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When stock photography fails to get the picture

Interesting observation here on stock photography usage from Katie KnightPaediatric Emergency Medicine Consultant, London, and 2018-19 National Medical Director’s Clinical Fellow. Katie is also one of the co-founders of Women Speakers in Healthcare

The lack of variety of medical stock photography images helps to perpetuate stereotypes and negate the existence of other experiences

When BBC Health published an article about asthma inhalers alongside a picture of a child not using a spacer device with their inhaler, the paediatric community was quick to call out the problem of normalising incorrect (and potentially dangerous) inhaler technique. A few retweets by disgruntled paediatricians got some attention, and the image was swiftly replaced.

Unfortunately, the “inhaler without spacer” drama has played out several times in recent memory, and there is a frustratingly obvious reason why.

Browsing stock photography websites brings up several thousand results for “asthma.” In the top few pages, none of the images show a child with a spacer and inhaler. (For non paediatricians: children can’t coordinate their breathing “in” with the puff of the inhaler, so without a spacer the medication will just spray into the mouth where it has no effect, rather than reach the lungs). The lack of a pictured spacer may seem a trivial observation until you consider that deaths from asthma in the UK are among the highest in Europe, two in three of which could have been prevented with the right care or are related to poor understanding of treatment. 

Ubiquitous stock photography creates shared mental images that are powerful, stereotyped versions of an idea—without the nuance of individual experience or the subtlety of professional expertise. And where health is concerned, images that enter the public’s mind (and our professional subconsciousness) have the potential to cause harm.

Let’s take a look at some concerning finds.

SEARCH: “depression.” Hundreds of images of a person sitting alone on a bed, holding their head in their hands appears. This erases the reality of the thousands of people who experience depression while still holding down full time jobs, raising families, supporting their friends, volunteering, engaging in activism. Does this stereotyped image make it harder for a person to talk to their family, their friends, or employer about their mental health when they don’t seem to fit the picture?

SEARCH: “childbirth,” and it brings up a gallery of white women with white partners surrounded by white medical professionals. You have to search multiple pages deep into search results until there is a woman from a black or ethnic minority and her baby. Black women in the USA and the UK report having their concerns dismissed or ignored in pregnancy. The chance of death is 1 in 2500 for black women during pregnancy and childbirth according to the UK Confidential Enquiry into Maternal Deaths; the rate was five times smaller for white women. Does the lack of visual representation reflect racial bias in healthcare?

SEARCH: “heart attack.” A familiar visual trope appears—the image of a middle aged man clutching at their chest. Not all heart attacks cause chest pain; women especially can present with abdominal pain, nausea, or dizziness. The lack of public (and professional) awareness of the gender differences here has led women to be diagnosed late—or not at all—with sometimes fatal consequences.  

In our current cultural climate, broadening the narrative and representing alternative viewpoints is essential. If a picture really paints a thousand words, the lack of variety of medical stock photography images helps to perpetuate stereotypes and negate the existence of other experiences. We deserve better stock photography and must demand it.

• This article was first seen on the BMJ opinion blog

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