Mixed Race Studies

Genomics and Health Care Disparities: The Role of Statistical Discrimination

The Journal of the American Medical Association
Volume 308, Number 19 (2012-11-21)
pages 1979-1980
DOI: 10.1001/2012.jama.10820

Katrina Armstrong, MD, MSCE, Professor of Medicine
University of Pennsylvania School of Medicine

Ten years ago, 2 events occurred that have transformed biomedical research. In 2001, the draft sequence of the human genome was announced. One year later, the Institute of Medicine released “Unequal Treatment,” the first comprehensive report on racial and ethnic health care disparities in the United States.1 Although the report downplayed the contribution of genetics to disparities, enthusiasm about the human genome spread rapidly to disparities research, creating a new field focused on translating knowledge of human genetic variation into reductions in disparities in health and health care. This Viewpoint examines the potential contribution of 2 pathways in this field—the identification of genetic variation as a cause of disparities and the reduction of clinical uncertainty and statistical discrimination. The terms race and ethnicity are used to mean socially determined, generally self-reported, categories.

A common hypothesis is that advances in human genomics will reduce disparities by identifying genetic causes of disparities. In support of this hypothesis, racial and ethnic differences in genetic variant frequency have been demonstrated for many diseases. However, translating this evidence into reductions in disparities has proven challenging for several reasons. First, many variants identified have a small attributable risk and explain little of the disease burden in any group, either because of a weak association between variant and disease or because the variant is rare in the population. Second, far more genetic variation occurs within racial or ethnic groups than between groups,and disease-associated variation has no apparent predilection for the 4% to 8% of variation that can be linked to race or ethnicity. Thus, if genomic variation explains a minority of most diseases and is unlikely to be linked to a racial or ethnic group, it becomes unlikely that genomic variation between groups will be a substantial cause of disparities in most common diseases. Third, developing interventions based on this information is challenging. Although prenatal or even premarital genetic screening can reduce the burden of severe diseases if screening influences reproductive decision making, lack of acceptance of these approaches has limited their effectiveness. For other diseases, knowledge of genetic risk factors should increase the ability to target preventive interventions to high-risk individuals. However, the limited effect of genomics on risk prediction for many diseases combined with the relative paucity of effective preventive interventions for some diseases has limited the benefit of such an approach.

Another pathway by which genomics may reduce racial disparities that has received considerably less attention is its effect on clinical uncertainty and statistical discrimination. The need to make decisions under conditions of uncertainty is one of the hallmarks of medicine. This uncertainty arises on 2 levels. For many decisions, there is no credible and consistent evidence about risks and benefits of different interventions. Moreover, even when evidence exists, uncertainty arises about the effect of that evidence on the individual patient. The gap between the average effect in a population and the effect in a specific patient can be substantial, in part because of differences between patients in practice and trial participants and in part because the average effect in a trial masks substantial variation among trial participants…

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The concept and measurement of race and their relationship to public health: a review focused on Brazil and the United States

Cadernos de Saúde Pública/Reports in Public Health
Volume 20, Number 3, Rio de Janeiro, (May/June 2004)
pages 660-678
DOI: 10.1590/S0102-311X2004000300003

Claudia Travassos
Departamento de Informações em Saúde
Centro de Informação Científica e Tecnológica,
Fundação Oswaldo Cruz, Rio de Janeiro, Brazil

David R. Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health; Professor of African and African American Studies
Harvard University

Race has been widely used in studies on health and healthcare inequalities, especially in the United States. Validity and reliability problems with race measurement are of concern in public health. This article reviews the literature on the concept and measurement of race and compares how the findings apply to the United States and Brazil. We discuss in detail the data quality issues related to the measurement of race and the problems raised by measuring race in multiracial societies like Brazil. We discuss how these issues and problems apply to public health and make recommendations about the measurement of race in medical records and public health research.

“Race is a social construct, but as for other aspects of social stratification, with biological consequences.”

The notion that health is influenced by the social position of individuals has been known for many centuries. Nancy Krieger notes that since Hippocrates the relationship between health and social position has been acknowledged. It has also been shown that social disparities in mortality exist for almost all causes of death in most societies, and these disparities have been increasing in recent decades in several developed countries.

Race has been used extensively in the medical and public health literature, especially in the United States, to measure social differences in health outcomes and treatment, and its use has increased in recent decades. In the US, there is a vast literature that relates race to disparities in health outcomes, which shows that race is an important predictor of health status. “Blacks” in the US are disadvantaged compared to “Whites” on most indicators of economic status and health. Despite a reduction in these racial inequalities on both of these indicators during and immediately after the Civil Rights movement (the mid-1960s to the mid-1970s), they have remained large or have widened ever since. In the US, adjustment for socio-economic status (SES) always reduces and sometimes even eliminates racial disparities in health. A recent publication of the Institute of Medicine also documented that there are large racial differences in the quality and intensity of medical treatment in the US, even after adjustment for access factors, SES, and severity of illness.

In Brazil, there are fewer studies of racial inequalities in health. Batista, using data from death certificates, has shown that “Black” men and women had the highest crude mortality rates in 1999 in the State of São Paulo. Data based on census and national household surveys show that aggregate infant mortality in Brazil in the years 1977, 1987, and 1993 was higher for “Blacks and “Pardos” (“Browns”) and that it declined at a lower rate when compared with “Whites”. Martins & Tanaka, using data from the Committee on Maternal Mortality, have also shown large differences in the risk of dying due to maternal causes in the State of Paraná in the years 1993 and 1997, which disproportionately affected “Black” and “Yellow” (Asian) women. Maternal mortality did not differ between “Parda” (“Brown”) and “White” women. Dachs, using data from the 1998 National Household Survey (PNAD), found no statistically significant difference by “skin color/ race” in self-assessed health status after adjusting for education and income level. Barros et al., based on longitudinal data, have shown worse health outcomes for “Black” children in Southern Brazil, which is reduced after adjustment for SES and various other variables (marital status, maternal age, parity, planned pregnancy, social support, smoking, work during pregnancy, and antenatal care). The study results also suggest that “Black” mothers receive lower quality of care as compared to “White” ones. There are also indications that in Brazil racial inequalities are more common in treatment than in access to health care services.

The objective of this article is to review the literature related to the concept and measurement of race with a focus on the US and Brazil. We will discuss both the measurement of race in these two multiracial societies and data quality problems. We also make recommendations about the measurement of race in medical records and public health research. Although the use of race in public health research has been discussed in relation to definitional and methodological problems in the United States, the Brazilian public health literature has not discussed in detail how such problems apply to Brazil. This article is intended to review the literature and introduce a discussion regarding broader as well as country-specific questions and problems related to the use of this category in public health…

…Despite the fact that race has been used as a surrogate for genetic information until the onset of molecular genetics, there is no scientific support to continue using race in Public Health as a marker for genetic susceptibility. Parra et al. have recently shown that skin color in Brazilians cannot be used as a genetic marker, because physical traits have been shown to be a poor predictor of African ancestry in this population. In both the United States and Brazil, although the risk of sickle-cell anemia varies by race, race is not a reliable predictor of sickle-cell anemia…

…Despite existing controversies in the biomedical literature, it is widely accepted that racial/ethnic categories are imprecise and changing measures that are historically, administratively, and politically constructed. The salience given to race, as well as the meaning and the measure of race itself in census and health data, varies across countries and across time. The history of race classification in the US and Brazil are good examples of these variations as will be discussed later in this article…

…Measuring race in admixed populations

The question of whether populations of mixed origins can be categorized into any simple, finite, discrete categories is becoming central to racial/ethnic taxonomy. Some societies have large proportions of admixed people and many others are increasingly becoming admixed. Immigration in the US, especially from Latin American countries, increased in the last few decades, making its population much more heterogeneous. The projection of the US Census Bureau is that by 2050 one half of the US population will be “Non-White” and 21% of the population will be of multiple ancestry.

Despite the possibility of answering questions with multiple races, the new OMB classification in the US is not a good solution for classifying admixed people. For miscegenation that goes back many generations, individuals simply do not know about their ancestry. Whenever people’s parents, grandparents, and great-grandparents descend from intermarriages of admixed people, “pure” ancestry becomes very difficult to trace. In Latin American countries such as Brazil where miscegenation occurred at very early stages, it is difficult for a large number of people to answer questions about their origins.

It can also be argued that people do not know their ancestry because origin played a distinct role in societies with early miscegenation. As a result, many people may not find a place in any of the selected discrete “races” categories. In the 2000 US census, 43% of people that identified themselves as “Hispanic or Latino” chose, in the race question, to answer “some other race” (http://www.census.gov/mso/www/rsf/racedata/sld008.htm, accessed on 10/Oct/ 2002). And they usually inserted their country of origin or an alternative term for their Hispanic ethnicity for their race.

When assessing their own race, recent immigrants from countries where race is not as central in social structure as in the US may apply criteria adopted in their original country. On the other hand, descendents of migrants are more likely to respond to the race question using different criteria from the ones used by their parents. The fact that this classification is based on pure-race categories of ancestry and the absence of a multiracial category increases the chance of misclassification or non-specification for admixed people. On the other hand, multiracial categories tend to be very heterogeneous, and the greater the admixture in a population, the lower the discriminatory power of racial classifications.

Therefore, fluidity and ambiguity of racial measurement increases as the population becomes more multicultural and admixed. The more admixed a society, the greater the misspecification and heterogeneity of racial categories based on ancestry. Bias will also affect classifications that allow people to be classified in more than one pure-race category, as in the new US classification. Multiracial categories also tend to be very heterogeneous. At the same time, US data on children born to Black/White unions indicate that infants with a Black mother and White father consistently have higher health risks than those with a White mother and Black father, suggesting that in at least some situations there may be health risks linked to the specific pattern of multiracial status.

The use of skin color may be a more adequate proxy for racial/ethnic discrimination in admixed societies than racial measurement based on ancestry. Ethnicity or nationality may also be more meaningful in societies with recent migrants…

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Biology, race and politics explored in upcoming Chancellor’s Lecture

Vanderbilt News
Vanderbilt University
2012-10-10

Kara Furlong

Is race a biological category written in our genes? Or are genomic scientists and biomedical researchers mistakenly using race to explain away health disparities among different population groups?
 
Dorothy Roberts, the Penn Integrates Knowledge Professor at the University of Pennsylvania, will explore this issue in an upcoming Chancellor’s Lecture at Vanderbilt University. Her talk, titled “Fatal Invention: The New Biopolitics of Race,” is scheduled from 5:30 to 6:30 p.m. Tuesday, Oct. 30, in Vanderbilt’s Sarratt Cinema…

…Roberts is the author of Fatal Invention: How Science, Politics and Big Business Re-create Race in the Twenty-First Century. A book signing and reception will precede her lecture from 4:30 to 5:30 p.m. in the Sarratt Cinema Lobby.
 
An acclaimed scholar of race, gender and the law, Roberts pored over scores of scientific studies and interviewed dozens of geneticists whose work claims that race is visible in our genes. As a result, biotechnology and pharmaceutical companies are tailoring medications and other patented products to treat illnesses seemingly prevalent among certain populations.
 
Roberts argues that race is and always has been a political system, that health disparities exist because of social inequalities, and to further the myth that race is a biological category does irreparable damage to social progress in the United States…

…In July 2012, Roberts became the 14th Penn Integrates Knowledge Professor at the University of Pennsylvania with joint appointments in the Department of Sociology and the Law School, where she is the inaugural Raymond Pace and Sadie Tanner Mosell Alexander Professor of Civil Rights. From 1998 to 2012, she was a professor of law, African American studies and sociology at Northwestern University…

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Dorothy E. Roberts: Fatal Invention: The New Biopolitics of Race [Vanderbilt University Lecture]

Vanderbilt News
Vanderbilt University
2012-10-30

Watch video of Dorothy E. Roberts—recently named Penn Integrates Knowledge Professor at the University of Pennsylvania—presenting “Fatal Invention: The New Biopolitics of Race” based on her latest book Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century.
 
An acclaimed scholar of race, gender, and the law, Roberts examines contemporary issues in health, bioethics, and social justice with a particular focus on how they affect the lives of women, children, and African-Americans. Synthesizing a range of disciplines, she sheds light on some of humanity’s most challenging issues to bring hope and awareness to underserved members our society.

The Philosophy of Race

Routledge
2011-12-14
1,584 pages
Hardback: 978-0-415-49602-5

Edited by:

Paul Taylor, Associate Professor of Philosophy; African American Studies
Pennsylvania State University

Since at least the early 1990s, philosophical race theory has emerged as a dynamic and fertile area of serious scholarly inquiry, and this new four-volume Major Work from Routledge meets the need for a comprehensive collection to facilitate ready access to the most influential and important foundational and cutting-edge scholarship.

Volume I (‘Philosophy and the History of Race, Race in the History of Philosophy’) brings together the key texts to have shaped the most widely recognized forms of ‘race thinking’. The second and third volumes in the collection, meanwhile, explore the questions that race raises in philosophy’s traditional subfields. Volume II (‘Racial Being and Knowing’) gathers the best and most influential work to unravel the implications of racial practices for metaphysics, ontology, and epistemology. And Volume III (‘Race-ing Beauty, Goodness, and Right’) collects the key scholarship to deal with the consequences of racial practices for aesthetics, ethics, and politics.

The final volume in the collection (‘Intersections and Positions’) assembles the most important work to grapple with the methodological and geographical complications that accompany a commitment to racialism. (Race is an inherently contextual phenomenon and some of the material gathered in this volume—in particular, that exploring racialization in Japan, Brazil, and Norway—provides a refreshing counterweight to the philosophical zeal for abstraction.)

The Philosophy of Race is edited by Paul C. Taylor, a leading scholar in the field. The collection is fully indexed and has a comprehensive introduction, newly written by the editor, which places the material in its intellectual and historic context. It is an essential work of reference and is destined to be valued by scholars and students as a vital one-stop research resource.

CONTENTS

• Volume I: HISTORY
  • Part 1: Philosophical Historiography
    • 1. Cornel West, ‘A Genealogy of Modern Racism’, Prophesy Deliverance! Towards an Afro-American Revolutionary Christianity (Westminster Press, 1982), pp. 47–68.
    • 2. Robert Bernasconi, ‘Race, Culture, History’ (plenary lecture at Sodertorn University, 28 May 2009), pp. 11–46.
    • 3. David Theo Goldberg, ‘The End(s) of Race’, Postcolonial Studies, 2004, 7, 2, 211–30.
  • Part 2: Early Figures and Moments
    • 4. Harry Bracken, ‘Philosophy and Racism’, Philosophia, 1978, 8, 2–3, 241–60.
    • 5. Richard Popkin, ‘Hume’s Racism Reconsidered’, The Third Force in Seventeenth-Century Thought (Brill, 1992), pp. 64–75.
    • 6. Meg Armstrong, ‘”The Effects of Blackness”: Gender, Race, and the Sublime in Aesthetic Theories of Burke and Kant’, Journal of Aesthetics and Art Criticism, 1996, 54, 3, 213–36.
    • 7. Bernard Boxill and Thomas E. Hill, ‘Kant and Race’, in Bernard Boxill (ed.), Race and Racism (Oxford University Press, 2003), pp. 448–71.
    • 8. Patricia Purtschert, ‘On the Limit of Spirit: Hegel’s Racism Revisited’, Philosophy & Social Criticism, 2010, 36, 9, 1039–51.
    • 9. Tom Jeannot, ‘Marx, Capitalism, and Race’, in Harry Van der Linden (ed.), Democracy, Racism, and Prisons (Philosophy Documentation Center, 2007), pp. 69–92.
  • Part 3: Late Modern Race Theory in/and the Canon
    • 10. Berel Lang, ‘Heidegger and the Jewish Question: Metaphysical Racism in Silence and Word’, in Julie K. Ward and Tommy L. Lott (eds.), Philosophers on Race: Critical Essays (Blackwell, 2002), pp. 205–21.
    • 11. Kathryn Gines, ‘Race Thinking and Racism in Hannah Arendt’s The Origins of Totalitarianism’, in Dan Stone and Richard King (eds.), Imperialism, Slavery, Race, and Genocide: The Legacy of Hannah Arendt (Berghahn, 2007), pp. 38–53.
    • 12. Jonathan Judaken, ‘Sartre on Racism: From Existential Phenomenology to Globalization and “the New Racism”’, in Jonathan Judaken (ed.), Race After Sartre (SUNY Press, 2008), pp. 23–54.
  • Part 4: Critical Race Theory and the New Canon
    • 13. Diego von Vacano, ‘Race and Political Theory: Lessons from Latin America’, in Jorge Gracia (ed.), Race or Ethnicity? On Black and Latino Identity (Cornell University Press, 2007), pp. 248–66.
    • 14. Howard McGary, ‘Douglass on Racial Assimilation and Racial Institutions’, in Bill E. Lawson and Frank Kirkland (eds.), Frederick Douglass: A Critical Reader (Blackwell Publishing, 1999), pp. 50–63.
    • 15. Nancy Fraser, ‘Another Pragmatism: Alain Locke, Critical “Race” Theory, and the Politics of Culture’, in Morris Dickstein (ed.), The Revival of Pragmatism (Duke University Press, 1998), pp. 157–75.
    • 16. Vivian M. May, ‘Thinking from the Margins, Acting at the Intersections: Anna Julia Cooper’s A Voice from the South’, Hypatia, 2004, 19, 2, 74–91.
    • 17. K. A. Appiah, ‘The Uncompleted Argument: DuBois and the Illusion of Race’, Critical Inquiry, 1985, 12, 1, 21–37.
    • 18. W. E. B. Du Bois, Dusk of Dawn: An Essay Toward an Autobiography of a Race Concept [1940] (Transaction Publishers, 1992), pp. 97–103, 114–17, 129–33, 137–40.
    • 19. Frantz Fanon, ‘The Lived Experience of the Black’, Black Skin, White Masks, trans. R. Philcox [1952] (Grove Press, 1967), pp. 78–99.
    • 20. Lewis R. Gordon, ‘Racism, Colonialism, and Anonymity: Social Theory and Embodied Agency’, Fanon and the Crisis of European Man: A Essay on Philosophy and the Human Sciences (Routledge, 1995), pp. 37–67.
• Volume II: Racial Being and Knowing
  • Part 5: What Races Are, What ‘Race’ Means
    • 21. Charles W. Mills, ‘”But What Are You Really?” The Metaphysics of Race’, Blackness Visible: Essays on Philosophy and Race (Cornell University Press, 1998), pp. 41–66.
    • 22. Lucius Outlaw, ‘Conserve Races? In Defense of W. E. B. Du Bois’, Critical Social Theory in the Interests of Black Folks (Rowman and Littlefield, 2005), pp. 139–62.
    • 23. Ron Mallon, ‘Passing, Traveling, and Reality: Social Construction and the Metaphysics of Race’, Nous, 2004, 38, 644–73.
    • 24. Robin O. Andreasen, ‘A New Perspective on the Race Debate’, British Journal for the Philosophy of Science, 1998, XLIX, 2, 199–225.
    • 25. Philip Kitcher, ‘Does “Race” have a Future?’, Philosophy and Public Affairs, 2007, 35, 4, 293–317.
    • 26. David Theo Goldberg, Racist Culture (Blackwell, 1993), pp. 80–9.
    • 27. S. Haslanger, ‘Language, Politics and “the Folk”: Looking for “the Meaning” of “Race”’, The Monist, 2010, 93, 2, 169–87.
    • 28. Joshua Glasgow, Julie L. Shulman, and Enrique G. Covarrubias, ‘The Ordinary Conception of Race in the United States and its Relation to Racial Attitudes: A New Approach’, Journal of Cognition and Culture, 2009, 9, 1–2, 15–38.
  • Part 6: What Racial Identities Are
    • 29. Linda Martín-Alcoff, ‘Philosophy and Racial Identity’, Philosophy Today, 1997, 41, 1, 67–76.
    • 30. K. Anthony Appiah, ‘Synthesis: For Racial Identities’, Color Conscious (Princeton University Press, 1996), pp. 75–105.
    • 31. Judith Butler, ‘Passing, Queering: Nella Larsen’s Psychoanalytic Challenge’, Bodies That Matter (Routledge, 1993), pp. 167–86.
    • 32. Paul C. Taylor, Race: A Philosophical Introduction (Polity, 2004), pp. 84–7, 112–15.
  • Part 7: Power, Knowledge, Self-Knowledge, and Experience
    • 33. Charles Mills, ‘White Ignorance’, in Shannon Sullivan and Nancy Tuana (eds.), Race and Epistemologies of Ignorance (SUNY Press, 2007), pp. 11–38.
    • 34. Anika Maaza Mann, ‘Race and Feminist Standpoint Theory’, in Kathryn Gines, Donna Dale-Marcano, and Maria del Guadelupe Davidson, Convergences: Black Feminism and Continental Philosophy (SUNY Press, 2010), pp. 105–20.
    • 35. Shannon Sullivan, ‘Ignorance and Habit’, Revealing Whiteness (University of Indiana Press, 2006), pp. 17–44.
    • 36. Ned Block, ‘How Heritability Misleads About Race’, Boston Review, 1996, 20, 6, 30–35.
    • 37. Michael Root, ‘The Problem of Race in Medicine’, Philosophy of the Social Sciences, 2001, 31, 1, 20–39.
    • 38. Ronald Sundstrom, ‘Race and Place: Social Space in the Production of Human Kinds’, Philosophy and Geography, 2003, 6, 1, 83–95.
• Volume III: Race-ing Beauty, Goodness, and Right
  • Part 8: Racism
    • 39. Kwame Anthony Appiah, ‘Racisms’, in D. T. Goldberg (ed.), Anatomy of Racism (University of Minnesota Press, 1990), pp. 3–17.
    • 40. Lewis R. Gordon, ‘Racialism, Racism, Racialists, Racists’, Bad Faith and Anti-Black Racism (Humanity Books, 1999), pp. 67–77.
    • 41. J. L. A. Garcia, ‘The Heart of Racism’, Journal of Social Philosophy, 1996, 2, 5–45.
    • 42. Tommie Shelby, ‘Is Racism in the Heart?’, Journal of Social Philosophy, 2002, 33, 411–20.
    • 43. L. Faucher and E. Machery, ‘Racism: Against Jorge Garcia’s Moral and Psychological Monism’, Philosophy of the Social Sciences, 2009, 39, 1, 41–62.
    • 44. Robert Bernasconi, ‘The Policing of Race Mixing: The Place of Biopower within the History of Racisms’, Journal of Bioethical Inquiry, 2010, 7, 2, 205–16.
  • Part 9: Race, the Right, and the Good
    • 45. Charles W. Mills, The Racial Contract (Cornell University Press, 1997), pp. 1–19.
    • 46. Anna Stubblefield, ‘Races as Families’, Journal of Social Philosophy, 2001, 32, 1, 99–112.
    • 47. L. Blum, ‘Three Kinds of Race-Related Solidarity’, Journal of Social Philosophy, 2007, 38, 53–72.
    • 48. Linda Martín Alcoff, ‘Latino/as, Asian Americans, and the Black-White Binary’, Journal of Ethics, 2003, 7, 1, 5–27.
    • 49. Howard McGary, ‘Psychological Violence, Physical Violence, and Racial Oppression’, in Lewis R. Gordon (ed.), Existence in Black: An Anthology of Black Existential Philosophy (Routledge, 1996), pp. 263–72.
    • 50. Samantha Vice, ‘How Do I Live in This Strange Place?’, Journal of Social Philosophy, 2010, 41, 3, 323–42.
  • Part 10: Selected Issues in Racial Politics
    • 51. Richard Wasserstrom, ‘Preferential Treatment, Color-Blindness, and the Evils of Racism and Racial Discrimination’, Proceedings and Addresses of the American Philosophical Association, 1987, 61, 1, 27–42.
    • 52. Howard McGary, ‘Achieving Democratic Equality: Forgiveness, Reconciliation, and Reparations’, Journal of Ethics, 2003, 7, 1, 93–113.
    • 53. Angela Y. Davis, ‘Racialized Punishment and Prison Abolition’, in Tommy L. Lott (ed.), A Companion to African-American Philosophy (Blackwell Publishing, 2003), pp. 360–9.
    • 54. Glen Coulthard, ‘Subjects of Empire: Indigenous Peoples and the “Politics of Recognition”’, Contemporary Political Theory, 2007, 6, 4, 437–60.
  • Part 11: Aesthetics
    • 55. Monique Roelofs, ‘Racialization as an Aesthetic Production: What Does the Aesthetic Do for Whiteness and Blackness and Vice Versa?’, in George Yancy (ed.), White on White/Black on Black (Rowman and Littlefield, 2005), pp. 83–124.
    • 56. Dan Flory, ‘Spike Lee and the Sympathetic Racist’, Journal of Aesthetics and Art Criticism, 2006, 64, 1, 67–79.
    • 57. Mariana Ortega, ‘Othering the Other: The Spectacle of Katrina for our Racial Entertainment Pleasure’, Contemporary Aesthetics, 2009, 2.
    • 58. Robert Gooding-Williams, ‘Aesthetics and Receptivity: Kant, Nietzsche, Cavell, Astaire’, Look, a Negro! Philosophical Essays on Race, Culture and Politics (Routledge, 2006), pp. 43–68.
    • 59. Falguni A. Sheth, ‘The Hijab and the Sari: The Strange and the Sexy Between Colonialism and Global Capitalism’, Contemporary Aesthetics, 2009, 2.
• Volume IV: Intersections and Positions
  • Part 12: Intersectionality
    • 60. Nira Yuval-Davis, ‘Intersectionality, Citizenship and Contemporary Politics of Belonging’, Critical Review of International Social and Political Philosophy, 2007, 10, 4, 561–74.
    • 61. Patricia Hill Collins, ‘It’s All in the Family: Intersections of Gender, Race, and Nation’, Hypatia, 1998, 13, 3, 62–82.
    • 62. Jorge J. E. Gracia, ‘The Nature of Ethnicity with Special Reference to Hispanic/Latino Identity’, Public Affairs Quarterly, 1999, 13, 1, 25–42.
    • 63. Ladelle McWhorter, ‘Sex, Race, and Biopower: A Foucauldian Genealogy’, Hypatia, 2004, 19, 3, 38–62.
    • 64. Stuart Hall, ‘Race, Articulation and Societies Structured in Dominance’, Sociological Theories: Race and Colonialism (UNESCO, 1980), pp. 305–45.
    • 65. Étienne Balibar, ‘Uprisings in the Banlieues’, Constellations: An International Journal of Critical and Democratic Theory, 2007, 14, 1, 47–71.
  • Part 13: Mapping Racial Imaginaries: Inventing the Other
    • 66. Edward Said, ‘Introduction to Orientalism’, in Moustafa Bayoumi and Andrew Rubin (eds.), The Edward Said Reader (Vintage, 2000), pp. 67–74, 78–81, 90–3.
    • 67. David Haekwon Kim, ‘Orientalism and America Enlarged’, Newsletter on Asian and Asian-American Philosophers and Philosophies, 2003, 2, 2, 30–4.
    • 68. V. Y. Mudimbe, ‘Discourse of Power and Knowledge of Otherness’, The Invention of Africa (Indiana University Press, 1988), pp. 1–23.
    • 69. Mahmood Mamdani, When Victims Become Killers (Princeton University Press, 2001), pp. 41, 56–9, 73–5, 80–90, 98–102.
    • 70. David Theo. Goldberg, ‘Racial Europeanization’, Ethnic & Racial Studies, 2006, 29, 2, 331–64.
    • 71. Nadia Abu El-Haj, ‘Racial Palestinianization and the Janus-Faced Nature of the Israeli State’, Patterns of Prejudice, 2010, 44, 1, 27–41.
  • Part 14: Positioning Critical Identities: Inventing Self and Community
    • 72. Sonia Sikka, ‘In What Sense are Dalits Black?’ (presentation to ‘Beyond the White–Black Binary’, conference held at Pennsylvania State University, 12 November 2010).
    • 73. Linda Martín Alcoff, ‘Mestizo Identity’, in Naomi Zack (ed.), American Mixed Race: The Culture of Microdiversity (Rowman and Littlefield, 1995), pp. 257–78.

Paradigm Lost: Race, Ethnicity, and the Search for a New Population Taxonomy

American Journal of Public Health
Volume 91, Number 7 (July 2001)
pages 1049-1056
DOI: 10.2105/AJPH.91.7.1049

Gerald M. Oppenheimer, Professor of Clinical Sociomedical Sciences
Columbia University Mailman School of Public Health

The Institute of Medicine (IOM) recently recommended that the National Institutes of Health (NIH) reevaluate its employment of “race,” a concept lacking scientific or anthropological justification, in cancer surveillance and other population research. The IOM advised the NIH to use a different population classification, that of “ethnic group,” instead of “race.” A relatively new term, according to the IOM, “ethnic group” would turn research attention away from biological determinism and toward a focus on culture and behavior.

This article examines the historically central role of racial categorization and its relationship to racism in the United States and questions whether dropping “race” from population taxonomies is either possible or, at least in the short run, preferable. In addition, a historical examination of “ethnicity” and “ethnic group” finds that these concepts, as used in the United States, derive in part from race and immigration and are not neutral terms; instead, they carry their own burden of political, social, and ideological meaning.

Read the entire article here.

What is most disturbing about the paradoxical use of race is the effect it may have on the trajectory of ongoing human genetic variation research. By making the moral argument that race-based therapeutics address injustice in health care, and at the same time maintaining that genetics research will ultimately eliminate the need for racial categories, racialization is allowed to proceed unchallenged despite its inherent contradictory claims that race is both biologically meaningful and meaningless. Rather than serving as a way station, the use of race is allowed to become more fully embedded in the production of scientific knowledge and medical practice.

Sandra Soo-Jin Lee, “Racializing Drug Design: Implications of Pharmacogenomics for Health Disparities,” American Journal of Public Health, Volume 95, Number 12 (December 2005): 2137. http://dx.doi.org/10.2105/AJPH.2005.068676.

Racializing Drug Design: Implications of Pharmacogenomics for Health Disparities

American Journal of Public Health
Volume 95, Number 12 (December 2005)
pages 2133-2138
DOI: 10.2105/AJPH.2005.068676

Sandra Soo-Jin Lee, Senior Research Scholar
Stanford Center for Biomedical Ethics
Stanford University

Current practices of using “race” in pharmacogenomics research demands consideration of the ethical and social implications for understandings of group difference and for efforts to eliminate health disparities. This discussion focuses on an “infrastructure of racialization” created by current trajectories of research on genetic differences among racially identified groups, the use of race as a proxy for risk in clinical practice, and increasing interest in new market niches by the pharmaceutical industry.

The confluence of these factors has resulted in the conflation of genes, disease, and race. I argue that public investment in pharmacogenomics requires careful consideration of current inequities in health status and social and ethical concerns over reifying race and issues of distributive justice.

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MSU scholar says medical recommendations should go beyond race

Michigan State University News
2012-10-23

Andy McGlashen, Media Communications

Sean Valles, assistant professor in Lyman Briggs College and the Department of Philosophy, says race-based medical advice is often misleading and harmful. Photo by G.L. Kohuth.

EAST LANSING, Mich. — Medical organizations that make race-based recommendations are misleading some patients about health risks while reinforcing harmful notions about race, argues a Michigan State University professor in a new paper published in the journal Preventive Medicine.
 
While some racial groups are on average more prone to certain diseases than the general population, they contain “islands” of lower risk that medical professionals should acknowledge, said Sean Valles, assistant professor in MSU’s Lyman Briggs College and the Department of Philosophy…

…By glossing over the varying degrees of health risk within a racial group, medical recommendations imply that all members of each race are biologically the same as one another and different from others – a view that promotes prejudice and discrimination, according to Valles…

Read the entire article here.

Should people’s ethnicity matter in their medical treatment?

OnCentral
Southern California Public Radio
2012-10-24

José Martinez

Chances are, medical research has found that your ethnicity makes you more likely to have certain conditions or diseases.

For Latinos, it’s diabetes. For black folks, it’s high blood pressure. For white people, it’s cystic fibrosis. For Asian women, it’s osteoporosis.

But one scholar says race-based medical recommendations to patients potentially mislead them about their health risks – and reinforce harmful notions about race at the same time.

That scholar is Sean Valles, an assistant professor of philosophy at Michigan State University in a new paper appearing in Preventive Medicine.

In his paper, Valles agrees that some racial groups are, on average, more prone to certain diseases and conditions than other ethnic groups. But, he says, within each ethnic group are what he calls “islands” of lower risk that shouldn’t go unacknowledged.

He gave a couple of examples. The government recommends that black people eat less salt than other ethnic groups, due to their predisposition for high blood pressure. But Valles notes that foreign-born black people tend to have different lifestyles, and as such have substantially lower rates of heart disease, for which high blood pressure is a risk factor…

…It can be tempting, though, for medical professionals to use any information they have to get an edge on their patients’ ailments. But still, said Dr. Felix Aguilar, the chief medical officer at South Central Family Health Center, “we have to be careful when we use race.”

Aguilar said oftentimes, when people point to ethnicity as a factor in medicine, they’re often conflating it with socioeconomic status.

“Yes, there definitely are genetics involved in a lot of these procedures, but that’s not the whole story,” he said, adding that health providers should ask themselves: “Are we using [ethnicity] for the genetic aspects or are we using it for the socioeconomic aspects?”

If the answer is the latter, said Aguilar, then ethnicity probably doesn’t need to be part of the discussion.

“Our position in society many times tells us how long we’re going to live, how healthy we’re going to be and whether we have access to clean water, clean air and good food,” he said.

“Why do Latina women have the highest rate of cervical cancer in the U.S.?” Aguilar continued. “You can say, ‘Alright, it’s genetic.’ And maybe there’s a genetic element. But most likely it’s access to care.“…

Read the entire article here.