The Importance of Representing Different Ethnicities in Medical Illustrations

Written by Dr Joanna Butler from The Medical Stock Images company 

Medical illustrations are a cornerstone of visual communication in healthcare education, offering vital visual tools for understanding anatomy, diseases, and medical procedures. However, historically, these illustrations have predominantly featured individuals with lighter skin tones, leaving a significant gap in representation. As the global population becomes increasingly diverse, the need for inclusive visual imagery in medical illustrations is more crucial than ever. Incorporating a broad range of ethnicities, body size, gender variations into these resources not only reflects the reality of patient demographics but also fosters a more equitable healthcare system.

Why Representation Matters in Visual Imagery

Representation in visual media, including medical illustrations, carries profound cultural and societal implications. Illustrations and imagery serve as powerful tools for shaping perceptions and fostering inclusivity. When different ethnicities, body size and gender variations and are represented in medical illustrations, it communicates a message of belonging and recognition to all patients. Conversely, the absence of such representation can reinforce feelings of marginalisation and perpetuate stereotypes that certain groups are less relevant in healthcare discussions. That is why we have been creating our medical illustrations that include the diversity found among populations, whilst extending their global reach to a broad range of audiences through our illustration Stock site.

Medical illustration is more than a technical tool, it is a medium for communication and education. In textbooks, patient brochures, and anatomy lectures, the illustrations you choose can shape not only how medical professionals view their patients but also how patients view themselves. If visual materials predominantly showcase one skin tone or ethnic background, it inadvertently signals that those individuals are the default or standard. This can alienate individuals from underrepresented communities, making them feel invisible or less valued within the healthcare context.

Enhancing Accuracy in Medical Education and Practice

Anatomy and pathology often manifest differently across skin tones and ethnicities. For example, conditions like rashes that feature inflammation and discolouration, eczema, pityriasis rosea, or acne vulgaris appear differently on darker skin compared to lighter skin. Illustrations that fail to capture these differences risk leaving healthcare professionals underprepared to diagnose and treat diverse populations. At The Medical Stock Images Company, we know that representation in medical illustrations is more than a matter of aesthetics; for example, it is crucial to show skin diseases correctly and a critical component of equitable healthcare. Skin diseases are a considerable burden on healthcare as they are among the most common health problems worldwide (Basra, M. K., et al., 2009)).  Neglected Tropical Diseases of the skin (skin NTDs) are serious and life changing that effect populations in sub-Saharan Africa, yet there was little by way of medical illustration in educational materials in Africa. A study carried out (Butler, J., et al., 2024)) used community workers to supply verbal feedback on the skin NTD Buruli ulcer, producing the first clinically approved medical illustrations of Buruli ulcer that provided much needed visual imagery to help improve disease detection, help seeking behaviour and adherence to treatment.

Additionally, health conditions that disproportionately affect specific ethnic groups, such as sickle cell anaemia or keloids, should be visually represented in a way that reflects the populations most impacted. Including these differences in medical illustrations ensures that practitioners can better understand and recognise these conditions in the communities they affect. When medical illustrations like ours account for ethnic and body type variations, they not only enhance the accuracy of education but also ensure that medical practitioners can deliver effective care to all patients, regardless of skin tone.

The Role of Cultural Representation in Health Education

Medical illustrations are widely used in health education materials designed for the public, such as brochures, posters, and online resources. For patients, seeing themselves reflected in these materials can significantly impact their understanding and trust in the healthcare system. A lack of representation can lead to feelings of alienation and reduced engagement, which may hinder effective communication between doctors and patients.

For example, when explaining a surgical procedure or treatment plan, a doctor might use a visual aid to guide the conversation. If the patient does not see themselves represented in the imagery, it may affect their ability to relate to the material and fully comprehend the information. Conversely, illustrations that reflect a diverse range of ethnicities help establish rapport and build trust, showing that healthcare is designed for everyone, not just a subset of the population.

Representation also matters when addressing cultural differences in health practices and beliefs. Culturally sensitive illustrations can help bridge gaps in understanding, ensuring that health education materials are respectful and inclusive of different cultural contexts.

Addressing Bias in Health Education and Resources

Anatomy textbooks form the foundation of medical education, yet studies have revealed that they overwhelmingly feature lighter-skinned individuals in their illustrations (Ilic, N., Prescot et al., 2022). This bias perpetuates a limited understanding of human anatomy and pathology among medical students, who may carry these gaps into their professional practice. By diversifying the imagery in these foundational resources, medical education can better prepare future practitioners to care for diverse populations.

Supporting Black Maternal Health Equity

At The Medical Stock Images Company, we believe we have created the largest library of pregnancy medical illustrations representing the Black population. We have supplied our illustrations for multiple online resources on a License basis for Doula’s, midwives, clinical education, and served clients such as the BLACK Wellness & Prosperity Center, USA, that have ranged from  a week by week visualisation of a baby’s development  to breastfeeding to preparation of a vaginal birth. The full catalogue of Black pregnancy medical illustrations  shows our many years of commitment to providing inclusive, supportive, collaborative art that serves global communities to greatly enrich health care education. Improved health outcomes is crucial when statistically the mortality rate is three times higher for women from Black ethnic minority backgrounds compared to White women.   

Supporting Equity in Doctor-Patient Consultations

Representation in medical illustrations also plays a vital role in the dynamics of doctor-patient consultations. Effective communication is essential in these interactions, and visual aids are often used to explain conditions, treatments, or surgical procedures. Patients are more likely to feel understood and respected when the visuals used in these conversations reflect their own ethnicity or cultural background.

For example, a Black patient discussing skin conditions with their doctor might feel more confident if the visual references include images of dark skin, demonstrating that the doctor is prepared to address their specific concerns. Such representation fosters trust and collaboration, which are critical for achieving positive health outcomes. 

The Broader Impact on Society

Representation in medical illustration also contributes to breaking down stereotypes and promoting inclusivity on a societal level. When diverse ethnicities are consistently included in educational and professional materials, it reinforces the idea that healthcare is a universal right, accessible to all people regardless of their background. This normalisation of diversity can help reduce implicit biases among healthcare providers and the broader public.

Moreover, inclusive illustration can inspire underrepresented individuals to pursue careers in healthcare, seeing themselves reflected in the field. Representation is not just about addressing the needs of today’s patients but also about shaping the future of the healthcare workforce and education.

Moving Toward Inclusive Medical Illustrations

The shift toward inclusive medical illustrations requires deliberate effort and collaboration among artists, medical professionals, and educators. Some steps that can help achieve this goal include:

1. Collaborating with Diverse Artists: Encouraging medical illustrators from various backgrounds to contribute their perspectives and expertise ensures a broader range of representation.
2. Updating Existing Resources: Revising textbooks, online resources, and educational materials to include diverse imagery.
3. Prioritising Inclusivity in Training: Educating medical students and professionals about the importance of representation and how to recognise biases in medical materials.
4. Engaging Communities: Collaborating with underrepresented communities to understand their specific needs and ensure accurate representation.

Conclusion

We are very proud of our diverse medical illustrations that we have created from scratch, as well as making available for use by License to all audiences. By including diverse ethnicities in our medical illustrations, we aim to create a more inclusive and effective healthcare system that serves everyone. Such efforts not only improve education and patient care but also contribute to a more just and empathetic society. In a world as diverse as ours, medical illustrations should reflect that diversity, ensuring that every individual feels seen, valued, and respected in the context of healthcare.

References

(1)     Basra, M. K., & Shahrukh, M. (2009). Burden of skin diseases. Expert Review of Pharmacoeconomics & Outcomes Research, 9(3), 271–283. https://doi.org/10.1586/erp.09.23

(2)     Butler, J., Ogden, J., Phillips, R., Hay, R., Simmonds, R. E., & Erolin, C. (2024). Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment. Journal of Visual Communication in Medicine, 47(1), 8–20. https://doi.org/10.1080/17453054.2024.2348170

(3)     Ilic, N., Prescott, A., Erolin, C., & Peter, M. (2022). Representation in medical illustration: the impact of model bias in a dermatology pilot study. Journal of Visual Communication in Medicine, 45(4), 253–262. https://doi.org/10.1080/17453054.2022.2086455