How race becomes biology: Embodiment of social inequality

Abstract

The current debate over racial inequalities in health is arguably the most important venue for advancing both scientific and public understanding of race, racism, and human biological variation. In the United States and elsewhere, there are well-defined inequalities between racially defined groups for a range of biological outcomes-cardiovascular disease, diabetes, stroke, certain cancers, low birth weight, preterm delivery, and others. Among biomedical researchers, these patterns are often taken as evidence of fundamental genetic differences between alleged races. However, a growing body of evidence establishes the primacy of social inequalities in the origin and persistence of racial health disparities. Here, I summarize this evidence and argue that the debate over racial inequalities in health presents an opportunity to refine the critique of race in three ways: 1) to reiterate why the race concept is inconsistent with patterns of global human genetic diversity; 2) to refocus attention on the complex, environmental influences on human biology at multiple levels of analysis and across the lifecourse; and 3) to revise the claim that race is a cultural construct and expand research on the sociocultural reality of race and racism. Drawing on recent developments in neighboring disciplines, I present a model for explaining how racial inequality becomes embodied-literally-in the biological well-being of racialized groups and individuals. This model requires a shift in the way we articulate the critique of race as bad biology.

Political Challenges to Biomedical Universalism: Kidney Failure among Egypt's Poor

“…7 I join Lock's and other scholars' calls to pay attention to the body as the sedimentation of historically and CHALLENGES TO BIOMEDICAL UNIVERSALISM 375 environmentally specific experiences (Lock 1993a(Lock , 1993b(Lock , 2010Fausto-Sterling 2005, 2008Gravlee 2009). In this case, attention to different bodily vulnerabilities enables us to scrutinize appeals to 'cultural difference' that can obscure underlying medical reasons for patients' reluctance to pursue high-cost late-intervention treatments such as kidney transplantation.…”

“…They link their vulnerability to kidney failure to larger social, political, and economic structures, while refuting corrupt medical facilities' claims on their bodies by locating them firmly within God's ownership (Hamdy 2008). In appealing to local biologies, these patients and family members point to how social, political, and economic history becomes embedded in people's very physiology (Lock 1993a(Lock , 1993b(Lock , 2001(Lock , 2010Fausto-Sterling 2005, 2008Gravlee 2009;Gravlee and Sweet 2008;Fassin 2003Fassin , 2007. If we are to rely on Euro-American popular and medical discourse about there being 'no harm' posed to a healthy kidney donor, then there is good reason to question its relevance and applicability elsewhere.…”

Palliative and End-of-Life Care in Correctional Settings

“…There is a complex relationship between race, health disparity, and incarceration; it is difficult to determine whether a causal relationship exists between these factors, and if so, in which direction causality points (Keen & Jacobs, 2009;London & Myers, 2006;Massoglia, 2008). Nonetheless, given the composition of the population and the abundant literature on health disparities by race (Barr, 2008;Cooper & Kaufman, 1998;Gravlee, 2009;Kaufman, 2008), the argument that inmates experience poorer health than their free counterparts is self-evident.…”

Combating Racial Health Disparities through Medical Education: The Need for Anthropological and Genetic Perspectives in Medical Training

“…This misconception demonstrates that many physicians have not been adequately exposed to the extensive body of research showing that U.S. racial categories reflect sociopolitical factors and American historical experience more than biology (Ossorio and Duster 2005;Braun et al 2007;Baer et al 2013;Barbujani et al 2013). Similarly, many physicians believe that genetic differences between racial groups account for the racial health disparities we see today (Braun et al 2007;Baer et al 2013;Hunt et al 2013;Tuckson et al 2013;Bonham et al 2014;Kaufman et al 2015), not realizing that there is sizeable body of scientific literature showing that most health disparities are caused by social and environmental factors (Sankar et al 2004;Gravlee 2009;Braveman et al 2011;Thayer and Kuzawa 2011;Sullivan 2013;Kaufman et al 2015). Clinicians do identify social and environmental factors as other important determinants of their patients' morbidity and mortality, but they feel ill-equipped to help their patients address and overcome the social, structural, and environmental conditions that have a negative impact on their health (Goldstein and Holmes 2011; Robert Wood Johnson Foundation 2011).…”