Intended for healthcare professionals


Taking racism out of clinical guidelines

BMJ 2024; 385 doi: (Published 30 April 2024) Cite this as: BMJ 2024;385:q942
  1. Alexander Mafi, editorial registrar1,
  2. Habib Naqvi, chief executive2,
  3. Veline L’Esperance, senior clinical adviser2
  1. 1BMJ, London, UK
  2. 2NHS Race and Health Observatory, London, UK
  1. Correspondence to: A Mafi amafi{at}

Guidelines should be reviewed to identify inappropriate use of race and ethnicity

Health systems continue to grapple with the deeply rooted consequences of systemic racism within healthcare. The immediacy of this challenge is evidenced in the recent Whitehead report,1 published in the UK, which highlights ethnic inequalities arising from the design and calibration of medical devices.

Internationally, race and ethnicity remain common clinical discriminators for guiding decisions within medical guidelines. Alongside efforts to identify and tackle racial inequalities associated with medical devices, health systems globally need to urgently review the appropriateness of using ethnicity to guide treatment decisions and to critically re-examine the rationale for using race or ethnicity as a clinical tool.

Race and ethnicity are constructs shaped by social and political factors with almost no biological basis. Historically, medicine has often attributed differences observed in ethnic minority populations to their biology and genetics, with limited or no scientific underpinning. The Human Genome Project has highlighted both substantial genetic variation between people of the same ethnic group and close similarity between people of different ethnic groups, making them a poor proxy for genetic difference.23 Using race or ethnicity as a marker for cultural differences can be equally unreliable and unhelpful.

Clinical guidelines and risk scores …

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