Comparison of racial genetic diversity from the Center for Genetics and Society report Playing the Gene Card?:
Contemporary data on human diversity supports a “nested subset” approach to race. This reflects the fact that “people have lived in Africa far longer than anywhere else, which has allowed the population in Africa to accumulate more of the small mutations that make up [human] genetic variation. Because only a part of the African population migrated out of Africa, only part of Africa’s genetic variation moved with them. For this reason, most genetic variation found in people living outside Africa is a subset of that found among Africans.”
Using race as a scientific variable ignores true genetic diversity, yet medicine does it all the time; in ASCVD and TOLAC calculators, or in estimating total lung volume are just a few examples. In each of these cases, selecting “black/African American” effectively demonstrates disadvantage. Without a critical lens, one might infer that this reflects genetic weakness or inherent racial flaws. Doing so, allows us to ignore potential confounders and not do the harder work of thinking critically about structural racism.
Examine the diagram above from the Center for Genetics and Society which demonstrates genetic diversity between races. Are we to assume that, despite centuries of intermixing in the United States, African Americans have uniquely inherited the genetic material that doesn’t overlap with other “races”? Additionally, that natural selection has preferentially and paradoxically favored the survival of those with the highest maternal mortality, worse health outcomes, and shortest life expectancy? Chalking up lower lung capacity or higher maternal morbidity to race or individual decisions allows us to ignore policies and histories that perpetuate inequity and might better explain disparities. It implies an acceptance that these disparities are inherent and unchangeable. Healthcare professionals become complicit by accepting that people of color have worse health outcomes because of inherent factors. Ibram X. Kendi notes, “when you just believe that black people should be disproportionately dying of police violence or even COVID-19, you're thereby not going to challenge - let alone look for - the policies that are actually behind this disproportionate black death.” By not challenging the racist assumptions in medicine, we support and perpetuate racism.
Race is not the risk factor. Racism is the risk factor.
Dr. Camara Phyllis Jones is a family physician and epidemiologist whose work focuses on the impacts of racism on the health and well-being of the nation. In this excellent TEDx talk, she uses four allegories to illuminate topics that are otherwise difficult for many Americans to understand or discuss. She hopes through her work to initiate a national conversation on racism that will eventually lead to a National Campaign Against Racism.