Veterinary Hospital and Clinic Websites: Do They Reflect the Racial Demographics of Their Geographical Region?

Abstract

Approximately 60% of the U.S. population own at least one pet, and many pet owners turn to the internet, including veterinary clinic websites, for pet health information. The pictures on these websites, and how accurately they reflect the racial diversity of their communities, have not been studied. This study assessed the perceived skin color of people depicted on veterinary websites to determine how well they represent their geographical area. Each photograph was rated, using the Fitzpatrick skin ratings, on a scale from 1 to 6, with 1 to 3 reflecting ‘White’ and 4 to 6 reflecting ‘Person of Color.’ The number of pictures categorized as ‘White’ was 638 (85.8%) and those categorized as ‘Person of Color’ was 106 (14.2%). For client/pet owner pictures, a total of 121 (80.2%) were categorized as ‘White’ and 30 (19.9%) were categorized as ‘Person of Color.’ The findings from this study reveal a glaring lack of racial diversity and representation among the images of people displayed on the websites of veterinary clinics that provide care within predominantly Black U.S. communities. One step that veterinary clinics could take to rectify this issue would be to partner with members of their communities to gather guidance on how to transform their social media presence to reflect their clients’ identities and needs more accurately.

1. Introduction

It is estimated that 60% of the U.S. population owns at least one pet, with dogs and cats being the most common pets [1]. Numerous studies have found that pet ownership can have a positive impact on many aspects of human physical and mental health. Specifically, owning a pet can reduce blood pressure, improve cardiovascular health, reduce loneliness through companionship, and decrease rates of mental illness [2,3,4,5,6].

Yet, the rate of pet ownership appears to differ among races and ethnicities. In 2011, the American Veterinary Medical Association (AVMA) reported that within the United States, Black people were the least likely to own pets (33%) compared to Asian people (48%), Hispanic people (63%), and White people (66%) [7]. A recent study found similar results, with approximately 29% of Black people versus 60% of Latinx people and 70% of White people owning a pet [1].

Possible explanations for these racial differences in pet ownership include barriers such as access to veterinary care (e.g., cost, geographical constraints, etc.) and racist policies and perceptions within U.S. society [8,9]. For example, housing policies that do not permit pets are more prevalent in neighborhoods with predominantly Black residents versus housing in neighborhoods with predominantly White residents [10]. Additionally, Linder has argued that dog breed-specific bans discriminate against specific minority groups who are perceived as more likely to own particular types of breeds, such as pit bulls, which are associated with young, Black males [8].

In addition to variances in pet ownership, it has also been suggested that there are differences in the human–animal bond across demographic groups [11]. Brown [12] found that White pet owners not only have more pets but also report a greater emotional attachment to their pet(s) when compared to Black pet owners. Yet, as Brown pointed out, it is important to note that different races and cultures may express attachment to pets differently, impacting attachment and bond scores [12].

Although it has been suggested that the frequency of veterinary visits and perceptions of veterinarians may be dependent on race and ethnicity [13,14], more recent research by Parks et al. [15] found that even though Black and Indigenous people identified a lack of trust in veterinarians as a deterrent to seeking veterinary care, no differences based on race or ethnicity were found in owners’ likelihood of seeking veterinary care. Instead, it is likely that systems of oppression create barriers to veterinary access rather than race and ethnicity acting as predictors themselves. Barriers to veterinary care include geographical, financial, and cultural challenges [13].

In addition to an in-person veterinary visit, many pet owners turn to the internet to find pet health information [16]. To increase their online presence, veterinary clinics advertise and market through many different mediums, with websites and social media recommended as the best ways to reach potential clients [17,18,19]. Although, to our knowledge, there have been no studies researching racial diversity in veterinary-related advertising, there have been many studies examining racial diversity within other fields [20,21,22,23]. These studies suggest that while racial representation has improved in recent years, further growth is still needed within many industries, including human medicine [20,24,25]. A recent study, for example, found that White patients are often overrepresented in online photos on hospital websites compared to the demographics of the communities these hospitals serve [26]. Another study argued that urgent care websites’ lack of racial diversity can negatively impact patients’ opinions of medical clinics and increase the racial disparities already found in human healthcare [27].

For these reasons, it is suggested that veterinary hospitals/clinics consider the diversity and representation of racial and ethnic groups within their online advertising presence. If hospitals/clinics are located in areas with primarily Black or Latinx populations, given the importance of marketing to geographical demographics, one would expect that their website photos would reflect this racial diversity. We investigated this hypothesis by considering whether the skin tone and perceived race depicted in images on veterinary websites reflect the diversity of the geographical location of veterinary clinics.

2. Materials and Methods

This was an observational study assessing the perceived skin color of photographs of people on the home pages of veterinary websites. We sought to determine to what extent the representation of skin tone and perceived race in these photographs resembled the distribution of race in the geographical area of the veterinary clinics. We selected 25 major U.S. cities with the largest Black populations, as measured by the U.S. census [28]. The zip codes within each of these cities were included for analysis if the total population met or exceeded 25,000 people with less than 50% of the population classified as White [29]. Institutional review board approval for this study was not needed as it did not meet the definitions of human subject research. A total of 53 zip codes from 24 cities were analyzed (one of the 25 U.S. cities did not contain any zip codes that met our criteria).

2.1. Image Coding

All photographs depicting the human form on the home page of each veterinary website within the zip codes that met our criteria were assessed. Images were excluded if they did not have clear depictions of skin. Partial pictures, including body parts that were large enough to determine skin color, were included. In addition to skin color, pictures were categorized as client/pet owner, veterinary professional, or unable to determine (other).

2.2. Categorizing Race and Ethnicity

To determine whether the veterinary websites’ images reflected the racial and ethnic diversity within the geographical location of the veterinary clinics, we used the Fitzpatrick skin scale [30]. The Fitzpatrick skin scale numerically categorizes human skin tone into 6 categories, with Type I being the palest and Type VI being the most deeply pigmented. This scale does not account for the impact of sun tanning that may lead to seasonal differences in skin tone. Two coders independently categorized each photograph depicting human skin using the 6-point scale. We used the Fitzpatrick skin ratings of 1–3 to depict ‘White’ and 4–6 to depict ‘Person of Color.’ Although the Fitzpatrick scale is an imperfect scale for categorizing race by skin tone, it has been used previously for such reasons and allows for objective categorization [31,32].

2.3. Interrater Reliability

After reviewing approximately 20 photographs on veterinary websites together, two authors (EB and TT) rated each picture independently and assigned it a number based on the Fitzpatrick skin scale. Cronbach’s alpha was 0.965. The averages of the scores were used for further analysis.

3. Results

The demographics of the zip codes analyzed were 53.68% Black, 33.26% White, 4.91% Hispanic/Latino, 2.72% Asian, 0.77% American Indian/Alaska Native, 0.18% Hawaiian or other Pacific Islander, and 3.75% Other.

A total of 107 websites with a mean number of 6.78 (SD = 6.72, median = 5, range = 1–38) photographs of individual people per website, for a total of 744 images, were rated. If a picture included more than one person, each person was rated. The total number of depicted people included 151 (20.3%) clients/pet owners, 569 (76.5%) veterinary professionals, and 24 (3.2%) other (unable to determine) (

Table 1. Numbers of zip codes, veterinary hospitals, and pictures rated within U.S. cities with the largest percentages of Black residents.

City, State	Number of Zip Codes	Number of Veterinary Hospitals	Total Number of Pictures	Number of Client/Pet Owner Pictures	Number of Veterinary Professional Pictures	Number of “Other” Pictures
South Fulton, GA	1	1	1	0	1	0
Jackson, MS	1	1	3	0	2	1
Detroit, MI	2	2	7	2	5	0
Birmingham, AL	1	1	2	1	1	0
Miami Gardens, FL	1	2	6	3	2	1
Memphis, TN	8	16	109	19	83	7
Montgomery, AL	1	3	17	2	15	0
Baltimore, MD	4	5	28	3	24	1
Augusta, GA	2	7	64	7	57	0
Shreveport, LA	1	1	3	0	3	0
New Orleans, LA	3	6	38	7	31	0
Macon, GA	1	2	17	5	12	0
Baton Rouge, LA	2	4	18	1	17	0
Hampton, VA	2	6	43	5	38	0
Newark, NJ	1	4	24	5	19	0
Cleveland, OH	3	6	42	19	19	4
Brockton, MA	1	2	28	5	23	0
Savannah, GA	2	5	37	3	34	0
Atlanta, GA	9	17	162	29	130	3
Columbus, GA	1	2	14	13	1	0
Beaumont, TX	1	2	7	0	7	0
Fayetteville, NC	3	9	69	20	43	6
Miramar, FL	1	1	2	2	0	0
Newport News, VA	1	2	3	0	2	1

).

The Fitzpatrick skin ratings of 1–3 to depict ‘White’ and 4–6 to depict ‘Person of Color’ were used to divide the average of the raters’ scores into two categories. Since the raters’ scores were averaged, this resulted in some pictures rated as 3.5; these were divided equally into the ‘White’ and ‘Person of Color’ groups. If the number of pictures rated as 3.5 was an odd number, the higher number was added to the ‘Person of Color’ category.

The overall number of pictures (n = 744) rated as 1–3 was 625 (84.0%), the number of pictures rated as 3.5 was 26 (3.5%), and the number of pictures rated as 4–6 was 93 (12.4%). Adding an equal number of the 3.5 ratings to the ‘White’ and ‘Person of Color’ categories resulted in 638 (85.8%) categorized as ‘White’ and 106 (14.2%) categorized as ‘Person of Color’ (

Table 2. Skin color ratings of total pictures, client/owner pictures, and veterinary professional pictures.

Rating	Skin Color	Total (n = 744)		Client/Owner (n = 151)		Veterinary Professional (n = 569)
		N	%	N	%	N	%
1.00	White	364	48.9	65	43.0	282	49.6
1.50		74	9.9	16	10.6	55	9.7
2.00		117	15.7	25	16.6	91	16.0
2.50		40	5.4	4	2.6	36	6.3
3.00		30	4.0	5	3.3	25	4.4
3.50		26	3.5	12	7.9	13	2.3
4.00	Person of Color	13	1.7	3	2.0	9	1.6
4.50		12	1.6	1	0.7	11	1.9
5.00		24	3.2	10	6.6	13	2.3
5.50		11	1.5	3	2.0	8	1.4
6.00		33	4.4	7	4.6	26	4.6

Note: White background (ratings 1.00–3.00) denote White skin color, light grey background (rating 3.50) denotes White/Person of Color skin color, and dark grey background (ratings 4.00–6.00) denote Person of Color skin color.

).

When assessing client/pet owner pictures (n = 151), there were 115 (76.2%) pictures rated 1–3, 12 pictures (7.9%) rated 3.5, and 24 (15.9%) pictures rated 4–6. Adding the 3.5 ratings to the two categories resulted in a total of 121 (80.2%) pictures categorized as ‘White’ and 30 (19.8%) pictures categorized as ‘Person of Color’ (Table 2).

When assessing veterinary professional pictures (n = 569), there were 489 (86.0%) pictures rated 1–3, 13 (2.3%) pictures rated as 3.5, and 67 (11.8%) pictures rated as 4–6. Adding the 3.5 ratings to the two categories resulted in a total of 495 (87.1%) pictures categorized as ‘White’ and 74 (13.0%) pictures categorized as ‘Person of Color’ (Table 2).

There were no correlations between racial population within zip code and the number of pictures categorized as ‘White’ for the entire sample (p = 0.260), client/pet owner pictures only (p = 0.251), or veterinary professional pictures only (p = 0.065).

4. Discussion

The findings from this observational study reveal a glaring lack of racial diversity among the images of people displayed on the websites of veterinary clinics that provide care within predominantly Black communities in the U.S. Disparities exist not only among the images of veterinary professionals but also among the images of portrayed clients. Given that the 2023 U.S. veterinary workforce was 90% White in 2023 [33], the fact that 87.1% of the veterinary providers’ photographs were perceived as ‘White’ is not surprising; however, 80% of client images were also perceived as ‘White.’ These numbers suggest racial favoritism and a lack of representation of the Black residents who make up the majority of the population in the cities and towns encompassed in this study’s sample.

Research indicates that pet owners are increasingly using online sources to learn about their pets’ behavior, medical conditions, and treatment options [34,35]. As pet owners click on veterinary websites, they form first impressions that influence how they perceive the veterinary hospital and staff [36]. Consumers want to see themselves represented in the services and products they use, a fact that has led to an increasing demand for accurate representation in advertising [21]. Images in advertising reflecting race and ethnicity matter [20] and directly influence consumer choices [37,38,39]. Including underrepresented populations in advertising has been found to be an effective strategy for reaching minority consumers, who respond positively to seeing representations of their own ethnic or racial groups [37,38]. For example, Forbes-Bell and colleagues [39] found that Black consumers demonstrate an increased intention to buy and a willingness to spend more money when the product advertised is accompanied by images of Black models. Several other studies have demonstrated that minority representation increases the effectiveness of advertisements and that people perceive companies with diversity in their advertising as moral and inclusive [37,40].

Racial stereotyping in advertising can reinforce and perpetuate existing biases and contribute to discrimination [41], and caution must be taken to ensure that the use of images does not perpetuate racism or racial stereotypes [23,42]. For example, Asian people have historically been overrepresented in business or technology settings and unrepresented in family or social settings [22,23], whereas Black males have been overrepresented as athletes and celebrities and underrepresented in romantic relationships [43] and Latinx people remain underrepresented in general [22,44].

Until we can increase the racial diversity of veterinary providers by attracting more diverse veterinary students to mirror that of the U.S. population, the profession must consider how to increase inclusive practices within veterinary care. Diversity is one of the American Veterinary Medical Association’s (AVMA) core values, affirming the dignity and equity of all people, and working towards increased diversity and cultural competence [45]. The findings from this study elucidate one relatively easy way for the profession to make changes that can positively impact inclusivity and better connect with the local community. Potential clients’ first impressions of veterinary hospital websites that lack diverse representation may result in a hesitation to seek veterinary care from that hospital/clinic. This may be compounded by racial health disparities and historical racism in medicine, which could contribute to feelings of mistrust [15,46]. This mistrust is perhaps evidenced by the lower likelihood of Hispanic, Asian, and Black people, compared to White people, to own a dog or cat [1,7]. It is noteworthy, however, that even with the lack of diverse ethnic and racial representation found within veterinary websites, no differences based on ethnicity or race have been found in owners’ willingness to seek veterinary care [15]. It is possible that ethnic minorities seek out veterinary care in spite of a lack of representation and would welcome a more inviting online connection with their veterinary hospital/clinic.

The benefits of pet ownership should not be limited to just one segment of society. There are numerous reasons why racial differences in pet ownership have been found, including economic and housing barriers as well as cultural beliefs [8,9,10,47]. These challenges should be addressed. Yet, one area that can be easily modified includes veterinary-related advertising. Because advertising reflecting race and ethnicity matters, it can influence consumer choices [37,38,39], and people of color may feel less welcome in veterinary hospitals. The veterinary profession must respond to the call to action originally created by the AVMA’s Task Force on Diversity in 2005 [48] to carry out workforce initiatives that integrate cultural competency and provide inclusive services to their clients. One initial step that veterinary clinics could take to this end would be to partner with members of the communities they serve to seek guidance on how to transform their social media presence to reflect their clients’ identities and needs more accurately. Considering best practices in community-based participatory action initiatives [49], the people of color who share their ideas, experiences, and wisdom should receive financial compensation for their time and the sharing of their personal stories.

Limitations

Even though this study extends our understanding of online marketing practices of veterinary clinics, a few limitations should be mentioned. The websites sampled for this observation study were those of veterinary clinics where at least 50% of the city’s population identified as Black. These findings may not be generalizable to cities with different racial diversities. We also acknowledge that the size of the cities varied and that some cities (i.e., Memphis, TN, USA; Atlanta, GA, USA) were much larger than other cities. Although we attempted to review all veterinary websites from each of the zip codes in our study sample, it is possible that we missed some websites that displayed more racial diversity. It is important to note that a few of the websites we reviewed had similar design templates and photographic images, which are likely indicative of large corporations providing website design templates. Therefore, the staff and clients of some clinics may not be accurately depicted on their websites. Lastly, while we incorporated a validated tool and utilized two coders to increase the reliability of rating perceived skin tones, perceptions of skin color are highly individualized and may represent personal biases.