Archive for health
“Health is politics by other means,” is the first sentence in Alondra Nelson’s Body and Soul: The Black Panther Party and the Fight Against Medical Discrimination (2011). This sentence echoes a certain veracity not only in the present day obstacles that continue to confront Black Americans, the poor and the ill, but also points out the multidimensional and rich considerations of the civil rights movement that are usually overlooked in favor of dogmatic recitations of equality. Today, the same racial and socio-economic inequalities like access to health care or the ability of minorities to obtain an equitable quality of treatment that were of concern to our civil rights leaders like Dr. Martin Luther King Jr. and the Black Panther Party in the 1960s, are still largely ignored in academic and policy circles alike. Unlike these past conversations that focused on the ability of Blacks, the poor and women to obtain treatment, we are currently confronted with a situation where FDA policies declaring human blood and the cells within this blood to be biologic “drugs” in need of federal regulation.
While there has already been some critical commentary on the regulatory over-reach of the FDA in declaring that “stem cells are drugs,” in Mary Ann Chirba and Stephanie M. Garfield’s “FDA Oversight of Autologous Stem Cell Therapies,” race-crits, critical sociologists, and critical theorists have not yet commented on how this denial treatment to sick and ailing patients–which not only violates one’s personal liberties, but propagates the already widening gap of pain and suffering for marginalized groups in America. While there will be any number of debates as to the effectiveness and long term safety of adult mesenchymal stem cells for years to come, early clinical studies have shown positive results—namely the decrease of pain, the increase of knee cartilage, and the improved functionality of joints. (See S. Wakitani et al., “Safety of Autologous Bone Marrow-derived Mesenchymal Stem Cell Transplantation for Cartilage Repair in 41 Patients with 45 Joints Followed for up to 11 Years and 5 Months,” Journal of Tissue Engineering and Regenerative Medicine 5.2 : 146-150). Beyond the clinical efficacy of said treatments, there remains a central concern raised by Patricia A. King in “Justice Beyond Belmont,” that is often overlooked in addressing healthcare disparities amongst the most vulnerable populations in America—namely do these groups have the same right to innovative medical treatments that show promise in decreasing their pain and suffering as the privileged?
The FDA’s argument for Regulating Adult Mesenchymal Stem Cells and the Slippery Slope towards an Indifference of Pain
What we are dealing with today is the attempt of a federal entity to extend its power over human bodies and the blood and blood products of those bodies under the auspices of its obligation to protect public safety. Remember the idea that stem cells could be regulated as drugs is the result of a procedural change in 21 CFR 1271 in 2006. The relevant section of that document currently states that:
[h]uman cells, tissues, or cellular or tissue-based products (HCT/Ps) means articles containing or consisting of human cells or tissues that are intended for implantation, transplantation, infusion, or transfer into a human recipient.
Before 2006, the bolded section here stated “another human recipient.” This legalese now gives the FDA an unbridled authority to regulate blood and blood/tissue products that do or could be used therapeutically in the human body. While the legal debate is concerned with the parameters of “minimal manipulation,” the societal effects of such indeterminate language opens the door to any number of FDA regulatory claims of human blood and cell products without clear guidelines and delineations as to the how or why human bodies and the blood and blood products of these bodies are subject to government oversight.
This is a dangerous precedent and one whose larger social, political and ethical implications have been overshadowed by the deliberate manufacturing of a looming public safety catastrophe from therapies involving stem cell treatments. If we read this procedural change in the context of the Regenerative Sciences case, and the recent attempts of the FDA to regulate the reproductive freedoms of consenting adults in America, we can observe a frightening pattern of government encroachment on individual freedoms and our civil rights—those rights that are supposed to protect American citizens from government intervention in their private lives. What is of even more concern for the civil rights minded and social justice oriented is how this small governmental regulation can amplify already disparate and racially determined healthcare treatment and failure of meaning pain intervention in racial and ethnic minorities’ lives.
Racism, Economic Exploitation and the Ethical Significance of Pain and Suffering
Poverty and the lives of the injured working class are filled with complex dissonances meant to deny the effects of disability and chronic pain to remain employed and economically viable. (Irmo Marini “The Psycho-Social World of the Injured Worker,” in Psychosocial Aspects of Disability: Insider Perspectives and Strategies for Counselors [New York: Springer Publishing, 2012], 287-314.) This effect is only amplified when we speak to race and racism in the healthcare system. As Carmen Green et. al. argue in “The Unequal Burden of Pain: Confronting Racial and Ethnic Disparities in Pain,” racial minorities experience more severe pain and less pain intervention by physicians throughout the healthcare system. (Pain Medicine 4.3 : 277-294.) As a group, African Americans are more emotionally and psychically tied to pain (Joseph Riley et al. “Racial/ethnic differences in the experience of chronic pain,” Pain 100.3 :291-298), but less likely to pursue medical treatments to intervene in cases of arthritis or other orthopedic ailments. In short, they don’t want to be cut on (Joanne M. Jordan, “Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasians: the Johnston County Osteoarthritis Project,” The Journal of Rheumatology 34.1 : 172-180.)
This is not simply an issue of disparate access to treatment, but the deliberate regulative intervention that suggests that pain and suffering can be concentrated amongst specific racial/ethnic and socioeconomic groups without hesitation. Just as we think of racism and economic exploitation as the intentional dehumanization of human beings, so to should we begin to think of pain and suffering as the vacating of humanity the unhealthy socially marginalized minority. As Edwin Lisson powerfully states in his 1987 article “Ethical Issues Related to Pain Control,”
pain is dehumanizing. The severer the pain, the more it overshadows the patient’s intelligence. All she or he can think about is pain, there is no past pain free memory, no pain free future, only the pain-filled present. Pain destroys autonomy: the patient is afraid to make the slightest movement. All choices are focused on either relieving the present pain or preventing future pain, and for this one will sell one’s soul.
Currently, there is not a bioethical conversation concerning the benign neglect of the oppressed’s suffering through the manipulation of medical disparity.
While the emphasis on intersectionality and discourse analysis have continued to privilege individual identity over structure, so to have these politics overlooked the overt manipulation of policy against racial/ethnic/ and economically disadvantaged folks. The overlap between the economic and racial segregation of urban African Americans and their experience of chronic pain suggests that the silence of race-crits and social justice scholars in this area, specifically concerning FDA regulations, is unjustified. The reduction of pain and suffering amongst the racially oppressed remains as it was in the 1960’s a very real and tangible civil rights issue. We only ignore this reality at the peril of our work and attempt to effect meaningful social change.
My son was born with a large bruise-like birthmark on his low back and buttocks. Not overly concerned, but curious, we asked our White nurse about it. She told us it was called a “Mongolian spot.” Both my husband and I must have had a visible reaction, because she quickly followed with, “I don’t know why they call it that. They just do.” A year later I recounted this story to a white family member (whom I am close to and love dearly). He didn’t see a problem. Thought I was overreacting. The conservation quickly deteriorated into a heated argument. Not knowing my history I was helpless to defend myself. Wasn’t “Mongolian,” he wondered, just a harmless – maybe even nice – reference to the people of Mongolia?
Mongolian spots are congenital birthmarks found on the lower backs, buttocks, sides and sometimes shoulders, of primarily infants with East Asian heritage (but also East African, Native American, Polynesians, Micronesians and Latin American). They typically disappear 3-5 yrs after birth.
The term was coined by German internist and anthropologist Erwin Bälz who spent 27 years in Japan and is considered cofounder of its modern (western) medicine. In 1881 he married a Japanese woman and had two multiracial Asian children of his own. In 1902, he was appointed personal physician-in-waiting to Emperor Meiji and the Imperial household of Japan. Finding blue spots on Japanese babies, he thought these spots were characteristic of Johann Bluembach’s “Mongoloid” race, and named them accordingly.
Johann Friedrich Bluembach was a massively influential figure in the development of race as we know it today. Sometimes referred to as the “Father of Scientific Anthropology” or the “Founding Father of Craniometry,” he laid out the scientific template for contemporary race categories.
In his On the Natural Variety of Mankind, he mapped a hierarchical pyramid of 5 human types (founded on the description of human skulls):
- the Caucasian, Caucasoid, or “white” race
- the Mongolian, Mongoloid, or “yellow” race
- the Malayan or “brown” race
- the Ethiopian, Negroid or “black” race
- the American or “red” race
Though Blumenbach strongly opposed slavery and believed in the potential equality of all people, he placed “Caucasians” at the top of his pyramid because a skull found in the Caucasus Mountains was to him “the most beautiful form of the skull, from which…the others diverge.” Many European scholars at the time showed tremendous interest in the Caucasus Mountains, particularly the holy “Mount Ararat.” It was there, according to the Old Testament (Genesis 8: 4), that Noah’s Ark came to rest after the Flood. Supporting a Judeo-Christian worldview, Bluembach considered the Caucasus Mountains to be the birthplace of humankind (i.e. only Europeans) and that the Mongolian and the Ethiopian had diverged from the Caucasian. By stark contrast, it is thought his use of “Mongoloid” derived from the Mongol people who caused great terror throughout Eurasia during the Mongol Empire invasions.
Blumenbach’s works themselves were not widely read in early America but American academics (notably Samuel George Morton) distorted and recast them. This “scientific” image of man went on to form the basis of modern racial theory, and hence racism. Today, in addition to obvious negative socio-political associations, the term “Mongoloid” is also considered derogatory by the scientific community due to its association with discredited models of racial classification. I believe most would agree all the –oid racial terms (e.g. Mongoloid, Caucasoid, Negroid, etc.) are controversial and offensive no matter how they are used.
And yet, despite its insidious history and racist associations, we continue to use “Mongolian spot” to label a physical appearance of our young Asian and multiracial Asian children. In fact, I have even heard it used endearingly, or sweetly, as a signal of the child “belonging” to Asian culture. Interesting to me how our nurse deferred blame to some unidentifiable other, “I don’t know why they call it that. They just do,” denying her role as an active agent in perpetuating the term. As a postpartum nurse she is on the frontline. She is in every day contact with hundreds, probably thousands, of parents of Asian and multiracial Asian children. Bewildered by the entry of a new person into their life, I’m sure many of these parents tiredly accept “Mongolian spot” on her medical authority, and then move on to try to figure out the incredible tasks of breastfeeding and/or sleeping. I suspect no one would reprimand her if she simply started saying, “O that’s just a birthmark. Sometimes we see those types of birthmarks on Asian babies.” Just leave out the “Mongolian” all together.
So what’s stopping her?
What’s stopping us?
~ Sharon Chang, originally posted at Multiethnic & Multiracial Asian Families
Yesterday, a few of us at the Graduate Center hosted an interdisciplinary group of scholars to think critically about ‘whiteness and health.’ Across the day, with a kind of staccato arousal, I was struck by several ideas, including the following:
- “Actionable Decoys” seemed to emerge as so many of the talks sketched the landscape of global, economic, and health “concerns” that are actually instances of structural injustice and violence in which “whiteness” comes to be privileged, the standard, normative, or even healthy, and people of color or those in poverty hold risk, contamination, disease, TB, waste. That is the racist landscape which is built into material conditions and cultural constructions; the “actionable decoys” are the sites of intervention that policy makers and public health advocates address. That is, instead of dealing with the power struggles of the Occupation in the Middle East, or structural/historic injustice in New Orleans following Katrina or in the Rockaways following Sandy, we address (just for a moment) mental illness. Or, instead of attending to the wide and deep reach of structural racism under the skin and in the mind, we invest in MRI machines and psycho-physiological indicators to “document” how brains light up around racial anxiety. Or, the public health fetish with TB framed as a housing issue, that then enables the state to enter and destroy poor people’s housing (Samuel K. Roberts, Lisa O’Sullivan).
- My worry of course is that “science” enables and creates a scientific lubrication and justification for the narrow shape of the problem, enabling a violent intervention that situates the problem in the body/mind/housing of racialized (and poor) people as if there were no connection to widening inequality gaps and swelling privilege. Thus, “actionable decoys” are the closing of public housing, obesity campaigns, limits on college access for formerly incarcerated students at the precise same time and as a reaction to the now quite predictable action of a white-boy-with-a-gun who blows up a community. What I want to argue is that actionable decoys appear to be a form of ‘care’, responding to the ‘pain’ and ‘crisis’ in communities of color (particularly low income), while occluding issues of structure, privilege, history, whiteness-as-healthy, and ultimately generating a privatized market or opportunities for elites (a new pharmaceutical drug, new housing in gentrified neighborhoods, new schools in same neighborhoods).
- In the language of social science, whiteness gets reinscribed as the independent variable (IV) becomes the dependent variable (DV). The grants we get, the funding and socialization of students are all saturated in a fundamental sea of epistemological violence so that “race disparities” (or “gender disparities” or both) reveal AND occlude the structural conditions of oppression in which gender/race/class/sexuality/disability… emerge as axes of power/lines of analysis – but not the Independent Variable to be ‘fixed. Funding streams fetishize “race” as a predictor (IV) and damage as an outcome (DV), occluding structure, history and the circuits that link privilege and marginalization
- Several people raised the specter of whiteness becoming a market (Nadia Abu El-Haj, Alondra Nelson, Lisa Brundage, Barbara Katz Rothman). I was struck by the contrast to the hyper-criminalization of people of color. The result then is that if you support the market you can avoid criminalization – the methadone/bupe/oxycotin discussion (Helena Hansen, Julie Netherland) was superb on this point – but like enlisting in the military, those with green cards may become citizens. If you give your body to the market or the military – feed the system, you can avoid being criminalized; but if you won’t, or can’t, the cage awaits.
- There were so many evocative and powerful ‘couplets’ during the same afternoon, it prompted me to think about other kinds of twinings, and the slippage between them. Questions arise about: Who is the addict vs. who is dependent? What is obscured vs. what is privileged? Likewise, I started thinking about who is the ‘sex addict’ (which a predominantly white, and flourishing industry) and who is the ‘sexual predator’ (more often a person of color, incarcerated)? In the panel on addition (Helena Hansen, Julie Netherland), I was led to wonder about who gets to be medicalized (bupenorphine) and who gets to be criminalized (methadone). And yet, it is so hard to speak about white pathology because as Richard Dyer suggests, it falls apart in your hands, or it appears merely ‘human.’ As Rebecca Tiger’s presentation suggested, it is difficult to talk about the “desire to excuse”Lance Armstrong , without the contrast of Whitney Houston, because it appears to ‘natural’ and ‘we are all fallible’ when the case is White, and elite. In many ways, this extends the work of Sarah Carney who found that in press accounts of “failure to protect laws” (in which children die through accident while parents are distracted), that Black mothers are treated much more harshly than either white mothers or white fathers.
- A corollary, as raised by Akemi Nishidi in conversation with Zinobia Bennefield, is that the “vulnerable” group or one under structural attack is often quick to distance from their more vile category-twin. Thus, communities of color rightfully point to the over-enrollment of special education students who are Black. “We Are Not Crazy” is a rallying cry from communities that have been painted with the lamination of insanity, or even trauma without addressing the structural attack on madness, and the slippery construction of this swampy categorization, the real pain and the fantasy of the absence of pain in those of us not labeled (see Rachel Leibert’s work on this).
- The eery presence of the (white)absence of white responsibility (more precisely white elites) was with us throughout the afternoon. It is so difficult to hold White people or whiteness accountable, to speak the structural benefits of whiteness without doubling it as merit. What this means is that whiteness makes it so hard to critique Lance Armstrong, or the white man whose child tragically dies in the back of his car, but so easy to condemn Whitney Houston, or the black mother when the same happens. It’s as though “white responsibility” is an oxymoron and black blame is redundant. Whiteness as Teflon.
- Finally, I was struck by the ironies of anti-racist interventions being co-opted and exploited, toward racist (or racial?) ends. So, for example, the Human Genome Diversity Project, or even the ‘discovery’ of bupe as an alternative to methadone, or the Implicit Association Test which measures unconscious racism, or the early ‘care’ given to persons/housing/communities with TB or VD, all of these presumably (maybe not bupe) emerged out of concern for communities of color, concern about racism, but all of these have been inverted and turned back to racial and often racist purposes, at minimum reiniscribing the very racial “differences” and disparities they were presumably designed to combat.
~ Michelle Fine, Distinguished Professor, Graduate Center, CUNY
The archived video(s) of An Exploration of Whiteness and Health A Roundtable Discussion
is available beginning here (updated 12/16/12):
The examination of whiteness in the scholarly literature is well established (Fine et al., 1997; Frankenberg, 1993; Hughey, 2010; Twine and Gallagher, 2008). Whiteness, like other racial categories, is socially constructed and actively maintained through the social boundaries by, for example, defining who is white and is not white (Allen, 1994; Daniels, 1997; Roediger, 2007; Wray, 2006). The seeming invisibility of whiteness is one of its’ central mechanisms because it allows those within the category white to think of themselves as simply human, individual and without race, while Others are racialized (Dyer, 1998). We know that whiteness shapes housing (Low, 2009), education (Leonardo, 2009), politics (Feagin, 2012), law (Lopez, 2006), research methods (Zuberi and Bonilla-Silva, 2008) and indeed, frames much of our misapprehension of society (Feagin, 2010; Lipsitz, 1998). Still, we understand little of how whiteness and health are connected. Being socially assigned as white is associated with large and statistically significant advantages in health status (Jones et al., 2008). Anderson’s ground breaking book The Cultivation of Whiteness (2006) offers an exhaustive examination of the way whiteness was deployed as a scientific and medical category in Australia though to the second world war. Yet, there is relatively little beyond this that explores the myriad connections between whiteness and health (Daniels and Schulz, 2006; Daniels, 2012; Katz Rothman, 2001). References listed here.
The Whiteness & Health Roundtable is an afternoon conversation with scholars and activists doing work on this area.
The roundtable is sponsored by the Advanced Research Collaborative (ARC) and the Critical Social & Environmental Psychology program at the Graduate Center CUNY. The event is hosted by Michelle Fine (Distinguished Professor, Social Psychology, Women’s Studies and Urban Education), Jessie Daniels (Professor, Urban Public Health and Sociology) and Rachel Liebert, (PhD Student, Critical Social/Personality Psychology).
Imara Jones at Colorlines raises the issue of a negative impact of this week’s Supreme Court’s degree on the health and the health insurance options for people of color. As a result of this week’s Supreme Court narrow 5-4 decision:
the Patient Protection and Affordable Care Act’s longterm effectiveness is in doubt, and the racial and economic inequalities at the very heart of the health care system stand to be reinforced. Medicaid—funded jointly by the federal government and the states—is the nation’s health care plan for the working poor . .. . Enlargement of Medicaid is the single most important provision of the Affordable Care Act for people of color. It’s the way that almost all non-whites covered by the law would receive insurance. If implemented as written, the law expected to cover 32 million Americans, accounting for 80 percent of those currently uninsured.
The law as written would force states to expand their Medicaid programs, to include the working poor, or else loose federal funds for all Medicaid. However the Supreme Court knocked down that provision. Some states will likely still seek these funds, but other states, especially with lots of working poor of color, likely will not:
And that’s a problem, particularly in the Southern, GOP-led states where huge numbers of working poor blacks and Latinos live. The majority of states, due to the recession, want to cover less not more people. . . . As former Republican governor, now Senator Lamar Alexander told The New York Times, “If I were governor of Tennessee, I would not expand Medicaid.” Republican Gov. Bobby Jindal of Louisiana echoed the point.
Saving the mandate got much of the media coverage, as many will be helped by what was saved, but
for millions more, the Supreme Court’s ruling will only exacerbate inequities at the core of our national health care crisis, and force the battle over the law back to the states. . . . Medicaid remains a bitterly fought over program today. The ruling yesterday will make it more so.
And the costs are of course very high in human terms, and in dollars as well:
The Center for American Progress estimates that this racial gap in health care coverage costs the country $415 billion a year in lost productivity.
And then there is the underlying question of why “we the people” allow such an undemocratic institution as our Supreme Court to even have this power over our health and health care? This decision by a few unelected folks over US health care is yet more evidence that we are not a democracy, but indeed a kind of plutocracy– that is, a pseudo-democracy that is actually ruled by an elite of the well-off and powerful, an elite that is also still mostly white and very disproportionately white male.
Although many whites (and some blacks) deny it, skin color still has a pervasive influence on peoples’ lives in America. Even the place where you live is related to your color. While new research indicates this country is becoming less residentially segregated, the vast majority of us still live in homogeneous areas with a smattering of people from other racial groups. This was a vestige of official U.S. Government policy that proscribed integrating established white neighborhoods. Today the Department of Housing and Urban Development annually investigates around 10,000 fair housing discrimination complaints—a hopeless situation given their limited resources and the estimated 2 million annual racial housing discrimination cases in the United States according to the United Nations.
One of the most deplorable examples of racism can be found in our judicial system that incarcerates over 2 million people, more than any nation in the world. About half of those locked up are people of color. The American Civil Liberties Union estimates that there are more blacks in prison, jail, on probation or parole than there were enslaved before the Civil War. Nearly 1 in 9 young black Americans is incarcerated, more than any other group, and they receive harsher sentences than whites for similar offenses. Thanks to modern technology, we are getting candid glimpses of the verbal and physical abuse people of color must endure at the hands of some law enforcement personnel, and the Innocence Project has demonstrated racial inequities in capital sentencing.
The Rev. Dr. Martin Luther King, Jr. once said “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Despite attempts to improve the health status of blacks and Latinos, they still lag far behind whites. Blacks live five years less, and have more than twice the number of infant deaths than whites, and, along with Latinos, they die more often from infectious and communicable diseases, heart attacks, diabetes and other problems that could be attenuated by preventive behavior and adequate health care. Once again, the data demonstrate that these disparities are not the result of genetic differences. The landmark study “Unequal Treatment” conducted for Congress by the Institute of Medicine concluded
Racial and ethnic minorities tend to receive a lower quality of healthcare than non-minorities, even when access-related factors, such as patients’ insurance status and income, are controlled.
Republicans, who are overwhelmingly white, are not oblivious to these disparities. They prefer to attribute differences in opportunities and the way people are treated to individual aberrations—solely the fault of recalcitrant blacks and Latinos who violate norms of probity and civility. Florida Senator Marco Rubio, the darling of Republican conservatives and an aspiring Vice Presidential candidate, reinforced this in a speech last August at the Ronald Reagan Presidential Library:
The free enterprise system does not create poverty. The free enterprise system creates prosperity, not denies it. . . ; [And] . . . we must understand that poverty does not create our social problems, our social problems create our poverty.
This popular myth has been woven into the fabric of our society through a public school system that perpetuates segregation, and dashes the hopes of millions of children of color and poor whites. Over 7,000 students drop out of school each day in the United States. Because of the demise of busing and the court’s acquiescence to the principle of unitary status, there has been a reemergence of neighborhood schools. Since most neighborhoods in this country are de facto segregated, schools are now more monochromatic than before the Brown decision in 1954.
Republican leaders’ strategy of unifying white middle and working classes against the supposed excesses of minorities is inherently perverse, blaming the victims of racism when they themselves are struggling to keep their head above water. It may help some people retain a shred of dignity believing that despite their misfortune, they are still superior to others below them on the social ladder—even if the rungs separating them are moving closer as the wealth of the nation becomes centered in the hands of the few.
Demographic changes in our society will make the Republican Party irrelevant if it does not change its rhetoric and become more inclusive. In a few decades minorities will be the majority. Focusing on issues of values and morals may temporarily capture the public’s attention, but they will find that blaming the victims of institutional deficiencies and greed is hardly a formula for success.
H. Roy Kaplan was the Executive Director of The National Conference of Christians and Jews for the Tampa Bay area. His most recent book is The Myth of Post-Racial America.
Have a racist encounter during the day? Chances are, if you were on the receiving end of that encounter, you’re not sleeping well tonight. New research suggests that experiences of racial discrimination are associated with an increased risk of problems sleeping. These problems may in turn have a negative impact on mental and physical health.
The study involved an analysis of data from the 2006 Behavioral Risk Factor Surveillance System (BRFSS), which is administered by the CDC. The BRFSS is the largest, ongoing telephone health survey of American adults, administered annually to people selected by states and random-digit-dialing. Researchers analyzed responses from 7,093 people in Michigan and Wisconsin, which were the only states to collect data on both sleep and racism.
The results of the study show that there was a link between experiences with racism and self-reported problems with sleeping. Experiences of racism – which the health disparities literature insists on referring to as “perceived racism,” as if the problem is with perception – is assessed with the question: sorted into two cateogires as either “worse” or “same or better.” Respondents were classified as having problems with sleep if they reported having difficulty sleeping at least 6 nights in the past 2 weeks. Lead researcher and author Michael A. Grandner, PhD, Postdoctoral Fellow at the Center for Sleep and Circadian Neurobiology at the University of Pennsylvania, is quoted in an interview saying:
“This study found that an environmental stressor that exists purely at the social level—perceived racial discrimination—had a hand in how likely a person was to experience disturbed sleep. The most surprising finding in this study was that individuals who perceived racial discrimination were more likely to experience sleep difficulties, and it did not matter if they were black or white, men or women, rich or poor, or even if they were otherwise depressed or not, since these were adjusted for in the statistical analysis.”
There are a couple of things to note about this research. First and foremost is the somatic, bodily impact of racism on those who experience it. Second, the overly cautious academic language of “perceived racism” undermines the voices and experiences of those in the studies who shared their experiences with researchers, relegating them to the realm of “perception,” the truth of which is to be determined later and by someone else, more removed, objective, and whiter.
Finally, what struck me about this research was that it’s framed within the language of health disparities in which the focus is always on African American, Latino, Asian and Native American folk. This is fine as far as it goes, as when it highlights the unequal burden placed on some when it comes to health.
What’s missing from this analysis is the unequal benefit that white people reap in all this. Encounters with racism are sometimes structural, sometimes personal. Over and over again in research like Living with Racism and The Myth of the Model Minority and Racism without Racists and Everyday Injustice and Racism in Indian Country, scholars have documented the experiences of Black, Asian, Latina/o and Native Americans with racist whites and with white power structures. Yet, the health disparities literature still frames these experiences as “perceptions” and white actors are rendered invisible through the academic use of the passive voice.
My guess is that most white folk are not losing sleep at night because of racism, and as a result of that, get an unearned benefit of greater physical and mental health.
Let me begin this blog with a disclaimer. I have recently returned from over a month on reservations in South Dakota, Oklahoma and Arizona. In the 30 years I have been making these trips, the situation has not improved. The Pineridge reservation continues to be the poorest county in America. According to the CDC suicides have increased, untreated health conditions such as diabetes continue to rise in numbers, infant mortality remains high. As a paralegal, one of the things I do while there is help people understand and move forward with legal issues and problems. Criminal justice is more criminal than justice as NPR discovered when investigating rape reports and convictions. In 2007, Native women had the highest rate of rape of any ethnic group, 2.5 times higher than the national average. This prompted Amnesty International to investigate and report on justice in Indian country. Their report firmly lays the blame on the justice system and the courts for this problem.
This situation was very present for me as I read the article in The Atlantic about the virtual nonexistence of Native American judges in the United States. The author takes issue with the Senate patting itself on the back for finally confirming an openly gay judge while having confirmed only one openly Indian judge in the history of this country. In 224 years, only one.
As it happens, a Native American judicial nominee is currently waiting on confirmation. Arvo Mikkanen was nominated 6 months ago. He received unanimously qualified ratings from the American Bar Association. His nomination was pronounced “dead” by the white Senator from Oklahoma. Apparently, the White House did not consult them before nominating him. This breach of professional etiquette is the theoretical reason for his nomination being stalled without hearings or consideration. Mikkanen makes his own case persuasively. He questions the reasoning of the senators and also of the White House which placed him in this position and has failed to speak on his behalf.
As a lawyer and a nominee, he is circumspect in his questioning. As a Native American and a race scholar, I intend to be more critical. Oklahoma is the end of the Trail of Tears. It has the second largest native population (after Alaska) of any state in the country. White Oklahoma elected officials have a long history of expressing that being Indian is reason enough to conclude incompetence. Not one of the elected officials in Oklahoma has spoken in defense of Mikkanen or elaborated on what makes him unfit.
Additionally, the White House has remained silent. I would suggest as Cohen hints that Mikkanen is a symbolic gesture and a pawn in the White House game to pretend to support Native justice while using Republicans as the foil to keep from actually delivering on that justice. To wit, the Cobell settlement for pennies on the dollar languished for almost 2 years before being approved after having spent 15 years in the federal courts. The Department of the Interior, which oversees Indian lands and resources has yet to promulgate new standards for leases, trust management or native protections. While signing the Native American Law Enforcement Act, Obama said,
government’s relationship with tribal governments, its obligations under treaty and law, and our values as a nation require that we do more to improve public safety in tribal communities.
The act itself only increases a possible sentence, for any crime in Indian Country including murder, from 1 year to 3 years. However, it does, finally, allow Indian courts to question and investigate crimes by white people on reservations. Not necessarily prosecute them or charge them or sentence them commensurately, but at least investigate them.
This is justice in Indian Country. This is the improvement the President touts. Meanwhile, there are no Indian judges off the reservation. This should not surprise us particularly, there have only been two Indian U.S. Senator in our history and 3 congressmen. No states have ever elected a Native American as governor.
An Indian, from India, in Louisiana, but no Native American. Arvo Mikkanek joins a long list of Native Americans whose qualifications for public service could not overcome their inherent disqualification of being Indian. Members of both parties will continue to make great public statements and act as if justice, health and representation for Native Americans are a priority. They will also continue to fail to enact any policy of inclusion or solution to the problems in Indian Country. Until one Senator or one White House official rises to defend the defamation of Mikkanen’s character, we can assume it is business as usual. White people take what they want, offer trinkets and solemn never kept promises while pursuing an uninterrupted program of annihilation of Native Americans through any means necessary.
There’s a growing body of evidence that implicates racism in a variety of negative health consequences. Yet, the research on ‘health disparities and race’ neither focuses on whiteness nor on the ways that racism plays a role in health.
The Health Disparities Industry. Much of public health is driven by a concern with, and research on, ‘health disparities.’ If you’re not familiar with this field (or, subfield), it works like this:
“The literature on racial disparities in health by definition involves comparisons across groups defined by some racial classification system. Perhaps the most common of these comparisons take the form of the following general proposition: [Black/Hispanic/Native American] [children or adults] have higher rates of [the condition, disease, or 'disability' under investigation] than whites, primarily because of [explanatory variable]” (Daniels and Schultz, 2006, p.97).
There is a vast amount of scientific literature, and a number of federal agencies, built on this formulation. The equation is always the same: measure some health outcome (rates of heart disease, diabetes, HIV/AIDS) in “minority” populations and compare it to the rates in the white population. Don’t misunderstand me. I think it’s a good thing, indeed an important thing, to focus on the health of folks who are black and brown because they carry a disproportionate burden when it comes to health. And, black and brown folks endure less than equal care when they encounter the health care system. Both these – health and health care – deserve attention from scholars, activists and those in public policy.
In a recent article critical of the health disparities industry, Shaw-Ridley and Ridley chart the scope of this industry and question the ethics of it. The problem is that there’s a lot that remains unexamined in the ‘health disparities’ framework.
Whiteness & The White Racial Frame in Health Disparities. Defining whiteness has been a central project of the construction of what it means to be American. What it means to be “white” is built into the U.S. Census. This history is the subject of a recent book by Nell Irvin Painter, The History of White People. She observes that:
“Until the 1960′s, there were two racial dialogues going on the United States. One was more or less Southern, and that was black-white. The other had to do with various kinds of white people.”
The fact that white people have dominated the U.S. since its founding has also meant that they (we) have shaped the very way that we view reality (e.g., everything from laws, relationships, media, discourse,) in the U.S. This shaping of how we ‘frame’ things is referred to by Joe Feagin as ‘the white racial frame.’ The basic idea of the white racial frame is as follows:
The North American system of racial oppression grew out of extensive European exploitation of indigenous peoples and African Americans. It has long encompassed these dimensions: (1) a white racial framing of society with its racist ideology, stereotypes, and emotions; (2) whites’ discriminatory actions and an enduring racial hierarchy; and (3) pervasively racist institutions maintained by discriminatory whites over centuries. White-generated oppression is far more than individual bigotry, for it has from the beginning been a material, social, and ideological reality. For four centuries North American racism has been systemic–that is, it has been manifested in all major societal institutions.
Even though as Painter and Feagin note that whiteness and the white racial frame are central to the the American social and political context, these are little remarked upon within the literature on racial disparities in health outcomes. Indeed, the white racial frame permeates the research on race and health, and in particular, the research on ‘health disparities.’
The usual construction of ‘health disparities’ research constructs whiteness in two ways:
“First, it establishes a comparison between whites as a referent group and some ‘other’ group whose health is evaluated in comparison to that of whites. In an Ideal world, such comparisons may demonstrate arenas in which health outcomes do not differ by race, challenging ideas of racial group difference. If, however, funders are less likely to support research in which susbstantial racial differences are not apparent, or if publishers are less likely to publish articles that find no statistically significant differences….the literature will reinforce racial health differences while minimizing similarities… (Daniels and Schultz, 2006, p.97).
The comparison group in this research is always whites, which puts those who are not white in a “one down” position. The question as it’s framed in this research is always “What’s wrong with this [non-white] group? What’s happening that their health outcomes are ‘disparate from’ [not as good as] the health outcomes of whites?” The second way that that health disparities research constructs whiteness is through:
“….the use of racial categories and comparisons with no consistent foundation fo rthe theorizing, understanding, or interpreting observed racial differences (or their absence) in health outcomes provides space for a wide range of potential explanations. Each of these ‘explanations’ implicity or explicitly constructs both race and whiteness. “ (Daniels and Schultz, 2006, pp.97-8)
The overwhelming majority of research on ‘health disparities’ never examines whiteness nor implicates the actions of white people in this equation. This may be changing, however. Very recent research by Blodorn and O’Brien (of Tulane University, “Perceptions of Racism in Hurricane Katrina-Related Events: Implications for Collective Guilt and Mental Health Among White Americans) examines the implications of health disparities on whites. This is a rare focus in this research.
Racism. Contrary to the passive voice construction of most ‘health disparities’ literature, there are indications in the literature that there are actors responsible for at least some of the racial inequality contributing to the racial inequality in health outcomes. As I mentioned at the beginning of this post, there’s an increasing amount of evidence in the scientific literature that supports the claim that racism is a contributing factor to ill health. The pernicious sleight-of-hand in the ‘health disparities’ literature is that most of this research focuses on “perceptions” of racism among black and brown folks, but none of this research (at least none that I’ve found) acknowledges the reality of racism nor does it address those who are the perpetrators of racism in contemporary American society.
What Needs to Change. Clearly, there are unequal health outcomes that need to be addressed (see for example, Glady Budrys, Unequal Health: How Inequality Contributes to Health or Illness). On almost every measure, those in our society who are Black, Latino or Native American will die sooner than those who are white. For almost every disease, such as cancer and diabetes, those who are Black, Latino or Native American are more likely to contract the disease than whites, and once the disease is contracted, more likely to die from it.
This is one of the many costs of racism in our society and it must change.
However, looking only at those who must pay these costs as the source for changing these mechanisms of inequality is misguided. We need to begin to critically examine those who hold the most power and resources in society, that is at white people, for the ways that they contribute to and benefit from the inequality in health outcomes.
Boston.com summarizes an encouraging research report on the fact that more students of color
are enrolling in US medical schools, according a study by the Association of American Medical Colleges, a nonprofit that represents all 150 accredited medical schools in the United States and Canada. Native Americans had the largest enrollment growth, at 24.8 percent, followed by a 9 percent increase for Hispanics; 2.9 percent for African-Americans; and 2.4 percent for Asians. The growth is in part due to a push by schools to attract more underrepresented minorities — African-Americans, Mexican-Americans, Native Americans, and mainland Puerto Ricans — to meet the needs of an increasingly diverse population.
Joyce Sackey, dean for multicultural affairs at Tufts medical school attributes the increase at Tufts of underrepresented minorities to growth there in scholarships available to economically disadvantaged students, many of whom are students of color. And Boston University School of Medicine’s associate dean, Jonathan Woodson, underscores as well the an early acceptance medical program there.As Boston.com summarizes this:
The [Boston University] program provides a more gradual transition into the curriculum through provisional acceptance into medical school at the completion of two years of undergraduate study.
In a country as large as the United States there are a great many students from economically and racially subordinated communities who would do well in our colleges and universities, including our medical schools. It is sad that so many talented young people of color are not allowed the privileges and access to educational resources of well-off whites. We all pay the price for that systemic racism. I make this knowledge expansion argument at the end of a recent book, The White Racial Frame:
A century ago, sociologist and civil rights leader, W. E. B. Du Bois, made strong arguments for the general societal benefits of ending systemic racism and building a real democracy for the United States. In his view when we exclude and marginalize many people, as is routinized in systemic racism, we leave out “vast stores” of human wisdom. When Americans of color are oppressed or marginalized in the country’s major institutions not only do they suffer personally and in their families and communities, but also numerous white-controlled institutions suffer significantly–and some may eventually deteriorate and decline as a result. Excluding or marginalizing a great many people of color has meant excluding much human knowledge, creativity, and understanding that they hold in their heads and in collectively preserved memories. A society that ignores such a great store of knowledge and ability irresponsibly risks its future.
Ending racial discrimination involves the kind of moral thinking and action that is in the long run good for this society’s health because that frees up the knowledge and energy of millions who have long faced substantial racial barriers to knowledge-generation, achievement, and prosperity. All Americans will benefit from the inclusion of new knowledges in the public and private spheres. Only by bringing in the perspectives and experiences of formerly excluded Americans can the U.S. government and the larger society expect to meet the hard challenges of a clearly difficult national and global future.
What do you think?