Divided: Racism, Medicine and Why We Need to Decolonise Healthcare – Book Review

Reimagining healthcare isn’t easy, but reading Divided is a good place to start

by Zoya Yasmine

Divided by Dr Annabel Sowemimo is a powerful book that lays bare the colonial and racist history of medicine. My own research explores our healthcare system, so this felt like a natural and urgent read. One thing that I like about my research area is that everyone usually has something to say about it because we have all been patients, interacting with our healthcare system in one way or another. Yet, Divided makes it clear that while we are all patients, medicine does not serve us equally. In the past and present, medicine largely serves the needs of cis, white, Western groups – while actively marginalising others.

Sowemimo does not stop at identifying the neglect of certain patients; she also exposes the ways in which medicine and its advancements have been an active agent of violence. Divided reveals health research and policies that have harmed, silenced, and killed individuals from the Majority World, the prison population, and people experiencing homelessness – unsurprisingly these are also those who are least protected by societal structures and the law.

One step forward, three steps back

“someone else’s pain is suffering so that yours will not” - Dr Annabel Sowemimo

My own interest in healthcare has long focussed on fields like gynaecology and obstetrics since they are areas that are positioned to support the underserved. However, Sowemimo shows how a lot of our ‘strives’ in these areas – usually in the name of equity– have been possible because of the harm and loss of lives of others in the world. For instance, the growth of obstetrics in the 19th century was not driven by a concern for women’s wellbeing, but rather by a need to maximize the reproduction of enslaved people on plantation farms. Furthermore, our developments in this space have usually come at the cost of experimentation on enslaved women who are subjected to procedures performed without consent or pain relief.

It’s easy to put these examples to rest as things of the past but looking back only a few years ago to the COVID-19 pandemic, we witnessed the same harmful patterns reoccur as vaccines were tried and tested in former colonies. Trials for Novavax and Johnson & Johnson’s vaccines were concentrated in countries like South Africa. Plus, India also bore the brunt of the labour involved in vaccine production. Yet, these were the very same countries who were denied the life-saving treatments and vaccinations that they themselves produced. Less than 8% of South Africa’s population were fully vaccinated by the end of 2021, holding the lowest rate in the world.

Healthtech is not neutral

Reading Divided and reflecting on the racist and colonial history of healthcare has also made me think about our approaches to healthtech. We often hear that technology will be the solution to solve healthcare’s deepest inequities, whether it be through superior diagnostic tools or bias-free algorithms. But Sowemimo’s argument is clear: we cannot simply just bolt new jazzy technologies onto our deeply flawed foundations if we want healthtech to work for everyone. The systems that we exist in are saturated with legacies of eugenics, race science, and imperialism. These ideologies continue to shape whose lives are prioritised, how technology is built, and whose deaths are dismissed.

If we are serious about inclusive healthtech, we must first confront these uncomfortable truths (and reading Divided is a great place to start btw). This reckoning will require more than just diversifying our health professionals or soliciting donations from corporate giants for health inequality initiatives. Crucially, I have been thinking about whether our deterministic approach to technology could also be the very thing that is holding us back. We must also begin to recognise that resistance to technology in healthcare is not always regressive or anti-progress. It can be a meaningful response to tools that are extractive, inaccessible, or dehumanising. This resistance can help us imagine more pluralistic futures for healthcare – with or without technology.

The role of communities and collective change

“Being around others, building communities is how we start to understand each other’s struggles and to look for common ground” - Dr Annabel Sowemimo

Inequalities in society persist precisely because they divide those without power, fracturing potential solidarities and making collective resistance more difficult. Therefore, as I sifted through the pages of Divided, I really saw how communities like OneHealthTech are more important now more than ever. These communities create space for people to learn from one another and explore other visions of healthcare which include broader voices, disciplines, and approaches. It’s great to have seen people collaborate in OneHealthTech from all across the UK, but also globally with hubs popping up in Nigeria, Australia, and Hong Kong. I hope to see this model expand further in the Majority World.

Reading this book was also sad and painful. No one should ever underestimate the emotional (and also professional) toll that can persist for anyone who is working to decolonise healthcare. Sowemimo explains her own unsettling experience of revisiting her university campus and passing through buildings which she once studied in but didn’t realise also housed the works and academics who developed, established, and legitimised the science of eugenics. Communities are important to support and care for each other as we unlearn and learn together.

Unlearn and reimagine

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”  - Margaret Mead

Divided recounts our long history of medical practices which are embedded in harmful stereotypes and ideologies. As such, it can be hard to know how to even respond and I don’t think there are any quick or easy answers. However, by situating medical practice (which is often perceived as neutral and objective) in the complex tapestry of social, historical, and political structures, Divided provides us with the foundations to help us dismantle harmful norms.

One of the most profound lessons I took from Divided was the realisation that imagining alternative futures for medicine and health technologies do not require formal expertise in biomedical science or advanced technical training. In fact, much of this reimagining begins with letting go of the narratives we’ve been taught by traditional ‘experts’ and elitist institutions.

Take, for instance, the common belief that certain illnesses are primarily the result of genetic flaws. While genetics may play a role, Divided reveals that many health conditions are far more accurately understood as outcomes of social and economic inequities: poverty, food insecurity, poor housing, limited access to clean water, the chronic stress of racism and precarious work, and the cumulative toll of environmental degradation. These are all socially produced conditions.

We first-hand witnessed this during the COVID-19 pandemic, when higher death rates among racially marginalised communities were hastily interpreted as evidence of genetic vulnerability. This framing obscured the true causes: frontline exposure, poor access to healthcare, overcrowded housing, and longstanding structural racism.

One example from the book about how things can be better was Sowemimo’s discussion of barbershops as informal but crucial mental health spaces for black men. This was a striking illustration of how health does not only happen in clinics or labs – it also happens in communities and in spaces shaped by trust and lived experience (like OneHealthTech!). 

I take this example as inspiration for how we should be developing healthtech. Perhaps, more inclusive healthtech might mean slowing down, designing with (not for) communities, or even deciding that a technological solution isn’t the answer after all. Don’t get me wrong, I think there are some amazing healthtech innovations that are saving lives, and this is not to discredit any of these interventions or the researchers working hard to make these possible. However, perhaps in our approach to healthtech we need just be more critical and intentional about when, how, and why we use it and whose lives are at stake.

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Blog post written by...

Zoya Yasmine, PhD Student at the University of Oxford

Zoya’s research explores the intersection between intellectual property, medical AI, data protection, and ethics. She previously obtained an LLB from LSE and MPhil from the University of Cambridge. Zoya has worked for numerous organisations in the healthcare industry including GSK.ai, BenevolentAI, MeditSimple, and the General Medical Council.