Race still used as indicator in Dutch healthcare

Science has agreed for years that there are no different races among humans - different skin colors do not impact anything in human biology. Despite this, “race” is still used as an indicator in many manuals and guidelines in Dutch healthcare, according to research by NU.nl.

“Race is an invented concept, but is sometimes presented in healthcare as a biological fact,” said Judith Venderbos, a researcher into social inequality at the national expertise center Pharos. “That is incorrect and contributes to health disparities.”

The General Practitioner Training Netherlands taught thousands of trainee GPs to register race in lung function tests because it would be important for interpreting the results, NU.nl found. A manual used by Amsterdam UMC stated that blood testing results were corrected “if black.” Erasmus MC still mentioned race as a factor “in patients with an African-Caribbean ethnicity” in a manual on its website. And the Longfonds still said that race is part of the spirometry test in that it explains differences in lung capacity.

All of the involved healthcare bodies except for the Longfonds scrapped race from their manuals and guidelines immediately after queries by NU.nl. General Practioner Training Netherlands called it an embarrassing but isolated error. “Race is outdated. That has been proven for some time,” clinical chemist Hans Schotman of Amsterdam UMC told the newspaper. Christian Ramakers of Erasmus MC said the use of race was an error that would be fixed immediately.

After questions from NU.nl, the Longfonds only changed “race” to “ethnicity.” A spokesperson said that the Longfonds based its findings on information from the Global Lung Function Initiative (GLI).

However, the GLI says on its website that lung science does not function optimally by thinking in terms of “race.” In fact, another widely used 2022 international lung testing guideline states that “race” as a factor in interpreting lung function test results is “inappropriate and unequivocally discouraged.”

Charifa Zemouri, a health scientist in the field of healthcare guidelines and health disparities, called the Longfonds' insistence to keep factoring in “race” or “ethnicity” dangerous to patients. “They misinform patients,” Zemouri told the newspaper. “As if ‘race’ exists and as if there should be difference based on that. Because of this outdated way of thinking, people with a dark skin color have to be much sicker than people with a light skin color to receive the same lung failure diagnosis.”

NU.nl found a similar attitude at the COPD & Asthma General Practitioners Advisory Group (CAHAG), which draws up guidelines for general practitioners. On the one hand, it says that “race and ethnicity should not be used in spirometry.” But it also advises GPs to keep doing so because “the scientific debate is still ongoing.” The CAHAG website even contains a world map that divides countries and continents into “races.”