Can ‘biological race’ explain health disparities?

Can 'biological race' explain health disparities?

Unveiling the Impact of Racism on Health: Beyond Biological Differences

Racism and Healthcare Design by Andrew Nguyen

Millions of people face racism on a daily basis, a problem that not only affects their day-to-day lives but also seeps into healthcare, often resulting in life-threatening consequences. The question arises, can biological differences explain racial health disparities, or is the misuse of science preventing us from truly understanding the root of the problem?

Microaggressions: Unintended Harms in Healthcare Settings

Microaggressions, a term coined to describe negative racial slights, biases, prejudices, and insults, have become a pervasive issue affecting people of different races and ethnicities. These instances can occur anywhere, and healthcare settings are no exception. Patients and healthcare workers alike experience the negative consequences of such discrimination, leading to lower standards of care and a higher risk of illness.

Recently, I found myself being asked a question that left me feeling uncomfortable and somewhat singled out. It made me wonder if individuals of different ethnic or racial backgrounds would face similar interrogation. These instances, although seemingly innocuous, contribute to the larger issue of racism within healthcare.

The Impact of Microaggressions: Personal Stories and Pandemic Speculations

Dr. Monique Rainford, an obstetrician and gynecologist, and author of the book “Pregnant While Black,” along with Angela Saini, a science journalist and author of “Superior: The Return of Race Science,” shed light on the impact of racism on health and the questionable basis for health disparities among different racial groups.

Dr. Rainford explained how microaggressions manifest as subtle and indirect offenses, often leaving individuals feeling marginalized and discriminated against. Angela Saini shared her experience during the early days of the COVID-19 pandemic when medical professionals speculated about racial differences in virus susceptibility—a practice lacking scientific evidence.

Racism in Maternal Health: Unearthing Tragic Stories

The impact of racism on maternal health is particularly devastating. Dr. Rainford recounted the tragic story of Dr. Shalon Irving, a Black mother who died from complications of high blood pressure three weeks after giving birth. Despite her background as an epidemiologist at the Centers for Disease Control and Prevention (CDC), she faced challenges in receiving appropriate medical care, highlighting the failures within the system.

This heartbreaking story motivated Dr. Rainford to delve deeper into the disparities faced by Black women in America, ultimately leading her to write her book. Examining these disparities became imperative for understanding and addressing the problem at hand.

The Stress of Racism: Unraveling Epigenetics and Weathering

The impact of racism on health extends beyond immediate consequences. Epigenetics, the study of changes in gene expression caused by environmental factors, plays a crucial role in understanding the long-term effects of racism. Dr. Rainford highlighted the findings of Dr. David Barker and Dr. Kent Thornburg, who observed transgenerational effects of adversity and stress, including chronic stresses of racism, on immune system function, mental health, and even gut microbiome composition.

Furthermore, Dr. Arline T. Geronimus coined the term “weathering” to describe the cumulative wear and tear on the body due to chronic stress caused by racism. Black individuals, for instance, may experience accelerated aging, reflected in a biological age exceeding their chronological age, predisposing them to diseases at an earlier stage of life.

Challenging Biological Explanations: The Role of Environment and Education

Exploring racial health disparities often leads to discussions around biological factors like the renin-aldosterone-angiotensin system. However, Angela Saini emphasized the lack of genetic evidence to support assumptions of inherent racial differences in health outcomes. She cited the work of Canadian epidemiologist Jay Kaufman and American hypertension expert Richard Cooper, who challenge the notion that biological differences explain racial health disparities.

Dr. Rainford further highlighted the role of environmental factors in health outcomes, particularly for disadvantaged communities. Access to fresh food, air pollution levels, and socioeconomic factors contribute significantly to health disparities. Addressing these structural issues goes beyond biology and necessitates societal changes.

Debunking the Concept of Race as a Biological Variable

The classification of race is not a fixed and objective variable. Angela Saini emphasized that racial categories have changed over time and vary between countries, shaped by historical politics, colonialism, and power dynamics. Applying color-based categories to understand human variation is outdated and fails to account for the complexity and fluidity of racial identities.

Angela Saini further stressed the importance of integrating social sciences and humanities into medical education to provide a more accurate understanding of race. By recognizing that race is a socially and politically defined concept, medical professionals can gain a clearer perspective on health disparities and challenge previously held biases.

Nurturing Change: Education, Representation, and Acknowledging Bias

Transforming the healthcare system and dismantling racism requires more than just representation. Angela Saini highlighted how the high representation of ethnic minorities within the U.K.’s National Health Service (NHS) has not led to a reduction in racism within the institution. Stereotypes and biases still persist due to deeply ingrained educational systems.

Dr. Rainford called for a comprehensive approach, addressing not only racial disparities but also the social, financial, and educational support necessary to overcome the effects of historically racist policies. Changing the education system to include a more accurate understanding of race and actively checking personal biases are crucial steps towards progress.

Continuing the Conversation: Unlearning, Awareness, and Action

Creating change requires ongoing dialogue and uncomfortable conversations. By opening our minds and critically examining societal norms, we can challenge deeply rooted biases. Initiating conversations, even within ourselves, is essential for personal growth and ultimately dismantling systemic racism.

Dr. Monique Rainford reminded us that as individuals, we must continuously strive to question our own beliefs and biases. Addressing racism is not limited to external factors; it requires personal reflection and change on an individual level.

In conclusion, racial health disparities cannot be solely attributed to biological differences. The impact of racism on health permeates multiple levels, from microaggressions in daily life to biases within healthcare systems. By recognizing the societal and environmental factors influencing health outcomes and fostering a deeper understanding of race, we can work towards achieving health equity for all individuals, regardless of their race or ethnicity.