The Subtle Knife

It’s been a cliche over the past few weeks to talk about how we in the United States are dealing with two pandemics; a novel coronavirus and the decidedly more established legacy of racism and discrimination that has plagued the US literally from the beginning. Wanting to make a weekly thing of this blog, I set out to write some words, but then wondered if it was really my place. After all, what hot take could yet another straight white guy bring to the table (during Pride month and on Juneteenth, no less)? Isn’t that kind of what got us in trouble in the first place? Certainly, there were better voices available, ones who had actually had relevant lived experience.

Obviously, I changed my mind. I still don’t know if I have anything tremendously relevant to offer, but perhaps I can at least explain what some evolution looks like. While my parents were certainly accepting of other races and cultures, and raised me with those values, it didn’t really go much deeper than that. It was in the vein of “not seeing color,” which was good enough to prevent egregious racism I suppose, but not to do much about it outside my bubble. I ended up with a Black roommate during my first go-around at college, and we got along very well, but I still never really understood his path, or why he was so passionate about certain projects, and in hindsight I can definitely see where I came up far shorter than I thought as an ally.

It was a combination of some additional schooling (both through an interdisciplinary health degree and then in my public health training) that really opened my eyes to the challenges that Black (and frankly other non-white) communities face every single day. There’s certainly a lot to dive into as far as the sociological and community implications for that, and that’s not my intent here because I completely lack the knowledge or experience to speak on those. What I can talk about is how this stuff works on the clinical side.

We in medicine often talk about certain risks or traits or what-have-you being genetically linked to racial groups. Perhaps the most well-known of these is that sickle-cell anemia predominantly affects Black families. We also “know” that Black men are more likely to experience hypertension (high blood pressure) and any number of other maladies, compared to their white counterparts. So, the initial conclusion is often that there’s something about one’s race that affects the odds. We see this pop up in things like spirometry measurements, which have predicted values based on demographic features like age, height, biological sex, and yes, race/ethnicity.

However, as it turns out, there’s no particular reason to do (or believe) any of that. As it turns out, and as many have been shouting into the void for quite some time now, there is no medical or scientific basis for “race.” Much of the discussion can be traced back at least as far as Samuel Morton, a Philadelphia physician who collected skulls & measured their internal volume in order to determine who had the biggest brains, and were therefore “more intelligent.” These “measurements” had been used to justify slavery, white supremacy, and other horrific assumptions.

Morton died in 1851, but his legacy lives on today. The assumption that people from different places are genetically different has colored research projects ever since, leading to erroneous assumptions like the spirometry corrections, that somehow genetic characteristics hold as much sway (or more) than physical ones. In addition, we have to accept that we’ve been drawing inaccurate conclusions about risk. Perhaps it’s not that Black families are innately more at risk for hypertension; perhaps it’s that these people tend to have lower access to healthier foods, lower health literacy, and lower quality access to care because of long-term socioeconomic factors. It’s these factors, not race, that make up those proverbial 1,000 cuts that lead to death.

It’s true that people from various places do have varying probabilities of genetic variations like skin color, eye color, and so on. It’s also true that babies born to neighbors may have more genetic variation than with babies born on the other side of the globe. We have to move beyond these overly simple categorizations and look at the underlying issues that affect people’s health. We know that when people have heart attacks, it’s generally not because the heart just stops working sometimes, or that people born on Wednesdays have bad genes. It’s because decades of strain from stress, subpar nutrition, lack of activity, or all of the above contributes to that day after day and week after week.

It’s time we start applying that thinking to the whole person, too.