Project to tackle lack of diversity in photographs of medical conditions

A shortage of photography showing medical conditions on darker skin tones will be addressed as part of a project led by UWE Bristol.

Funded by NHS England, the REFRAME initiative aims to capture digital images of conditions on people with a wide range of skin tones to create a diverse photo library available for free to clinicians, educators and the general public.

Members of the public are being invited to attend one of 30 photography sessions being held at venues across Bristol this year to capture close up images of a range of health conditions - from rashes and scars to amputations and jaundice.

It is hoped the comprehensive new image library, hosted on the NHS England website, will reduce health inequalities by lowering the possibility of misdiagnosis that can occur in cases where conditions present differently on darker skin compared with lighter skin (e.g. meningitis and seborrheic dermatitis).

The project team say the photographs taken of the volunteer participants will be helpful for identifying conditions in all skin tones, leading to faster diagnosis and offering patients better experiences of healthcare.

Project lead Debbie Hubbard, a senior lecturer in physiotherapy at UWE Bristol, began investigating the lack of diversity in healthcare imagery after she and colleagues noticed an underrepresentation of darker skin tones in academic medical textbooks and online.

She said: “When I look for pictures of different medical conditions on different skin tones, they are biased towards people with white skin. One example is jaundice - there’s not many, if any, pictures of that condition on darker skin tones. Generally on Google Images, you may see one or two people with darker skin tones on the medical photos, but they're mostly white. We thought this could be a project that could help reduce that gap and create a library of more inclusive healthcare images.

“It’s a huge problem - if we don't have those images it means healthcare professionals may not be able to recognise the signs of disease and illness. Some conditions do present quite differently in different skin tones, for example chickenpox. This causes people to have delayed diagnosis, misdiagnosis and potentially receive incorrect treatment or no treatment. This ultimately contributes to people having a poor experience of healthcare.”

Debbie said the REFRAME initiative, which began with a pilot photo session in St Paul’s on Wednesday 24 January, has been well received by the diverse communities of Bristol.

She said: “The response has been really positive. This is a collaboration with people in the community - they are essential for it to succeed and we can't do this project without them. It's for them.

“Potentially, we can impact positively on health inequalities by creating this new resource.”

All images taken of participants’ medical conditions (photographed on an anonymous basis) will be independently verified by medical professionals before being added to the catalogue of photographs and published online. In all, the project team are hoping to capture images of 70 different medical conditions.

The project has received almost £80,000 from NHS England and is being supported by Medical Illustration, a team of medical photography experts based at University Hospitals Bristol and Weston NHS Foundation Trust.

A second strand of the REFRAME project, running this year alongside the main part of the initiative, will focus on creating more diverse images of the healthcare workforce to capture pictures of a wide range of healthcare professionals working in different settings to increase the visibility of underrepresented groups.

Debbie said: “If I want to put a picture on my PowerPoint slide of say, a physio working in the intensive care unit, generally the physios and the patients in those pictures tend to be white, non-disabled people. This is about being inclusive and ensuring the community is represented.”

Sarah Todd, Senior Specialist in Education for Urgent and Emergency Care at NHS England in the South West, said: “This is a landmark project to improve care for patients, by supporting healthcare professionals in clinical situations and allowing educators to broaden their teaching for healthcare students. And more directly, anyone will be able to use the images as a source of reference if they’re concerned about their own health.”

For more information, to offer a community space for a pop up photo shoot, or to sign up to be photographed visit https://www.reframe-diverseimages.co.uk, or email diversifyingimages@uwe.ac.uk. Further details can be found on X by following @ReframeImages