Divided: Annabel Sowemimo’s book on racism in medicine and coloniality in global health
BMJ 2023; 383 doi: https://doi.org/10.1136/bmj.p2547 (Published 02 November 2023) Cite this as: BMJ 2023;383:p2547
- Sophie Harman, professor of international politics
Divided:Racism, Medicine and Why We Need to Decolonise Healthcare is a new book by Annabel Sowemimo,1 a sexual and reproductive health registrar and reproductive justice activist. Motivated by what was missing from her medical and postgraduate healthcare training and by the questions asked in her inboxes and at clinics, Sowemimo has written an accessible and urgent call to action to tackle racism and racial inequalities in the healthcare system. This timely book is published as the UK continues to wrangle with its place in the world, its imperial past, and the resulting systemic racism in healthcare and society, exemplified by appalling rates of maternal mortality in black women.
The power of Divided is twofold. First, it sees and validates the experiences of racially marginalised groups. It tells anyone who’s experienced racism in the health sector—whether their pain wasn’t believed, a rash wasn’t recognised on their skin, or their partner died in childbirth—that they’re not alone. Their experiences and lives matter and make up a wider trend of racism and inequality in the health sector.
Second, the evidence of the stark consequences of racism in health are so clearly explained that those in power cannot dismiss them. Divided represents more than just a book: it’s part of an anti-racist movement seeking to decolonise healthcare and demand better care for racially marginalised people.
Sowemimo pitches Divided as being published at a “moment of reckoning” after covid-19 and the resurgence of the Black Lives Matter movement. Tim Bale, an expert on conservative politics, argues that the Tories in the UK and other mainstream conservative parties in Europe are shifting ever more towards the far right.2 As parties shift to more extreme positions, echoes of race science about “difference” and “otherness” come to the fore. For example, while the world rightly demands more of leaders to reverse climate change, “eco-fascists” wrongly attribute climate change to population growth in low and middle income countries.3Divided is vital in the current moment, as it exposes the ignorance behind race science and the real, deadly consequences of what happens when people believe it.
Pushing for change
The book covers many areas: the history of eugenics, the relation between global health and colonialism, technology, incarceration, and mental health. Despite its compelling style, in chapter 9, which focuses on global health, Sowemimo’s analysis of colonial power relations is deployed only in passing, when discussing contemporary vaccine trials and the power of global philanthropy. She says little on the rush towards research “partnerships” between low and middle income and high income countries that often replicate the same power imbalances, in research hierarchies and knowledge extraction, that they’re supposed to contest. A book can’t do everything, but there are contradictory changes in global health that Sowemimo’s keen eye misses.
As part of a panel at the launch of Divided, the writer Jacqueline Ray emphasised the importance of white people reading the book and understanding the issues contained in it, as she says that “white readers have the power to change things.” Racially marginalised people know how they’re treated or mistreated in healthcare; white people need to know too. There’s no greater barometer of whose lives are valued in society than who lives, who dies, and who gets to live a long, healthy life.
Sowemimo’s book presents us with a choice: we can ignore the clear evidence she lays out before us, or we can change. New generations of medical students and practitioners are pushing for change in what and how they’re taught and in how science and medicine engage in anti-racist practice.
I know that most of my students will inhale every word of Divided. But we can’t wait for them to be in positions of power to change things. If we believe in science and medicine as a means of helping people, we need to listen to Sowemimo and learn from Divided. As she puts it, “rational people don’t think rationally about race”—and it’s time they started.
Footnotes
Competing interests: I declare no conflict of interest.
Provenance and peer review: Not commissioned, not externally peer reviewed.