Publishers Weekly
04/08/2024
Nature reporter Liverpool debuts with a damning investigation of how racism affects health outcomes across the globe. People of color are disproportionately harmed by environmental pollution, Liverpool contends, citing research that found Black and South Asian Brits are hospitalized for asthma at higher rates than their white counterparts due to living in areas with poorer air quality. Healthcare systems often exacerbate existing racial disparities, Liverpool warns, citing as an example one American health insurance algorithm that selected patients for preventive treatment based on anticipated future costs. Because Black Americans face obstacles to accessing medical care, insurers often spend less on their treatment, which led the algorithm to estimate Black patients weren’t as sick because they weren’t receiving as much care and to consequently deprioritize them. Elsewhere, Liverpool studies the biological consequences of racist policies, suggesting that studies showing early childhood trauma increases the risk of late-life dementia explain the high rates of dementia documented in aboriginal Australian peoples, who were subject to forced assimilation policies that separated children from their families between the 1910s and 1970s. The extensive research captures the alarming scope of the problem, yet Liverpool also includes reason for hope, highlighting efforts to “sequence DNA from traditionally unrepresented groups” and to support “aspiring and current doctors of African and Caribbean heritage” in the U.K. It’s a troubling assessment of a pervasive problem. (June)
From the Publisher
"Systemic is a wide-ranging, inquisitive book about health care and society — and ultimately a call for change. Liverpool makes available a plethora of resources and advocacy groups that should help everyone to get involved in anti-racism efforts."—Sirry Alang, Nature
"Systemic is an important new book about the relationship between racism, illness, and manufactured disability. Global in scope, Layal Liverpool takes us from Europe to the Americas, from Africa to Australia, illustrating the transnational scourge racism has on the health of the public the world over. Scientifically and technically masterful but never lacking heart, Liverpool draws upon her own lived experiences with vulnerability and grace, so that readers may better understand their own."
—Steven W. Thrasher, PhD, author of The Viral Underclass
"Across a global canvas Layal Liverpool deploys deep compassion, gut-wrenching testimony, and peerless scientific journalism to show how racism lives and kills. But then she guides us to a revelation: once we know the truth of racism, it’s possible to chart a way to a health system in which anti-racism is medicine. It’s a prescription that everyone needs. Start by reading, and then organize!"
—Raj Patel, co-author of Inflamed
"A groundbreaking, brilliantly argued book that debunks the myth that illness is the great equalizer. With a strong foundation in science and biology, Layal Liverpool unequivocally proves that addressing bias in medicine and data gaps in research will lead to a healthier and more equal world."
—Siddhartha Mukherjee, bestselling author of The Emperor of All Maladies, The Gene and The Song of the Cell
"Layal Liverpool has produced a work of towering importance that will undoubtedly change science and save lives, but it will also change the way you see yourself and the people around you. Systemic is beautifully written and scholarly but perhaps almost uniquely for such a book it is deeply personal and accessible, packed with compelling stories and fascinating details which are harnessed to make an impassioned argument for a better world."
—Chris Van Tulleken, NYT bestselling author of Ultra-Processed People
Kirkus Reviews
2024-04-02
An urgent study of how ethnic minority patients are medically disadvantaged because they are economically and socially disadvantaged—and they are dying because of it.
Liverpool, a British journalist for Nature with an expertise in immunology and virology, takes a broad view of a thorny problem: Racism plays a critical factor in health care and, as the Lancet notes, is “a public health emergency of global concern.” Systematic racism presents in many ways in the health sphere, including the persistent belief that Black people have differences enough in their pain receptors that they require less anesthesia in surgery. Biological differences do exist, notes the author, but these are at the genetic level and affect such things as the ability to metabolize certain therapeutic drugs, in the same way that people with certain genetic markers have difficulty metabolizing dairy products. Racism is often marked by simple carelessness. Algorithms for one dermatology app, for instance, were trained on light-skinned people, making their diagnostics suspect for those of darker complexion. Liverpool herself suffers from a skin condition that white doctors said was incurable until one dermatologist pronounced it common eczema that expresses itself somewhat differently on darker skin. Racially grounded disparities in health care are everywhere: Black patients wait far longer for organ transplants than whites, and standardized tests eliminate many from the candidate rolls; Black and brown people were disproportionately affected by Covid-19, and hospitals treating Black patients received fewer funds; childbirth mortality rates are higher for Black women than for white women; and so on. Liverpool notes that while these disparities are measurable, “instead of simply stating that Black people are dying disproportionately because they are poor, we should be asking why Black people…are disproportionately poor in the first place.”
A powerful argument for a more equitable approach to health care.
