Health Implications of Colorism: A Narrative Review of the Literature.

Abstract

Colorism, first conceptualized by writer and activist Alice Walker in 1982, is a byproduct of racism that refers to discrimination based on skin tone, hair texture, and facial features. Although less studied than race-based discrimination-which typically involves negative attitudes and unfair treatment of individuals based on their racial identity, usually propagated between racial and ethnic groups-colorism is a critical area of research that provides insight into health disparities occurring within racial and ethnic groups. This narrative literature review assesses the extent to which colorism's impact on global health outcomes has been studied. Skin pigmentation, determined by melanin, evolved as a protective adaption to environments with high levels of ultraviolet radiation. However, skin color is rarely contextualized or applied using its evolutionary meaning; instead, it often serves as a basis for social stratification. Individuals with darker skin tones frequently face discrimination in their healthcare that contributes to significant health disparities, particularly in fields such as dermatology. Additionally, the societal preference for lighter skin has fueled the widespread use of skin-lightening products, which carry serious health risks. The majority of studies examining colorism and health outcomes are concentrated in the United States and Latin America, limiting our ability to accurately assess color-based health disparities in regions such as Asia, Africa, Australia, and Europe. While most existing studies identify skin color as a significant predictor of health, others report no consistent associations. This conflicting evidence signals the need for more comprehensive studies to explore the underlying mechanisms, such as perceived discrimination and socioeconomic status, that influence health outcomes for individuals with darker skin. We also find that current dermatological education does not sufficiently prepare students to diagnose skin conditions in patients with darker skin tones, leading to reduced diagnostic accuracy and worse health outcomes compared to lighter-skinned patients. Finally, we identify the need for more longitudinal studies on the health effects of skin bleaching, and more cross-country comparisons to differentiate between country-specific and universal trends in health outcomes among those who use skin-lightening products.