The history of medicine is fraught with unnecessary racialization. In “The Diseased Heart of Africa: Medicine, Colonialism, and the Black Body,” Comaroff writes about how the black body became “associated with degradation, disease, and contagion” and how colonial medicine “link[ed] racial intercourse with the origin of sickness.” These overtly racist ideas have decreased in influence over time. However, even today, the remainders of these ideas still manifest themselves in racial inequalities in treatment and access to medical resources, and in the general racialization of medicine, both in the U.S. and around the world.

Smedley and Smedley write about the consistent racial and ethnic disparities in health care in their paper, “Race as Biology is Fiction, Racism as a Social Problem is Real.” They report a series of shocking statistics, which include that Africans Americans and Hispanics in the U.S. tend to receive lower quality health care across many different disease areas, African Americans are more likely than whites to “receive less desirable services, such as amputation,” and that these disparities are “found across a wide range of clinical settings including public and private hospitals, teaching and nonteaching hospitals.…” Similarly, Livingston details a scenario where a patient O (a black man) is expected to endure an incredible amount of pain during a bone-marrow biopsy without making any sounds of pain. When Mr. J (a white man) undergoes a similar bone marrow aspiration, Dr. A holds his hand and the Motswana nurse comforts him. Livingston writes that “his whiteness apparently creates different expectations around his stoicism.” Smedley and Smedley write that racialized science (and any science that looks for differences between racial groups) can only maintain and reinforce existing inequalities. Although many racial disparities in health are also the product of socioeconomic differences, Smedley and Smedley argue that when we accept this concept, there is the implicit idea that these socioeconomic differences are acceptable.

In her recent book, Breathing Race into the Machine, Lundy Braun writes about racial comparisons in lung capacity and about the race correction of spirometers. Since the 19^th century, it has been a well-established concept in scientific literature and in the medical community that African Americans (and most other racial groups other than people classified as whites) have a lower lung capacity than whites. Therefore, when doctors measure patients’ lung capacity even today, their spirometer values are “race corrected.” This means that the spirometer values considered “normal” for black patients are reduced, and black patients are not offered treatment or any sort of medical interventions for lower lung capacities than white patients with the same numbers. There are a few issues with this practice.

First, using race to correct for lower lung capacity ignores socioeconomic or environmental reasons for this decreased lung capacity. Often race issues are tied to socioeconomic differences and socioeconomic factors in lung capacity can also be connected to environmental explanations. Neighborhoods with lower socioeconomic status and high rates of minorities have also been shown to have higher rates of environmental pollution. Secondly, there is the issue of whether race should even be considered when taking this kind of medical measurement. When Braun interviewed physicians, they did not have a standardized way of determining race. Some physicians determined their patients’ race by looking at them and others asked patients to self-identify. Modern genomics show that there is more genetic variation within a race than there is between races, so using race as a biological concept seems even more flawed.

In the scene from Improvising Medicine, the doctors expect different things from the black man than from the white man and accordingly treat the two patients in different manners. However, juxtaposing Braun’s work on spirometers and race correction with Smedley and Smedley’s statistics on racial inequalities seems to create a sort of tension. Medical professionals are acknowledging how a certain minority group has worse health than others, but at the same time, they continue to be given worse care in the hospital. Race is one of the major factors in health care inequalities, and it would seem like acknowledging it would help fix this problem. Often, the first step to resolving an issue is addressing the issue and determining the roots of the problem. Nonetheless, the race correction of spirometers seems racist and unproductive in its current use.

It would be incredibly problematic if this type of race correction occurred globally and included other measures of health. Race correction could become a way of explaining structural violence and inequality produced by racial and socioeconomic factors, as well as becoming a method through which further inequalities were perpetuated through the decreased distribution of therapy or other medical interventions to these groups.

Discussion Questions:

1. How do we move forward from simply acknowledging and naming racial inequalities in health to working to eliminate these inequalities (especially if simply making physicians aware of these inequalities doesn’t change anything)?
2. If race is more of a social concept than a biological one, how productive is it to acknowledge race in terms of medical inequalities?
3. How can race correction (and other similar viewpoints in the general public or in the medical community) be eliminated?
4. Thinking about how “normal” is thought of differently (in relation to PTSD symptoms in Liberia, or classifying “normal” around the world), can race correction be justified if it shifts measurements towards the average value of the under-privileged community?

Sources:

Comaroff, Jean. 1997. “The Diseased Heart of Africa: Medicine, Colonialism, and the Black Body.” In Knowledge, Power and Practice, S. Lindenbaum, and M. Lock. University of California press, 305-29.

J. Livingston. 2012. Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Durham, N.C.: Duke University Press.

Shaban, H. 2014. “How Racism Creeps Into Medicine.” The Atlantic. [http://www.theatlantic.com/health/archive/2014/08/how-racism-creeps-into-medicine/378618/, accessed Sept 29, 2015].

Smedley A. and Smedley, B. 2005. Race as Biology is Fiction, Racism as a Social Problem is Real: Anthropological and Historical Perspectives on the Social Construction of Race. American Psychologist 60(1): 16-26.