Systemic by Layal Liverpool review – the price of prejudice

<span>Layal Liverpool. </span><span>Photograph: Amit Lennon/The Observer</span>
Layal Liverpool. Photograph: Amit Lennon/The Observer

When I was 15, I went to Southend High Street after school one day with two of my best friends. A group of white men drinking beer walked past us, a trio of brown girls in school uniform. One of them pointed and shouted in a ripe estuarine accent: “Oi, Steve, would you fuck one of them Pakis?” As it happened, only one of us was of Pakistani extraction: me. This pedantic point of fact helped my friends and me process this disturbing incident as tragicomedy.

This is how racism is widely understood – as a character defect that causes predatory boors like Steve’s mate to shout slurs in the street – but it is a woefully shallow analysis. Being called nasty names is unpleasant, but it is only one manifestation of deeply embedded patterns of thought and behaviour that touch every aspect of society.

Experiencing direct, interpersonal racism has a physiological effect on the body that can sicken and age a person beyond their years, especially when it is repeated over a lifetime. Yet there are other less easily discernible kinds of racism. Systemic, Layal Liverpool’s lucid and impressive first book, lays out the evidence that racist modes of thinking are incorporated into the structures of our society from healthcare to housing, with wide-ranging effects. It is a convincing argument for considering racism a kind of root-and-branch disease, rather than merely a recreational activity for individual lager louts.

Systemic shows that racism and inequality hurt people in a host of different ways, from increased maternal mortality to exposure to environmental toxins. Liverpool, whose surname comes from an enslaved African ancestor, likely named after the port, is a science journalist with a PhD in virology. Her own experiences bring intimacy to the statistics. Other stories, like that of Streatham MP Bell Ribeiro-Addy, are heartbreaking. Ribeiro-Addy believes that the way she was perceived by healthcare professionals affected the care she had, to the point that she became unwell and ultimately lost her baby daughter.

Liverpool tracks down the pseudoscientific racist beliefs that undergird some clinical practices

The data Liverpool draws on is frequently shocking. For example, while the vast majority of deaths of babies under one globally occur in low-income countries, the pattern of disproportionately high mortality among black and brown infants persists even within high-income countries.

“Black infants in the US die at more than twice the rate of White infants,” Liverpool writes. “And across England and Wales, Pakistani, Black Caribbean and Black African babies have the highest infant mortality rates, which are all around twice the rate among White British babies.”

She shows that the effects of systemic racism can multiply grotesquely. Natural black hairstyles are perceived by employers as “less professional” than straightened, Eurocentric styles. There is, therefore, economic pressure on working black women to conform to this beauty standard. Yet doing so can come with health risks. One study from the US showed that those who used lye-based hair-relaxing products most often “were 30% more likely to develop breast cancer, compared with those who reported lighter use of these products”. To complete this miserable sequence of injustice, she points out that black women who get breast cancer are 40% more likely to die from it than white women.

Lung function measurements have for years been adjusted on the basis of “a suggestion by US doctor Samuel Cartwright back in the 1850s” who “claimed that Black people had lower lung capacity than White people and were therefore only healthy when enslaved”. Cartwright, who was a slave-owner, is known for his invention of the Orwellian-sounding term “drapetomania” to describe what he believed was the psychiatric disease of enslaved black people trying to escape their enslavers.

Racist notions permeate modern medical practice, but there are reasons to be cautiously optimistic. In April, the British Medical Journal published an editorial, “Taking racism out of clinical guidelines,” addressing the problem. Things are finally starting to change, but not fast enough. Despite evidence that adjusting lung function for ethnicity is scientifically questionable, some UK guidelines on interpreting spirometry tests haven’t been amended yet. It would appear that Samuel Cartwright’s racist ghost still haunts black patients in Britain today.

Systemic is a challenge to the way race has been posited as an explanatory full stop rather than an opening to rigorous scientific inquiry into the root causes of inequality. Liverpool pushes back against the lazy thinking that allows this. The result is a bracing, informative read that illuminates the grim social reality of racism and its effects.

• Systemic: How Racism Is Making Us Ill by Layal Liverpool is published by Bloomsbury Circus (£22). To support the Guardian and the Observer buy a copy at Delivery charges may apply.