In Systemic (Astra, June), Berlin-based journalist Liverpool surveys how racism harms the health of people of color across the world.

You write about your experiences with racism while seeking medical care. Was it difficult for you to step out of your role as science reporter and take a more personal angle?

It was not something that I planned to do when I pitched the book, but as I was interviewing people, their stories made me remember things I had been through and I decided to include some of that. I feel that I’m very privileged in a lot of ways, privileged enough to be able to write this book, and I had perhaps trivialized some of my experiences. What I realized as I was writing is that regardless of whether the issue is something small or big, it’s all part of the same problem.

Did your sense of the problem change as you were writing?

I was surprised how deeply embedded some racist ideas are. Take lung function testing. It can be traced back to Samuel Cartwright, a U.S. doctor and slaveholder from the 1800s who perpetuated the idea that Black people’s lungs are weaker and that they benefit from enslavement because it’s some-how good for their health. He helped develop the spirometer for lung function testing. Many devices had a Black race adjustment embedded within them. Only recently have medical organizations like the American
Thoracic Society and the European Respiratory Society finally changed their recommendations, suggesting that it doesn’t make sense to incorporate race in lung function testing or the interpretation of results.

How does the U.S. compare with other places you’ve researched?

I think people in the U.S. are very aware of the issue, maybe more than Europe. A lot of the research and background on racism in medicine comes from the U.S., where it’s clear that there are inequities across the board. I recently gave birth to my first child so I’m thinking a lot about maternal and child health. That’s where you see clear health gaps in the U.S. Black women like me experience greater risk of dying during childbirth, and their infants also experience greater risk in the first year of life. These issues start at the very beginning of life.

What needs to be done first?

I think it will be crucial to start by recognizing racism as an urgent global public health crisis. I believe that we should approach it the same way that we react to viral pandemics, and that tackling the problem is in everyone’s best interest. If we can eliminate inequities in society and within healthcare, that will improve global health, increasing our resilience to disease epidemics like Covid. At the same time, if we can engage a more diverse range of people in medical research, that will enhance scientific discovery.