Diversity in product design can be a matter of life or death. As our columnist SJ recounts, her recent experience with a pulse oximeter drives home the point that a lack of inclusive thinking can have devastating consequences
Diversity, equity, and inclusion – or DEI. Convenient lip service paid by companies and industries to show that they care about employees and customers. But does it really matter for design? I mean, diversity of thought always makes for better products, sure — but is it ever going to be important enough to be life or death?
I’m positive it is. “Yes, I’m positive” – the three most overused words since the 2020 outbreak of the Covid pandemic.
With shaky hands, I turned to my wife and showed her the tiny little rectangle with the two lines that matched hers.
We both had Covid. We both had underlying conditions. And we were both black, which makes us statistically twice as likely to be hospitalised with Covid, according to the Mayo Clinic.
As I lay there, barely able to pull air into my lungs, my wife’s hands shook as she struggled to fit the pulse oximeter onto my finger. “I can’t take you to the hospital for COVID treatment unless your oxygen reads less than 93%,” she mumbled.
A bunch of expletives flew from her lips as she took it off one finger and placed it onto another, over and over, trying to find a reading. There was none.
She took the device off my hand and tried it on hers – 99%. It worked, just not for me. A sob choked out of her lips as she whispered, “It’s not fair.”
My wife has always had complicated feelings about her biracial heritage. Hovering somewhere between not quite dark enough to be ‘black’, and not quite pale enough to pass for ‘white’, her identity and origin are always questioned whenever she enters a room.
How many drops of blood does it take to be considered black? For our marriage, it never mattered. But as I lay there, barely able to breathe, unable to obtain a pulse ox reading, we both felt the immense distance, this chasm between us – all down to nary but a few drops of blood separating us.
One size doesn’t fit all
Pulse oximeters were widely adopted in standard medical practice in the late 1980s. They are a non-invasive way to measure oxygen, using light absorption. The LED in the device sends light through the patient’s finger and then calculates their oxygenation, by figuring out how much of the light was absorbed by haemoglobin in the blood.
For people with darker skin – especially those of Black, Asian and Hispanic descent – skin pigmentation also absorbs this light, resulting in inaccurate readings.
For these patients, incorrect readings (which often report oxygen levels as being higher than they actually are) have prevented them from receiving critical oxygen support in Covid wards.
Many people have died as a result of this systemic exclusion. All because the original design of the device was tested on primarily white patients. And that comes as no surprise when you consider that the desegregation of the US-wide hospital system didn’t pass until 1964.
So, as I lay there listening to my lungs rattling against my ribcage, my blood ran cold not from lack of oxygen, but from the knowledge that it was a lack of diversity – of DEI – that could inevitably bring about my downfall.
I thought of all the social media posts I’d been bombarded with over the past two years. All of it sounding like lip service, because I know and deeply understand how slowly mindsets shift. The pulse ox was designed when civil rights was in its infancy – and this is just one example of 50 years of systemic inequality having the potential to literally kill someone. But in this case, not just anyone. Me.
Not recognising what makes each of us unique can have a drastic impact on how we navigate the world
It’s DEI or die, right? As a black, gay, nonbinary person, I have many intersections when navigating predominantly white engineering spaces. And I’m often reminded that when one considers diversity, it is about so much more than skin color. There’s the diversity of gender – not just men and women, but non-binary and trans humans as well. Additionally, there’s diversity of mind – also called neurodivergence – which includes members of our communities struggling to disguise their autism, their ADHD. You can’t forget that one coworker who always has the answers to every problem but can’t seem to figure out how to convert a word doc to a PDF – that may be diversity of age. Finally, I’d also like to bring attention to our colleagues with disabilities, because making and creating spaces that are accessible make them safer and better for all.
All of this diversity gives us a magnanimous, wide-ranging horizon as we go forward creating new companies and new technologies. I think of the excitement sparked by the first iPod; the grimace (but also curiousity) generated by the Croc sandal; and the wonder that the first VR headsets sparked.
Those designs were novel and exciting – first-of-their-kind wonders that left us all hungering and hopeful for more. But, in my opinion, the single greatest attribute of a design that is determined to make an impact is that it is inclusive. For everyone and anyone at all intersections – no matter our race, gender, body shape or size, disability, age, neurodivergence or any combination thereof.
When it comes to engineering design, DEI is truly life or death. We are shaped by our environment – impacted by our diverse intersections – and this in turn shapes the products we produce.
Some would argue that recognising the physical or mental differences between us is in itself discriminatory, but not recognising and appreciating what makes each of us unique can have drastic consequences down to the healthcare we are given, on how we navigate the world.
About the author: Contributor SJ is a metal additive engineer, aka THEE Hottie of Metal Printing. SJ’s work involves providing additive manufacturing solutions and #3dprinting of metal parts to help create a decarbonised world.