The Health of Black Folk: Disease, Class, and Ideology in Science
Krieger, Nancy, Bassett, Mary, Monthly Review
THE HEALTH OF BLACK FOLK: DISEASE, CLASS, AND IDEOLOGY IN SCIENCE
Since the first crude tabulations of vital statistics in colonial America, one stark fact has stood out: black Americans are sicker and die younger than whites. As the epidemic infectious diseases of the nineteenth century were vanquished, the black burden of ill health shifted to the modern killers: heart disease, stroke, and cancer. Today black men under age 45 are ten times more likely to die from the effects of high blood pressure than white men. Black women suffer twice as many heart attacks as white women. A variety of common cancers are more frequent among blacks--and of cancer victims, blacks succumb sooner after diagnosis than whites. Black infant mortality is twice that of whites. All told, if the mortality rates for blacks and other minorities today were the same in the United States as for whites, more than 60,000 deaths in minority communities could be avoided each year.
What is it about being black that causes such miserable odds? One answer is the patently racist view that blacks are inherently more susceptible to disease--the genetic model. In contrast, environmental models depict blacks as victims of factors ranging from poor nutrition and germs to lack of education and crowded housing. Initially formulated as an alternative to the genetic model by liberals and much of the left, the environmental view has now gained new support from the right and becomes a major prop for Reagan administration health policies: instead of blaming the victims' genes, these conservatives blame black lifestyle choices as the source of the racial gap in health.
We will argue that these analytic models are seriously flawed, in essence as well as application. They are not the product of a racist use of allegedly "neutral" science, but reflect the ways in whic ideology and politics penetrate scientific theory and research. Typically, they deny or obscure that the primary source of black/white health disparities is the social production of disease under conditions of capitalism and racial oppression. The "facts of being black" are not, as these models suggest, a genetically determined shade of skin color, or individual deprived living conditions, or ill-informed lifestyle choices. The facts of being black derive from the joint social relations of race and class: racism disproportionately concentrates blacks into the lower strate of the working class and further causes blacks in all class strata to be racially oppressed. It is the left's challenge to incorporate this political reality into how we approach racial differences in health.
The Genetic Model
Despite overwhelming evidence to the contrary, the theory that "race" is primarily a biological category and that black-white differences in health are genetically determined continues to exert profound influence on both medical thinking and popular ideology. For example, an editorial on racial differences in birth ideology. For example, an editorial on racial differences in birth weight (an important determinant of infant mortality) in the January 1986 Journal of the American Medical Association concluded: "Finally, what are the biologic or genetic differences among racial or ethnic groups? Should we shrink from the possibility of a biologic/genetic influence?" Similarly, a 1983 handbook prepared by the International Epidemiologic Association defined "race" as "persons who are relatively homogeneous with respect to biological inheritance." Public health texts continue to enshrine "race" in the demographic trial of "age, race, and sex," implying that "race" is as biologically fundamental a predictor of health as aging or sex, while the medical literature remains replete with studies that examine racial differences in health without regard to class.
The genetic model rests on three basic assumptions, all of which are flawed: that "race" is a valid biological category; that the genes which determine "race" are linked to the genes which affect health" and that the health of any community is mainly the consequence of the genetic constitutions of the individuals of which it is composed. …