Title Systemic: How Racism is Making Us Sick
Author: Layal Liverpool
Bloomsbury Publishing
AD/PR – Thank you @netgallery for the advanced ecopy.

In this data-driven nonfiction book, Liverpool draws on diverse global stories and research to shine a light on how racism is interwoven into both science and medicine to compound disparities that already exists in healthcare.
I have worked in women and children’s health for decades and it is sad to see that many inequalities continue to exist based on colour, race and ethnicity. To give you a flavour of some of the topics that the author referenced, she discusses
Differing interpretation of pain in various cultural groups and how people are treated accordingly with pain relief being withheld based on colour.
Black women’s experience and discrimination in of pregnancy and childbirth
The nonstandard symptoms of health attacks being overlooked and ignored
Racism embedded in psychiatric care
Environmental racism
The systemic impact of the hight rates of deaths from Covid amongst people of colour
Higher death rates and lower five-year cancer survival rate in black and ethnic minorities
Lack of diversity in medical textbooks thus impacting education and learning.
Under or non-representation in medical research data.

This give a flavour of the width and breath of book. The takeaway message is that race and ethnicity are social constructs not biological ones, and it is only through culturally sensitive care can we begin to narrow that gap and improve on health outcomes for all. We must remain curious, we must advocate and educate and we must strive to challenge the status quo.
As an advocate for public health initiatives, that look at both the macro and micro influences in health, this book adds hugely to my understanding of how conscious and unconscious biases pervades diagnosis, treatment and outcomes for black minorities and other ethnic groups.

**Book Review: _Systemic_ by Layal Liverpool**

_Layal Liverpool's_ _Systemic_ is a compelling and insightful exploration of the intricate ways in which systems of power and inequality shape our world. Through meticulous research and accessible writing, Liverpool dissects complex topics, shedding light on the interconnected nature of social, economic, and health disparities. Her approach is both scientific and humanistic, offering a balanced view that is thought-provoking and empowering.

What makes _Systemic_ truly stand out is Liverpool's ability to break down challenging concepts into relatable discussions, encouraging readers to reflect on their own roles within these systems. This book is a must-read for anyone interested in understanding how deep-rooted structures affect everyday lives and how change can be driven from within.

This book is a crucial examination of how racism impacts health, combining personal stories with published research across various medical specialties. It highlights racism as a global health threat, explores its role in health inequality, and delves into the historical context of racism and colonisation. Additionally, it provides insights on delivering culturally safe healthcare and addressing these disparities. It's a challenging but essential read for all health professionals like myself, offering vital knowledge and perspective on reducing health inequalities.

This is a first for me by the author and one I enjoyed and I would read more of their work. The book cover is eye-catching and appealing and would spark my interest if in a bookshop. Thank you to the author, publisher and Netgalley for this ARC.

The truth hurts. Unfortunately, people of colour seem to pay for it with their health. This book is an anger-inducing but important review of how the societal systems are letting black people down. Liverpool shares the data but brings it to life with real life stories, so we see the impact of the systemic biases integrated into the practice of medicine. She dispels the myth that poverty is sole cause and the excuses that governing bodies use to not make change. I hope that those who have influence and power in government and civil society read this book - and do better.

A very important and interesting book that I'll probably reread in the near future. It is well written and easy to understand for people who have no background in science.

Systemic by Dr Layal Liverpool is a thought-provoking and beautifully written book that delves deep into the complexities of systemic racism and oppression in society. Layal’s writing is both powerful and poignant, as she skillfully navigates through the various systems that perpetuate inequality and injustice.

The book is divided into clear and concise chapters that tackle different aspects of systemic racism, from education to healthcare to the criminal justice system. Layal provides well-researched data and statistics to support her arguments, making it impossible to ignore the pervasive nature of systemic racism in our society.

What sets Systemic apart from other books on this topic is Layal’s ability to humanise the data and statistics by sharing personal stories and experiences. Through these narratives, readers are able to connect on a deeper level and truly understand the impact that systemic racism has on individuals and communities.

Overall, Systemic is a must-read for anyone looking to gain a better understanding of the root causes of inequality and oppression in our society. Layal’s insightful analysis and compassionate storytelling make this book a powerful tool for sparking important conversations and driving meaningful change. I highly recommend Systemic to anyone interested in creating a more just and equitable world.

Systemic is an accessible, essential text, particularly for anyone working in healthcare. Liverpool uses the many years of experience she has gained in medical journalism to bring together stories and research from across the globe.

Key subjects covered included gynaecology, genetics and medical research, but it draws in threads from across the field. Everything is rooted in academic studies and personal case studies, making a very compelling read.

I really appreciated this and have already recommended it to a number of people offline as well as online. I would love to see a copy in every medical library across the UK and for it to be added to university reading lists for prospective and current medical students.

I vacillated for some time before requesting this book because I wondered how biassed it was going to be. Whilst it may do a great job of covering the racial aspects, perhaps it failed to take into account any ethnic predisposition towards particular medical issues. In the end I decided that without reading it, I would never know.

Having now read it, there seems to be no real acceptance of anything other than White people are the cause of all Black ills. My apologies if that seems to support the author's arguments but, when there is only passing mention of other skins than Black and White (using her defined capitalisation), I can only conclude bias.

For example, a few decades ago the milk industry in the US had what they called the Milk Mustache (sic) campaign. Nowt wrong with that, except it was spearheaded mostly by Black athletes. That would have been absolutely fine if Black people do not have a very high disposition towards Lactose Intolerance.

Whilst I would be the first person to agree that slavery is an abomination, I do feel unfairly singled out, because I am White, when the blame for slavery is placed solely on White shoulders. The African slave trade was supplied by the Black peoples of Africa. If the "rulers" in Africa had no slaves of their own, I doubt White folk would have come up with the idea PLUS if those African rulers had said NO, we will not supply you with our people to be your slaves, I cannot see how the exploitation of Black by Whites could have happened. No doubt by now I have been labelled racist which is the real theme of the book even though it is titled Systemic.

I could offer a lot more examples but then this review would turn into a book of its own. To end, may I suggest that slavery has been around for a very long time, as the Old Testament reminds us, and, until relatively recently, Whites had nothing to do with it. Whites are not paragons of virtue but neither is anyone else.

This is a must read for all. Following this I have gone back to read much of Layal Liverpool's articles and various works and would highly recommend.

This book was insightful, well researched and thought provoking. It provided a lot of real life study cases, many of them were heartbreaking, and how we can prevent this from happening in the future.

I’d recommend this to others, like me, who are still learning about medical racism. It was very informative. I’d especially recommend this to those working in the medical field to improve their care for all patients.

Although I've read a few race-based social justice books which include health inequality narratives and statistics, and a couple of books on women's health which include racial inequality information, this is the first book I've encountered which is entirely about the racism endemic in societies around the world and the effects that has at grass-roots level.

Taking a truly global perspective, looking at personal narratives and data (where the latter exist, one theme of the book, demonstrating that many countries don't keep adequate statistics) to show how systemic racism, from policy-makers to healthcare providers in the field, affects a whole range of health areas for global majority people, from pregnancy and birth to cancer diagnosis and treatment, Covid inequities, genome sequencing and research in general.

The author is a science journalist and obviously has a clear understanding of the field and how to interpret research. She is honest that she's not able to cover all the intersectionalities, concerning herself mainly with race, although gender obviously comes in when talking about pregnancy and birth, and also when discussing the different presentations of heart attacks in male and female patients as it crosses over with Black and Brown people being less likely to be believed by White health professionals. Layal also includes lots of data and studies on Indigenous people, who are often left out of racial justice narratives.

There's a lot of shocking information, of course, particularly, I felt, the ancient hangovers from older now disproved research making claims about bodily differences on racial lines and outdated adjustments to measures of disease which mark out unwell people as healthy. Layal does a super job of bring all this to the audience in approachable language, with lots of real-life examples from people's own experiences. I hope this will be read widely.

Review published on my blog 13 June: https://librofulltime.wordpress.com/2024/06/13/book-review-layal-liverpool-systemic/

This is a thought provoking critique of how unconscious bias, misinformation, persistent myths based in historic assumptions in the medical world is adversely affecting people of colour.
A much needed study which will hopefully have the impact it deserves on how people of colour are treated in medicine and thus their medical outcomes.
Well written , clear, easy for layperson to read and sincere.

Well-written research on the correlation between race and health. However, the book suffers from a noticeable lack of coherence, likely due to some of the articles that were originally published previously. Each chapter feels like an isolated piece, and I would've loved if it read more like a unified body of work.

This was a very detailed, through and eye opening book.
The research that must have gone into this is immense and a really great way to educate people.
I've read a lot about racism, but this author writes in a way that is easy to understand, offering their own experiences and those of others, to help the readers acknowledge what is happening.
I really enjoyed it.
Thanks to Netgalley and the publisher for an ARC in exchange for an honest review.

a hugely important book on how racism affects health through individuals' stories of experiences with racism & health that happen all too often, and published research from different specialties. it explores racism as a global health threat, the role of racism in health inequality, the historical context of racism and colonisation and it's impact on heath inequality and how to provide culturally safe health care & reduce these inequalities and so much more.

it's a hard but vital read and I think all health professionals should have to read this.

thanks to netgalley for an arc of this book

“Recognising that it is racism, rather than race, which is the most significant contributor to racial and ethnic health equalities globally means we are acknowledging that change is possible.”

There is plenty to appreciate about Systemic. It’s an accessible primer on the impact of racism on peoples’ health, ranging from environmental racism to minority stress to poorer education about how diseases present in darker skin. It does a good job explaining some concepts that can be difficult to grasp: for example why, if race is a social construct, some drugs perform worse on some races.

This book also highlights some topics which I didn’t know about. For example, the modifiers applied to certain medical tests if the patient is black, which makes it harder for certain conditions to be diagnosed.

However, whilst I think this is an important book, I don’t think it’s the best it could have been. There was, at least for the first few chapters, an over reliance on anecdotes to provoke an emotional reaction. Some were horrific, such as the story of a child who died from asthma exacerbated by air pollution. Others were less convincing, such as the story of a woman whose doctors hesitated to give her more morphine.

In addition, not all of the points the author made felt like they should have had a place in the book. In particular, the half a chapter about hair relaxants: this felt like something the author had a bee in her bonnet about and just wanted to talk about, rather than a real health hazard to black women (the single study she cited about the effect of hair relaxants concluded that an extremely small portion of their sample might have had an increased cancer risk, but having read the study I couldn’t figure out how big that subsection was).

There were quite a lot of points in this book I disagreed with (for example, the author doesn’t think that genomic data should be open source, which I think stands in the way of medical progress) but that doesn’t mean that she’s wrong. If I agreed with every book I read, what would be the point of reading? Ultimately I think this was a pretty good starting point in learning about medical racism, and I would recommend it if you particularly want to learn about that subject, but I wouldn’t recommend it to the average person who is interested more broadly in science writing.

(I received a free copy in exchange for an honest review!)

I really enjoyed Systemic by Layal Liverpool! It felt like such a necessary book and it was really hard to read at times because some of the stories and people we meet in this story have faced such tragedies within the healthcare system that are severely overlooked or underestimated.

It felt like a really broad overview of not only how patient discrimination occurs within medical settings but also the medical consequences of living in a society for those who experience racism. I wish books like these were in the mainstream media and distributed in schools because I'm embarrassed to say I was actually surprised by a lot of the statistics and the degree to which medical discrimination is nothing short of deadly.

Some parts felt a little slow and the chapters were pretty chunky, but this book is full to the brim with references and case studies that were both heartbreaking and highly relevant.

A pivotal book at a crucial time for health systems to address systemic inequality and bias within the structure of so many areas. This book delivers statistics, studies and heavily researched topics where the heavy toll of such biases is predominantly placed on the shoulders of ethnic minorities across different systems in mostly Western countries.

This was an interesting novel which cast a light on a bit of history I didn’t know much about, the aftermath of WW2 in the Netherlands.

The book is set in 1961 and the two main characters are 30-year-old Isabel and Eva, a couple of years older, so both had been children during the war years. Isabel is paranoid and neurotic, living alone in a house on the east coast which her uncle purchased during the war for her mother and the children to live in after the death of her father; it has been promised to Louis, the older of her two brothers, on her uncle’s death. Her other brother Hendrik is in a relationship with a French man of mixed descent, two facts which are quietly not mentioned in the family. Eva is the latest in a long line of short-lived women Louis introduces to his siblings. Most of these girlfriends come to one dinner and are never seen again, and are generally despised by Isabel and Hendrik, but in spite of an awkward first meeting with the family Eva asks to stay with Isabel while Louis is away on business for a month.

The story builds slowly and menacingly. Isabel lovingly cares for the house and her mother’s favourite things including a set of dinnerware with a hare motif. She is shocked when Hendrik casually mentions that it wasn’t their mother’s at all but had come with the house, which had been bought fully furnished in 1942. She is discombobulated by Eva’s arrival, becoming convinced that Eva is stealing things. She becomes more and more anxious and uptight, and the atmosphere becomes increasingly claustrophobic, until a turning point comes when she is forced to acknowledge that her dislike of Eva is in fact underpinned by a fierce sexual attraction. For a while it feels as though the novel is just going to be a lesbian romance, but the final third takes another turn.

The shadow of the war looms large, even 15 years after its end, all the more present for the memories not really being confronted head on. A dimly remembered episode, when the family were visited just after the end of the war by a hysterical woman with her daughter demanding that her property should be returned, has long ramifications for the plot. I did see the final twist coming from very early on, which probably doesn’t matter since this isn’t a thriller, but it did make the middle third, the developing relationship between Isabel and Eva, feel too long. As obligatory queer subplots in contemporary novels go, this one fitted in better with the overall purpose than some others I’ve read, but I am getting to the point where it’s a device in historical novels that is making me a bit weary.

So, as is often the case with well researched first novels, I’m going to say that there is a lot in this one which is of great interest, and it’s written very well, but it needed to be a bit tighter I think. Worth reading though.

I found this book an great read and was extremely well written. The author's approach to discussing race and racism in relation to health and wellbeing was incredibly insightful and well-articulated. Unlike other books on race which are often more general, this one delved into the intricate connections between racism and health, offering a detailed exploration that I found to be quite compelling.

One chapter that particularly stood out to me was the one on environmental racism. It shed light on the profound impact of not only experiencing racism but also living under the constant threat of it on one's everyday life and overall health. If your body is constantly in fight or flight due to the threat of racism it is obvious going to have a detrimental affect on health and wellbeing.

While I did notice some generalisations in the text and some scientific studies used as examples have relatively small participant numbers, I appreciated the book's strong scientific foundation. The extensive bibliography also made it easy for me to delve deeper into the referenced studies.

The book also brought to my attention the issue of racial bias in medicine, illustrating how medical professionals often only encounter examples of conditions on lighter white skin. This systemic bias hinders the recognition and treatment of conditions in individuals with different skin tones, which was a perspective I hadn't fully considered before.

The author also emphasised the critical importance of data in addressing discrimination. This resonated with me, as I encounter similar challenges with data in my professional life. The book highlighted how the absence of accurate data not only hinders efforts to address discrimination but also affects various aspects of intersectionality. I was particularly struck by the discussion of the sensitive nature of medical data collection in some European countries, such as Germany, due to historical fears and valid concerns about privacy and misuse.

At times I did find that the book could be a little repetitive but overall, I thought it was, thoughtfully structured, and truly eye-opening for those who may not have firsthand experience with racism.