Week 7 Journal: Race and Health

May 24

When we refer to ethnic identity, we are using highly malleable social groupings, not biological demarcations. In genetic terms, all human beings are more than 99.9% the same (Roberts, 2016). And if the remaining 0.1% falls outside of racial bounds, why do so many instances of racial bias continue to appear in clinical technologies? Race isn’t just a convenient technical shorthand for diagnosis bias. It has a deeply disturbing history, where Civil War era physicians such as Samuel Cartwright ‘discovered’ the mental illness of drapetomania, the desire of a slave for freedom. The condition of genu fluxit, in which slaves exacted awe and reverence towards their master. And dysaesthesia aethiopica, used to explain the perceived lack of work ethic among slaves (Cartwright, 1851). Cartwright promoted the idea that different races experience disease differently, arguing that slavery was beneficial for black people (Cartwright, 1860). Given their lower lung capacity, a claim still upheld today by modern spirometers (Braun, 2015) and pulse oximeters (Moran-Thomas, 2020), Cartwright argued forced outdoor labor was good for them.

Such insights are of course, abhorrent. But they illustrate that technology bias is ultimately human bias. That clinical instruments are only as biased as those who create them. The problem of ‘correcting for race’ (Roberts, 2016) isn’t in the technology, it’s in the continued upholding of the bias, which results in widespread difference in racially motivated healthcare decisions, reduced access to resources, and the perpetuation of discrimination. Seeing race as a social category of discrimination which shapes biological outcomes, allows us to surface the legacy of structural violence which produces them, offers a path for us to reverse the past’s failures of humanity (Kleinman, 1989), and shapes a future which dismantles longstanding bias.

References:
Braun, L. (2015). Race, ethnicity and lung function: A brief history. National Library of Medicine. [Digital File]. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631137/.
Cartwright, S. (1851). Diseases and Peculiarities of the Negro Race. DeBow's Review. Vol. 11, no. 1. 1851 pp. 64–74. [Digital File]. Retrieved from: https://en.wikipedia.org/wiki/Samuel_A._Cartwright.
Cartwright, S. (1860). Slavery in the light of ethnology. In: Elliott EN, editor. Cotton is king and proslavery arguments. Augusta: Pritchard, Abbott & Loomis; 1860. [Digital File]. Retrieved from: https://archive.org/details/cottoniskingpros00elli/page/n703/mode/2up.
Kleinman, A. (1989). The Illness Narratives: Suffering, Healing, And The Human Condition. Basic Books. [Digital File]. Retrieved from: https://canvas.upenn.edu/courses/1781220/files/133613891?module_item_id=29900548.
Moran-Thomas, A. (2020). How a Popular Medical Device Encodes Racial Bias. The Boston Review. [Digital File]. Retrieved from: https://www.bostonreview.net/articles/amy-moran-thomas-pulse-oximeter/.
Roberts, D. (2016). The problem with race-based medicine | Dorothy Roberts. YouTube.com. [Digital File]. Retrieved from: https://www.youtube.com/watch?v=KxLMjn4WPBY.