Many healthcare images do not represent the communities we serve. Medical conditions can look different depending on a person’s skin tone. Generally, in healthcare resources, there are very few pictures of people with different skin tones. An audit of the NHS Health A to Z website found that out of 61 pages of reference images, black and brown skin featured in just three pages1. This means people with darker skin experience a greater chance of misdiagnosis than people with lighter skin.
NHS England, the University of the West of England Bristol and medical illustration at University Hospitals Bristol and Weston NHS Foundation Trust are leading the ‘Reframe Project’ to build an image bank of inclusive images for healthcare across two strands. Working closely with local communities to gather images, the aim is to build an image bank containing over 70 medical conditions. To date, we already have approximately 2,500 images ready to be added.
The first strand of the project focuses on taking photographs of different medical conditions on different skin tones. These pictures will be helpful for teaching and identifying conditions on all skin tones, leading to faster diagnosis and better experiences of healthcare for global majority people.
The second strand of this project focuses on creating more diverse images of the healthcare workforce because we have identified a gap in the representation of other marginalised groups, including people who are disabled, the LGBTQIA+ community, as well as people from global majority backgrounds.
The image bank (due to be available by March 2025) will be an online library of images that can be downloaded and used widely for healthcare education, clinical diagnosis and recruitment or marketing. The images are all professionally acquired, which makes them standardised and of high quality. Also the images are currently being verified by teams of dermatologists from the British Skin Foundation and the British Association of Dermatologists. Our aim is that the images will be free to access and download.
We are working with medical illustration teams across the country to ensure that more images continue to be added to the image bank and that it will be sustainable in the long-term.
An integral part of the project has been the engagement and co-production with local communities. To ensure effective communication, we developed culturally appropriate materials, considering language preferences and cultural nuances. This approach was essential to ensuring our message resonated with all members of the community.
To reach a wider range of local individuals, we strategically selected venues for our photo shoots — for example, community centres, community groups and medical centres. These locations are frequently visited by diverse groups of people, including families, children and healthcare professionals. By conducting photo shoots in these accessible settings, we aimed to increase visibility, encourage participation and foster a sense of community involvement in the project. Feedback from organisations such as the Black Southwest Network, Dhek Bhal (a South Asian community group) and Chinese Community Wellbeing Society was invaluable and helped us to refine our approach.
Establishing trust with local communities and community leaders is essential for successful engagement. The relationships we had already developed with local groups made it easier to collaborate effectively. Trust is the foundation of any successful community project.
The diverse perspectives and experiences of our project team played an invaluable role in shaping the project. Our team was made up of individuals from various cultural, ethnic and professional backgrounds, which not only enriched our problem-solving and decision-making processes but also enhanced our ability to engage authentically with the communities we worked with.
Our vision from the beginning has been to support the education and clinical practice of all healthcare professionals by providing images that will help with earlier, more accurate clinical diagnosis to raise the profile of under-represented healthcare professions and, ultimately, to help reduce health inequalities.
Please do get in touch with the Reframe team if you have any questions about the project and further information can be found on our website.
Sarah Todd, senior responsibility officer and head of allied health professional education, NHS England — South West;
Debbie Hubbard, project lead and associate director, Cluster 1, University of the West of England Bristol;
Puspa Raj Pant, project officer, University of the West of England Bristol.
- 1.Smith R. Making content about skin symptoms more inclusive. NHS England. July 30, 2021. https://digital.nhs.uk/blog/design-matters/2021/making-content-about-skin-symptoms-more-inclusive
