Racism, Whiteness and the Health Disparities Industry

• • health, racism, scholarship, scientific racism, white racial frame

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.

racism
( Creative Commons License photo credit: rwdownes )

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.

Racism Wastes Much Knowledge: Risking Societal Progress or Survival?

• • African Americans, Asian Americans, education, health, Latinos, Native American



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?

World AIDS Day: Black Women, HIV/AIDS, and Racism

• • African Americans, gendered racism, health

Today is World AIDS Day, when people around the globe stop to reflect on those lost to the HIV/AIDS epidemic, which is almost in its third decade. While many people may associate the disease with white, gay men because they were one of the groups initially infected and affected by HIV and among the most political vocal about it, the fact is the epidemic has changed.   Within the U.S., if you examine the epidemic across racial and ethnic groups, you will see that HIV/AIDS is not a disease that exclusively, or even primarily, affects whites.   Blacks and Latinos are increasingly affected by the disease, as this graph based on 2007 CDC statistics illustrates:

The changing nature of the epidemic is even more striking when you include gender.Today, black women are the group with the highest rates of new HIV/AIDS infections.  According to CDC:

  • African American women account for a majority of new AIDS cases (66% in 2006); white women and Latina women account for 17% and 16% of new AIDS cases, respectively.
  • African American women account for the largest share of new HIV infections among women (61% in 2006), an incidence rate nearly 15 times the rate among white women.   (For more detailed look at statistics about the epidemic’s impact on African Americans, see: “Black Americans and HIV/AIDS” compiled by the Kaiser Family Foundation, opens PDF.)

During the first decade of the epidemic, most social science research focused on changing individual behavior (e.g., wearing condoms, using clean needles) as the primary intervention strategy to prevent HIV infection, these efforts often failed in the face of complex settings of social inequality.  For example, telling a woman that her partner should wear a condom becomes a risky proposition if she is economically dependent on that man for survival and he sees the request to wear a condom as an affront of some kind.   Thus, researchers and community activists interested in stopping the spread of the disease began to look at the dynamics of sexuality within a broader social and cultural factors.

Just as an increasing amount of research demonstrates that mothers who experience racism are more likely to have low-birth-weight babies, the experience of racism and sexism are part of the social and cultural factors affecting HIV/AIDS rates among African American women. One way to measure this combined racism and sexism, is to look at what national leaders have to say about the HIV/AIDS epidemic among black women.  In 2004, when journalist and vice-presidential debate moderator Gwen Ifill raised this important issue in the form of a question to then-candidates John Edwards and Dick Cheney, neither one could stammer out a coherent answer.  It was clear that the alarming rates of HIV/AIDS among black women were simply not a concern for powerful political leaders (who also happened to be white men).

Some of the most exciting research that attempts to address this inequality is the pioneering intervention studies conducted by Gina Wingood and Ralph DiClemente of Emory University who, drawing on Connell’s gender and power theory, began to think differently about HIV prevention for young, black women.  Wingood and DiClemente developed an intervention study for African American adolescent girls that used workshops that emphasized ethnic and gender pride along with the usual HIV-prevention information.  Basically, the researchers included a consciousness-raising group about race and gender along with the usual health education information.  These positive messages about racial and gender pride are important for enabling and empowering young, black women who encounter a layered burden of racism, sexism and often, poverty.

However, not all black women who are HIV-infected are poor, as several activists remind us. Marvelyn Brown, for example, diagnosed at age 19 with HIV/AIDS has become an outspoken proponent and visible spokesperson for HIV-prevention among young, black women.  The author of Naked Truth: Young, Beautiful and (HIV) Positive, Brown has won several awards for her activism. Rae Lewis-Thornton, diagnosed at age 23, was featured on the cover of Essence magazine in 1994 and described as, “I’m young, I’m educated, I’m drug-free, and I’m dying of AIDS.” It’s been fifteen years and, fortunately, Lewis-Thornton is still very much alive and an tireless activist.  Yet, she struggles with the legacy of her diagnosis (powerful video interview with Lewis-Thornton here).   And, young black women who are allies, are harnessing the power of new media to raise awareness about HIV/AIDS, such as Karyn and Luvvie of the Red Pump Project.

The growing epidemic among black women in the U.S. reflects a global trend.  The World Health Organization’s estimate (via AIDS.org) is that there are over three million women with HIV in the world, most of them in Africa. In fact, one in 50 women in sub-Saharan Africa is infected with HIV.  AIDS is the leading cause of death for women ages 20-40 in major cities in the Americas, Western Europe, and Africa.   The fact that this disease is shape-shifting into one what disproportionately affects black women both here in the U.S. and globally raises important questions about whether or not we will, collectively, be able to put aside our racism (and sexism) to address this epidemic.

Today, as you go to a service, attend a vigil, or just hold a good thought or observe a moment of silence on this World AIDS Day, reflect also on the ways that racism shapes the epidemic and who we lose because of it.  If you care about racial and gender equality, you need to start paying attention to HIV/AIDS.  IF you’re concerned about HIV/AIDS, you need to start learning about racism and sexism.

For more on the public health crisis affecting black women, you can watch this video (approximately 27 minutes) which features a discussion with C. Virginia Fields, President of National Black Leadership Commission on AIDS, Monica Sweeney, MD, Assistant Commissioner for the Bureau of HIV/AIDS Prevention and Control of the NYC Department of Health and Mental Hygiene, and Marvelyn Brown.

[This post is from the archive: 12/01/09.]

Did the Government Invent AIDS to Kill Black People?

• • gendered racism, health, history, women

The news that doctors representing the government intentionally infected Guatemalan citizens with STDs has inevitably provoked comparisons to the famed Tuskegee experiment where black men were denied treatment for syphilis so that doctors could study the course of the disease. In another post, Jessie has eloquently discussed the broader public health and racial implications of this work. But while comparisons to the Tuskegee experiment are often the first that come to mind, these are not the only cases where mostly white doctors have exploited patients of color in the name of experimentation and/or racist ideology. Journalist Amy Goodman recently interviewed medical historian Susan Reverby (who brought the Guatemalan scandal to light) and reporter Eileen Welsome to discuss other cases where people of color have been abused and mistreated by the medical community, often with governmental support. This is a transcript of the interview between Goodman and Welcome, discussing the case of Elmer Allen:

“AMY GOODMAN: I want to turn to Eileen Welsome, who won the Pulitzer Prize for revealing the names and doing the investigation into eighteen people who were injected with plutonium in the ’40s without their knowledge by federal government scientists. In a 2004 interview on Democracy Now!, I asked Eileen Welsome about one of those people. His name was Elmer Allen.

EILEEN WELSOME: The sad part about and the tragic part about Elmer’s story is that nobody believed him. He went to his doctor and told him, you know, “I think I’ve been injected with something.” His doctor diagnosed him as a paranoid schizophrenic at the same time that he was conversing with the atomic energy scientists in Argonne National Lab to provide them with tissue samples and—

AMY GOODMAN: Wait, wait, wait. His doctor said he was a paranoid schizophrenic at the same time his doctor was providing Elmer’s tissues to the government scientists doing the experiment?

EILEEN WELSOME: That’s correct. That’s what the medical records show. So, Elmer was not only used in 1947 when he was injected with this radioactive isotope, but he continued to be used as a guinea pig for the rest of his life.

AMY GOODMAN: That was Pulitzer Prize-winning journalist Eileen Welsome. She revealed the names of eighteen people in this country injected with plutonium. Elmer Allen was a black conductor on a train in San Francisco. He was injected at the University of San Francisco hospital. This story of the people injected with plutonium, he’d always said—he used the term “I was guinea-pigged by the government.” His wife was a nurse. His daughter was a teacher. We spoke with Elmerine Allen, his daughter. They never understood what he was saying, and they believed what the psychiatrist was saying. Yet the psychiatrist was working with the US government, telling them he was crazy. But he wasn’t.”

And another story about medical experimentation on Puerto Rican women:

“So, what happened in Puerto Rico is that the research, you know, for birth control pills was done—the major work was done here in Massachusetts, actually, but giving out birth control pills was illegal. Contraception was illegal in Massachusetts. So the research was done in Puerto Rico. And the use of very high estrogen dosages was because at that point they really weren’t sure what would be necessary, and they wanted to absolutely make sure that they could stop the pregnancies. So, and there were connections to people. They were working with a physician who had connections in Puerto Rico. So, that’s one of the reasons they went there. There were some objections, clearly, within the Puerto Rican community to this, but women also, frankly, wanted a better way to protect themselves from endless pregnancy. At that point, in Puerto Rico, the Church actually protected sterilization and thought sterilization was acceptable after women had had enough children. But the Church actually objected to the research on the pills, when a number of women—we think a couple of women died because of the high estrogen.”

I raise these stories here to make the point that there is a long history of abuse, gross mistreatment, and exploitation of people of color by the medical establishment in this country. Such stories are documented both in the accounts of these unnamed Puerto Rican women, Elmer Allen, and in several excellent books that show the disturbingly recurrent and often government-sanctioned nature of these practices. Jennifer Nelson ‘s exceptional book, Women of Color and the Reproductive Rights Movement, explores the widespread practices of sterilization abuse wherein mostly white male doctors performed hysterectomies on women of color without their knowledge and consent for decades, with some of the most notable examples of this being the forced sterilization of Fannie Lou Hamer , a 1960s activist, and Minnie Lee Relf, a mentally disabled young woman who was underwent this process at age 13 without giving consent or understanding the effects of the procedure. Rebecca Skloot’s book, The Immortal Life of Henrietta Lacks, also explores the medical community’s exploitation of a poor black woman’s medical tissue without her or her family’s consent.

These cases abound, and there are probably additional ones of which I am unaware. The common theme among them, however, is the story of white doctors and other members of the medical establishment—often acting with the support of local, state, and federal governments—engaging in ethical and medical violations that exploit communities of color in various ways. These practices erode trust, minimize confidence in the medical establishment, and most importantly, manifest some of the worst forms of racial dehumanization and inequality. Yet they also highlight a particular irony in contemporary discourses about race relations. Often, one of the talking points used to imply that blacks are oversensitive and embellish racial issues is the citation that blacks are more likely to believe various theories about the inception and spread of the AIDS virus that point to government complicity or intent.

In 2005, a Washington Post article cited that more than 25% believed the virus was produced by the government, 12% believed the CIA was responsible for spreading it, and 15% asserted that it was a form of genocide among black people. During the 2008 presidential campaign, Dr. Jeremiah Wright was widely mocked for his endorsement of some of these statements, which were used to further the image of him as a crazy radical (and by extension, to cast doubt upon then-Senator Obama). Ultimately, the statistics about the number of blacks who believe government involvement in the creation and/or spread of the AIDS virus are often used to imply that blacks are paranoid, crazy, and grossly exaggerate racial issues to the point where they believe absurd conspiracy theories, or else that their willingness to endorse such theories hinders their treatment. This latter argument is particularly significant when it comes to the spread of HIV, since black Americans comprise only about 14% of the population but constitute the majority of new AIDS cases. Both arguments, however, suggest that the endorsement or embrace of these beliefs represents something problematic on the part of black Americans.

Rather than dismissively marginalizing African Americans’ perceptions or blaming them for allowing these beliefs to influence their health practices, I think that the recent information about yet another case of the medical community’s egregious breach of the trust of minority communities should spur a renewed attention to the continued, ongoing perils of racial stratification and inequality. Susan Reverby’s findings are undoubtedly important and critical, both on their own and because they point to a larger pattern of state-sanctioned medical abuse. But they also give broader context to ongoing public health issues like the rise of HIV/AIDS in black communities. With information available about the Tuskegee Experiment, Henrietta Lacks, Minnie Lee Relf, and now the Guatemalan women who were deliberately infected with viruses, it’s not so surprising that the theories about government involvement in the AIDS virus might take hold among certain communities who have been the target of the worst kinds of medical racism.

Let me be clear: I am not writing this to advocate the theory that the AIDS virus was government invented. However, I do believe that these blatant examples of the medical establishment’s state-sanctioned abuse of minority communities have a great deal to do with why blacks in particular are less likely to trust doctors and government.  I also think it’s a mistake to suggest that blacks who hold this belief are the problem, given that there is ample evidence that government has in the past engaged in medical experimentation, mistreatment, and negligence when it comes to people of color. Acting as if some blacks’ concerns about the origins of the AIDS virus are evidence of racial paranoia or a self-imposed inhibitor to treatment is akin to suggesting that black men who express misgivings about the criminal justice system are inventing a paranoid racial reality, rather than relying on exhaustive evidence of racial profiling and disproportionate arrest rates.

The larger issue, in my opinion, is to assess how we can create a more racially equitable society so that these sorts of egregious violations don’t exist to eradicate trust in the first place.

Guatemala: New Research on Ethical Violations by White Researchers

• • government action, health, history, scholarship, scientific racism

Susan Reverby, a Wellesley College professor, recently discovered records that reveal a two-year study designed by white researchers and supported by the U.S. government was conducted in which people in Guatemala were intentionally infected with sexually transmitted diseases (STDs).

This STD study conducted from 1946-48, health researchers from the United States and Guatemala intentionally infected Guatemalan sex workers, prisoners, soldiers, and hospitalized psychiatric patients with gonorrhea, chancroid, and syphilis.  Reverby’s student prompted the U.S. Department of Health & Human services to release this information about the study.  It is officially referred to as “The 1946 STD inoculation study.”   And in an email statement, Dr. Thomas Frieden, head of the Centers for Disease Control (CDC) – the current version of the institution that originally ran the study – said this:

The 1946 STD inoculation study should never have happened.  We are committed to the respect and safety of research participants.  In this spirit, the U.S. government will convene an international group of experts to review and report on the most effective methods to ensure that all human medical research conducted around the globe today meets rigorous ethical standards and how training of researchers will ensure such abuses do not occur.  If you have questions or comments regarding ethical human research and this study, please send them to 1946Study@cdc.gov.

This renewed commitment to ethical research by Dr. Frieden is an important one but may fail to persuade skeptical listeners familiar with the history of other ethical violations.

The fact is that the researcher who discovered the Guatemalan study made this discovery in the archived papers of Dr. John Cutler, a U.S. public health researcher who was also involved in the Tuskegee syphilis study.  Cutler was white and all the “participants” in the study were African American men.   While the Tuskegee study design did not intentionally infect subjects with syphilis (a common misunderstanding), the researchers violated medical and research ethics by withholding treatment – a simple shot of penicillin – that would have effectively cured the disease.   Further, the men in the study were never told that they were being used as research subjects.   The combination of these two facts (withholding medical treatment that would have cured the disease, and not telling them they were research subjects) are used as textbook examples of ethical violations in research.   The additional, and some could argue, central fact that these were white researchers violating the human rights of black subjects is an ethical violation that continues to reverberate today in a variety of ways.    (For further research on Tuskegee, see James H. Jones’ classic text, Bad Blood and the more recent, and broader in scope, Medical Apartheid, by Harriet Washington.)

The reality is that the actions of Cutler, in Tuskegee and Guatemala, were not the isolated actions of a “bad apple” working outside the aegis of the CDC (and its predecessor organization, the U.S. Public Health Service).   He was a well-respected M.D. and public health researcher who defended his involvement in the Tuskegee study until his death in 2003.  (For video footage of Cutler defending Tuskegee on camera, be sure to see the documentary The Deadly Deception, which also includes interviews with a handful of the survivors of the study.)

Both the studies designed by Cutler, in Guatemala and in Tuskegee, Alabama, were premised on several notions that remain with us today.  First, is the notion that the pursuit of “scientific knowledge” is a worthwhile goal in and of itself, followed closely by the idea that pursuing this goal justifies almost any means necessary to achieve it.  Still with us, too, is the idea that white researchers are somehow entitled to the biological “resource” of others.   As a society, we continue to subscribe to the idea that there are some groups of people who, because they are less powerful, it’s okay to conduct research on them.   Perhaps the key idea underpinning Cutler’s research was that the “course of the disease” of syphilis would be different in blacks (or Guatemalans) than in whites.  Today, many continue to cling to facile notions of racial differences in biology, while research consistently show these are insignificant.  These ideas, taken together, share much in common with the worldview of the doctors that Robert Jay Lifton describes in his book, Nazi Doctors, about the physicians who practiced medical experimentation on Jews held in concentration camps.    In an interview with Cutler, James H. Jones asked him whether he saw any similarity between his study at Tuskegee and the experimentation in the death camps.  Cutler, looking incredulous and wounded, replied, “But they were Nazis!”

When the panel Frieden is convening comes together, they would do well to not only review the historical legacy of racism in public health, but keep in mind the way these ideas continue to permeate public health research today.

Racism & Health: New Evidence

• • health, racism

Racism is bad for your health, new evidence suggests.  We’ve written before about the link between racism and health.  Traditionally, scholars have conceptualized this in only one direction; that is, racism is bad for people of color.   African Americans, Latinos, Asian Americans who are the targets of racism are worse off than whites in terms of their health on a wide range of measures.   Some of this is about health disparities rooted in income inequality, but there’s a growing body of research that points to racism as a root cause for at least part of these differences.  Now, some new research suggests that racism may also be harmful for white people.

Elizabeth Page-Gould discusses some of this in a recent piece at Alternet:

In one study, Wendy Berry Mendes, Jim Blascovich, and their colleagues invited European-American men into the laboratory to engage in social interactions with African-American men or with men of the same race as themselves. The participants were hooked up to equipment that measured the responses of their autonomic nervous system while they played the game Boggle with their white or black partners.  When interacting with African-American partners, the white men tended to respond as to a physiological threat, marked by diminished blood pumped through the heart and constriction of the circulatory system. However, European Americans who had positive experiences with African Americans in the past responded as though the game posed a challenge—increased blood pumped by the heart and dilation of the circulatory system.

This doesn’t seem to be an isolated finding.  Page-Gould conducted similar research and found that those who scored high on a measure of prejudice had increases in cortisol during the friendly interaction with a cross-race partner, but produced less cortisol when interacting with a same-race partner.  Those who were low in prejudice were not stressed during either cross-race or same-race interactions. In other words, prejudiced individuals perceived partners of a different race as a physical threat, even though they were in a safe laboratory setting and engaging in a task that was structured to build closeness between the participant pairs.

While this research focuses on individual level prejudice, other research points to the harmful effects of structural, institutional racism for whites’ health.

The good folks at Sociological Images caught some new research by Philip Cohen of Family Inequality which demonstrates one of the many hidden costs of racism.  In Cohen’s recent paper published in the Journal of the American Society of Nephrology, he illustrates that in any given neighborhood in addition to the traditional way we’ve understood racism and health – that black people are always less likely to get access to a kidney specialist before their kidneys fail – there’s also another trend that’s bad news for white folks.  White people living in a neighborhood with a higher percentage of blacks are less likely than whites in a predominantly white neighborhood to see a specialist.  In other words, whites also suffer from the institutional racism that structures residential segregation.

(Image from SocImages)

I think it’s important to point out the ways that racism also costs whites as a strategy for dismantling this American version of apartheid that continues here.  Both of the pieces that report on this research frame the research in terms that are meant to appeal to whites’ self-interest.   Page-Gould (Alternet) writes:

“In the urban metropolises of the United States and Canada, it is almost impossible to avoid talking to someone of another race. So imagine the toll it would take if every time you did, your body responded with an acute stress reaction: You experience a surge in stress hormones, and your heart pumps harder while your blood vessels constrict, inhibiting the flow of blood to your limbs and brain.These types of bodily reactions are helpful in truly dangerous situations, but a number of recent studies have found that racially prejudiced people experience them even during benign social interactions with people of different races. This means that just navigating the supermarket, coffee shop, or modern workplace can be stressful for them. And if the racist person then has to go through this every single day, the repeated stress can become a chronic problem, which places them at heightened risk for disease in later life.   Harboring prejudice, it seems, may be bad for your health.”

The intended audience member here seems to be the prejudiced white reader who, unable to avoid encounters with people of color, should learn to react differently or risk harming their health.   As powerful as the imperative to health is (especially among whites), I doubt this is going to shift anyone’s approach to cross-racial interactions.    As an urban dweller in the U.S. in a reasonably diverse city, I can attest to the ways that people remain racial segregated and can quite easily never interact with someone of another race.

The persistence of racial segregation in housing is also part of the problem I have with the analysis of whites’ self-interest in the kidney failure study.  It seems just as likely – maybe more – that whites would read that research by Cohen and conclude, “ah, note to self: do not live in predominantly black neighborhood.”  Lisa, writing at SocImages, is more pointed in her framing of the research:

White people should worry about racism.  They should worry about racism because it’s wrong.  But if that’s not enough of a motivation, they should worry about it for their own damn good.

Yeah, they should.  We should.   I’m just skeptical that self-interest will triumph where an entire civil rights movement based on moral reasoning has failed.

No Post-Racial America: Racial Inequalities in US Medicine

• • academic, African Americans, diversity programs, education, health, Native American



Over at diversityinc.com, Gail Zoppo has an important post—“Is There a Black, Latino Doctor in the House?”– on the huge problem of lack of people of color in U.S. medical schools and professions. Racial inequality remains central in the medical professions and facilities in this “post-racial America.” We still have relatively few black, Latino, and Native American medical students across the country. Zoppo underscores the slow pace of improvement, noting that three years these groups made up only 15 percent of the 40,000 applicants to U.S. medical schools, even as they make up a third of the U.S. population in their typical age range. (She does not discuss data on Asian Americans in her post.) This is a key result from this longterm reality:

That same year, only 8.7 percent of doctors were from these underrepresented groups, according to a study published in the Journal of Academic Medicine.

She then discusses where we are at in the recent American Association of Medical Colleges data, just slight changes since 2006:

Among the 42,269 med-school applicants in 2009, only 16 percent were Black, Latino or American Indian.

Other medical professions are also characterized by a lack of black, Latino, and Native American personnel:

… a mere 6.9 percent of people from underrepresented groups ended up as dentists in 2007, only 9.9 percent were pharmacists and just 6.2 percent were registered nurses.

One national issue is also that white medical personnel are much less likely to work in undeserved communities of color:

Black, Latino and American Indian/Pacific Islander physicians are nearly three to four times more likely than whites to practice in underserved communities, reports the AAMC.

On the positive side, Zoppo does discuss some important attempts to deal with this underrepresentation in medical schools and professions, such as the Rutgers University Office for Diversity and Academic Success in the Sciences (ODASIS)

How Diverse is the Dominant US Culture?

• • capitalism, health, international, media, popular culture



Often when I am talking about how the dominant culture in the U.S. is white-centered, shaped, and maintained, someone usually pipes up with a comment about the “diverse” array of foods that are now central to our “highly diverse” general culture.

They like to cite Chinese food, Japanese food, Middle Eastern food, Asian-Indian food, Mexican food, and so on, to try to make the point that whites of European origin no longer dominate U.S. culture, and thus that the U.S. is a truly “diverse” culture. There is certainly some truth to this reality of diverse foods and some other cultural features, such as music, but the typical comments miss very important points.

One of these is how adulterated much of this “diverse food” really is. I have been reading former FDA Commisioner (and MD) David Kessler’s relatively new book, The End of Overeating, and at one point he makes this very important point:

Bottled teriyaki sauce … combines soy sauce and rice wine to mimic Japanese flavorings, putting an American spin on a classic Japanese cooking technique. The amount of added sugar makes it far sweeter than anything found in Japan. We’ve also invented new approaches to sushi classics—for example, mayonnaise-topped tempura shrimp now comes wrapped in rice as a sushi roll. . . . The dish we call ‘General Tso’s chicken’ is loaded with sugar, much to the consternation of the Taiwanese chef who created it. . . . Traditional Chinese cuisine also makes use of a lot more vegetables than are included in our versions.

Many other international foods are similarly adulterated with high fat, high sugar and/or high salt.. Kessler discusses throughout his book how U.S. food corporations have aggressively added sugar, fat, and salt to—and otherwise significantly altered–many food items from across the world. So, Chinese food is not really Chinese food, and Mexican food is not exactly Mexican food. And so on.

Working for top corporate executives in the food industry, who are aggressively seeking so much added profit that people are often harmed, thousands of U.S. workers are constantly redesigning the world’s foods to fit what Kessler calls “American desires.” Once again, as we often ask here, just who are the Americans who have disproportionate power to redesign the world’s foods — and then to successfully manipulate via advertising, the media and other avenues U.S. (and then overseas) consumers to eat them (and, increasingly, become obese)?

I have not seen any demographic data on these top food industry executives lately, but I’ll bet they are mostly white, male, and upper middle class and middle class. And the Us food culture is not as international and diverse as it is often made out to be.

Colorblindness Linked to Racism Online and Off

• • cyber racism, discrimination, health, social networking sites

An important and path breaking new study links colorblind racial ideology to racism online and off.  The study, by Brendesha Tynes, a professor of educational psychology and of African American studies at University of Illinois at Urbana-Champaign and Suzanne L. Markoe of the University of California, Los Angeles, is published in the March issue of Journal of Diversity in Higher Education.

The study, which examined the relationship between responses to racial theme party images on social networking sites and a color-blind racial ideology,  found that white students and those who rated highly in color-blind racial attitudes were more likely not to be offended by images from racially themed parties.  In other words, the more “color-blind” someone was, the less likely they would be to find parties at which attendees dressed and acted as caricatures of racial stereotypes (e.g., photos of students dressed in blackface make-up attending a “gangsta party” to celebrate Martin Luther King Jr. Day) offensive.

To conduct the study, Tynes and Markoe showed 217 ethnically diverse college students images from racially themed parties and prompted them to respond as if they were writing on a friend’s Facebook or MySpace page.   Fifty-eight percent of African-Americans were unequivocally bothered by the images, compared with only 21 percent of whites. The majority of white respondents (41 percent) were in the bothered-ambivalent group, and 24 percent were in the not bothered-ambivalent group. n the written response portion of the study, the responses ranged from approval and nonchalance (“OMG!! I can’t believe you guys would think of that!!! Horrible … but kinda funny not gonna lie”) to mild outrage (“This is obscenely offensive”).

The students also were asked questions about their attitudes toward racial privilege, institutional discrimination and racial issues. Those who scored higher on the measure were more likely to hold color-blind racial attitudes, and were more likely to be ambivalent or not bothered by the race party photos.  Respondents low in racial color-blindness were much more vocal in expressing their displeasure and opposition to these images, and would even go so far as to “de-friend” someone over posting those images.

Tynes’ research also revealed an incongruence of reactions among white students that she’s dubbed “Facebook face,” which she explains in an interview:

“To their friends, they would express mild approval of the party photos or just not discuss race,” Tynes said. “But in private, in a reaction that they thought their friends wouldn’t see, some students would let us know that they thought the image was racist or that it angered them. We think that it’s because whites have been socialized not to talk about race.”

According to Tynes, a color-blind racial attitude is the prevailing racial ideology of the post-Civil Rights era, and is the view that seeing race is inherently wrong:

“If you subscribe to a color-blind racial ideology, you don’t think that race or racism exists, or that it should exist. You are more likely to think that people who talk about race and racism are the ones who perpetuate it. You think that racial problems are just isolated incidents and that people need to get over it and move on. You’re also not very likely to support affirmative action, and probably have a lower multi-cultural competence.”

Since a color-blind racial ideology is associated with endorsement of the racial theme party photos, Tynes says that mandatory courses on issues of racism and multicultural competence are necessary for students from elementary school through college.

Tynes, who recently was awarded a $1.4 million grant to study the effects of online racial discrimination by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, said that along with the role children and adolescents play in producing online hate, her inspiration for the study was the numerous racially themed parties that occurred on college campuses across the country in 2007 and the resultant blowback when images from the parties were posted on Facebook and MySpace.

The “Racism” in the Health Care Bill: Tanning Beds

• • government action, health, politics, white privilege, whites



Think Progress posted this piece today:

The recently passed health care reform act includes a 10 percent tax on indoor tanning salons to help pay for expanded insurance coverage for millions of Americans. Radio host Doc Thompson, subbing in for Fox News host Glenn Beck on his radio show today, used the tax to make the absurd accusation that the health bill is somehow “racist”:

“For years I’ve suggested that racism was in decline and yeah, there are some, you know, incidents that still happen with regards to racism, but most of the claims I’ve said for years, well, they’re not really real. But I realize now that I was wrong. For I now too feel the pain of racism. Racism has been dropped at my front door and the front door of all lighter-skinned Americans. The health care bill the president just singed into law includes a 10 percent tax on all indoor tanning sessions starting July 1st, and I say, who uses tanning? Is it dark-skinned people? I don’t think so. I would guess that most tanning sessions are from light-skinned Americans. Why would the President of the United Stats of America — a man who says he understands racism, a man who has been confronted with racism — why would he sign such a racist law? Why would he agree to do that? Well now I feel the pain of racism.”

This sounds like a parody, but this fellow Thompson is quite serious about Obama doing racist stuff to whites. He of course ignores an important reason for such a modest provision in the legislation–to reduce some skin cancers.

If he were not serious, we could all laugh ourselves silly about such an commentary on a major radio show. Can the far-reaching imaginations of playwrights of the absurd even begin to match such societal reality today?