Opinion: ‘We’re ensuring people have access to diverse images for healthcare’

Flicking through the pages of academic medical textbooks back in 2022, our team spotted a surprising omission: a stark absence of images of health conditions on darker skin tones.

Whether rashes, scars or jaundice, the photographs almost exclusively showed how these conditions presented on people with white skin.

Further research online, with a few cursory searches on Google Images, quickly revealed a similar lack of diversity in pictures of all sorts of medical conditions.

Our discovery was worrying as it highlighted a clear underrepresentation of UK’s diverse population in medical resources. But perhaps more seriously, there was a risk of misdiagnosis where conditions appear differently on dark skin compared with light skin.

Thankfully, as academics, we were able to take action to address this health inequality. With funding from NHS England and support from medical photography experts based at University Hospitals Bristol and Weston NHS Foundation Trust, we set about forming the Reframe project aiming to capture digital images of health conditions on people with a wide range of skin tones.

We invited members of the public to volunteer as models for close-up pictures of their conditions at photography sessions held at venues across Bristol last year.

With these images, we proposed setting up a diverse photo library of medical conditions available for free to clinicians, educators and the general public. This library, we hoped, could play an important role in lowering misdiagnosis, speeding up correct diagnosis and offering patients better experiences of healthcare.

Fast forward 12 months and we’re immensely proud to be preparing to launch our library of images that can be downloaded and used widely for healthcare education and clinical diagnosis.

Incredibly, we amassed more than 1,000 images of medical conditions in total from 158 Bristolians, captured in six photoshoots held in various locations in the city since January 2024. The images are being verified by teams of dermatologists from the British Skin Foundation and the British Association of Dermatologists ahead of the launch of the library in March.

It took a Herculean effort from our talented and committed team to reach this point, and we’ve learned many lessons along the way. Successful engagement with the diverse communities of Bristol was perhaps the most critical element of the project.

To ensure effective communication, we developed culturally appropriate materials, considering language preferences and cultural nuances. To reach a wider range of people, we strategically selected venues for our photo shoots - for example, community centres, community groups and medical centres. These locations are frequently visited by diverse groups of people, including families, children and healthcare professionals.

By conducting photo shoots in accessible settings, we aimed to increase visibility, encourage participation and foster a sense of community involvement in the project. Feedback from organisations such as the Black South West Network, Dhek Bhal (a South Asian community group) and the Chinese Community Wellbeing Society was invaluable and helped us to refine our approach.

The diverse perspectives and experiences of our project team played an invaluable role in shaping the project. Our team was made up of individuals from various cultural, ethnic and professional backgrounds, which not only enriched our problem-solving and decision-making processes but also enhanced our ability to engage authentically with the communities we worked with.

We are hugely thankful to members of the public who have supported us on our journey. They have placed their trust in us, taken time out of their day to attend photo shoots in all weathers, revealing parts of their bodies to our team of medical photographers without fuss. They have supported the project secure in the knowledge that their participation might one day help someone with a health condition in the UK, or perhaps even in another part of the world.

This wonderful support from the public in Bristol has paved the way for the project to expand nationally. By collaborating with medical illustration departments across the UK, we aim to build a growing and lasting resource that better reflects the diversity of the communities served by the NHS and support our healthcare professionals and learners to better diagnose and treat the public.

By Debbie Hubbard, lead for the Reframe project and an associate director in UWE Bristol’s School of Health and Social Wellbeing.