racism that contributes to these disparities, we realize that we can do something about it – which to me is really motivating used to be.

What is the message or impression you want to leave with people after they read the book?
I would like people to think about racism in the same way they think about other things that are widely believed to be harmful to our health – like smoking or eating unhealthy foods.

Scientific racism is at the root many beliefs that doctors have today. Ideas about Black people have less sensitive nerve endings or thicker skin. Why do these ideas persist? It seems amazing.
It was quite shocking, but there was a history behind some of these ideas, that they had a purpose at the time. To take one example: the idea that black people’s lungs are different or weaker than those of white people. There was one in the US doctor and slave owner who made the argument that black people’s lungs are weaker and they are healthier when enslaved so they benefit from slavery.

It is very clear that there was a motivation at the time to justify the oppression of black people, and science came to support the ideas passed on. It is grandfathered in and we lose the ability to ask questions.

The medical establishment is said to be full of some of the smartest and most caring people in society – and their knowledge is based on testing and reviewing evidence. Yet it seems ingrained in racist ideas that result in negative consequences for large parts of the population.
They are among the most caring people, and many people are very dissatisfied with the situation and want to challenge it.

Fortunately, in recent years, people have felt more empowered to do this. It’s great that we listen 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. These are guidelines, practices that are passed on, and not individual doctors. Of course, there may be individual bad actors, but if we really want to address racial and ethnic health inequities, we need to look at the systems, the structures that underpin medicine and our entire society.

How should doctors consider race? You advocate anti-racist medicine and not color-blind medicine? Can you clarify the distinction?
I think about this a lot. We do not want to perpetuate or reify these biological ideas about race based on pseudo-scientific views.

But at the same time, race is very real. I experience it in the world as a black woman. I know that the way I am seen or believed is influenced by how I come across, how people racialize me. So that is a very real experience.

You often hear that race is a social construct. It is something fluid that changes in time and place. In Ghana, where my parents are from, I am racialized differently than here in Britain or if I went to Brazil or South Africa. That shows that it’s not really scientific – if it’s a variable that changes so much, but is still something that influences my lived experience. It affects how I’m seen when I go to the doctor.

In the book you tell the story of how Serena Williams almost died during childbirth. Doctors ignored her request for a scan for blood clots – a condition for which she takes medication. You make the point that if you are rich, you are relatively privileged Black woman in a well adequately resourced hospital is ignored, it does not bode well for everyone else.
Serena Williams said doctors don’t listen to us. And that was such a theme among the various people I interviewed: the feeling that you are not being listened to, that you have doubts or do not believe in a medical setting, but perhaps also in life.

I think that’s interesting, that Serena felt like she had to diagnose herself. I wonder if that’s also an aspect for black women, for people of color who feel a lack of confidence in healthcare. There was a Doctor Carol Ighofose, who I interviewed who had a heart attack, and she was diagnosing herself and trying to convince the paramedics that she was having a heart attack. I thought that was so shocking and an example of Black women being doubted or not believed when they have health issues.

What advice would you give someone who believes that the health advice or diagnosis he or she receives is based on racism?
It shouldn’t be our responsibility to advocate for ourselves in healthcare, but people belonging to marginalized groups often feel the need to do so.

I hope that the book can give them the strength to do so. At the same time, I hope we can empower doctors and health professionals to educate themselves – for example, on how conditions appear on different skin tones. I think we are reaching a stage where doctors can feel more confident, and we are at a point where there is more awareness that there is a problem.