Diversity is more than skin deep. It is a mindset, a conscious decision to become aware of one’s unconscious blind spots, and then to confront these biases so as to better appreciate the beautiful humanity in all of us.
This broader definition of what it means to practice inclusion has been a foundational principle for Obagi since the company launched, and it is a message the company is sharing with the skincare industry through its global SKINCLUSIONTM initiative that launched in May 2019. More so, SKINCLUSION is a call to the physician, industry, and consumer communities to see the beauty in our differences. But SKINCLUSION is about more than changing mindsets; instead, the initiative seeks to reshape our perceptions of beauty and to inspire conscious decision-making and behaviors that reflect the growing diversity of the global population.
Over the years, Obagi has been an industry leader in testing its products on all Fitzpatrick skin types to ensure consistently excellent results, but also to understand and appreciate how its various products might affect people with different skin tones. Testing products across skin types I-VI shows a sensitivity to the needs of individual patients. It is important to the company that both physicians and consumers understand Obagi’s R&D focus so that they can feel comfortable recommending and using products.
“Unfortunately, darker skin types are underrepresented in research, in skincare and in general,” says Jeanine Downie, MD, director of Image Dermatology P.C. in Montclair, NJ. “The implication is that sometimes when there’s different products on the market, brown and black skin tones think that perhaps that’s not for them because it wasn’t tested on their skin type. So they feel excluded …and it leads to many patients not figuring out what could be very excellent for them or their family.”
Partnering for Change
During a launch event earlier this year, Obagi introduced actor, producer, and activist Priyanka Chopra Jonas as the SKINCLUSION Ambassador.
The partnership with Ms. Chopra Jonas, who has been recognized by Forbes over the last two years as one of the World’s 100 Most Powerful Women, aligns with several objectives of the initiative. The daughter of a prominent aesthetics provider in her native India, Ms. Chopra Jonas is familiar with the intricacies of the skincare industry and has been dedicated to fighting for inclusion and diversity over the course of her 20-year career.
She says the Obagi SKINCLUSION initiative aligns with her values and personal experience, adding, “The initiative supports the idea that we should be more conscious about everything we do, including how we address the automatic assumptions we make about others based on their skin tone.”
Obagi has also reached out to leaders in the medical community who, like Dr. Downie, deal with patients with diverse skincare types and needs to inspire changes in practice behaviors.
“I love the fact that Obagi is really trying to focus on people’s unconscious biases, specifically those surrounding skin tone. Because if you have biases, which unfortunately 85 percent of the population does, they can cause the blind spots and prevent us from understanding and knowing more about, quite frankly, humanity the way that we all could see it,” Dr. Downie says.
Those “blind spots” may also have direct impact on patient care.
There is variability in how the signs of aging manifest across skin types. For instance, according to Dr. Downie, types I and II typically show more fine lines and wrinkles in the early stages, whereas types V and VI show more hyperpigmentation and sagging. Although there is a certain inflection point after which all skin types tend to display the same aging signs, a failure to appreciate early differences might hinder a consultation when patients are first noting changes in their skin.
Another example is that laser-based applications have variable effects on different skin tones. Physicians may get tripped up by unconscious biases during a consultation by assuming the ethnicity of a light skinned patient. Dr. Downie says she has had a number of patients who simply answered “white” in response to a question about their ethnicity, only to discover during follow-up questioning that they have mixed heritage or are of Cuban descent, with the latter suggesting they will respond more like a patient with type IV or V skin.
“If you don’t ask them the question and you just assume, ‘Oh, that’s a white skinned individual’ without asking them a question, then that becomes a huge problem. If you go to treat them and then the laser does not do well for them or they do have a complication, the patient will wonder why you didn’t ask a simple question to avoid this complication. It’s like not asking somebody about their allergies and giving penicillin to someone who is penicillin allergic,” Dr. Downie says.
Revealing Patients’ Underlying Needs to Improve Patients’ Experiences
One of the central tenets of the SKINCLUSION program is to challenge the skincare industry to confront implicit biases—those beliefs and behaviors that we may not even be aware of, but which shape our actions and interactions. An implicit bias is, by definition, often unintentional, perhaps beyond our own awareness, and is shaped by background, cultural environment, and personal experiences; yet implicit biases are so deeply ingrained that they can color how we interact with one another on a daily basis.
Implicit biases might ultimately lead to decision making that could do more harm than good. One issue that Dr. Downie is particularly passionate about is the assumption that, because type V and VI skin rarely if ever tans or burns, individuals with darker skin do not need to wear sunscreen or practice good sun hygiene. She notes that all individuals, regardless of skin tone, are at risk for solar induced skin cancers—but African Americans tend to develop lesions in atypical areas like on the feet, palms, and soles, and in the genital area. Unfortunately, the risk for melanoma is underappreciated in African American patients, leading to missed or improper diagnosis, with potentially profound consequences.
“Everybody needs to wear sunblock and everybody needs to reapply it,” says Dr. Downie. “You have to wear sunblock every day, rain or shine, January through December, just like the rest of the population, because we get solar induced skin cancers as well. Basal cells can just spread locally and become destructive; as we know, squamous cells can metastasize and kill us.”
The potential for implicit biases to affect patients’ health is one reason Obagi is also partnering with International Cultural Diversity Organization (ICDO) and Project Implicit as part of the SKINCLUSION initiative. ICDO is a global nonprofit dedicated to promoting peace, humanity, diversity, and interculturality. It seeks to challenge cultural misperceptions to ensure equal participation of every individual or group within society, principally by encouraging cultural interaction and closing cultural gaps. Project Implicit is a virtual laboratory and research organization developed by behavioral scientists to provide education about implicit bias through Implicit Association Tests (IATs). The tests, which focus on 11 different areas, including skin tone, gender, race, and sexual orientation, are free to take and can be completed in under 10 minutes.
Dr. Downie says she has witnessed some unfortunate examples of bias in her professional interactions. For example, some patients, mostly women, and mostly women of color, were called hysterical or outright blocked by another provider from seeking a second opinion. She has also seen physicians try poorly conceived attempts at humor that wind up crossing a very obvious line regarding racial sensitivity.
Society may be moving in the right direction, Dr. Downie says, noting, “Millennials have sparked a 15 percent decline in skin tone bias. They’re not as concerned about skin tone as other age groups, which is happy news, but we have to move that forward even more.”
A Call to Action
“I would really encourage everybody to go to Skinclusion.com and take the skin tone implicit association test and then note what their biases are, if they have any, and then focus on them,” Dr. Downie says. “My call to action is to say not only do we need to test on all skin types, that’s one, but two, we need to advertise with all skin types, because that’s showing that everybody’s included.” She also encourages the pharmaceutical industry to increase diveristy in hiring and leadership.
A focus on diverisy and inclusion benefits all parties, Dr. Downie says. She challenges all those involved in patient care to assess and address their own biases, “Because if you don’t know your own bias, then you’re not going to be able to challenge it or overcome it and create a better place and a better space for everyone.”
More information about SKINCLUSION can be found at skinclusion.com.