by Sarah L. Berry, PhD
In April 2021, the CDC officially declared racism a public health threat. What does this mean, how did we get to this point, and how do the humanities offer ways to address this problem?
Racism is not part of US history; rather, it is US history. The 1619 project shows that the economic, political, legal, and social structures of the US were founded upon race-based slavery and colonialism. Inequity melded into national structure has a downstream effect on health for all citizens, but impacts BIPOC people disproportionately.
According to the CDC’s statement on Racism and Health, centuries of race-based policies and practices “affecting where one lives, learns, works, worships and plays” created inequities in access to housing, education, wealth, and employment. “These conditions—often referred to as social determinants of health—are key drivers of health inequities within communities of color, placing those within these populations at greater risk for poor health outcomes.” Health inequities affect every dimension of daily life, including explicit and implicit bias in healthcare settings; access to care, physically, socially, and linguistically; trust in the medical profession; the health effects of internalized racism; exposure to race-based violence; somatic and behavioral responses to chronic experiences of racism and discrimination; and intergenerational, inheritable health effects of historical and personally-experienced racism.
Understanding the complex relations between race and health through a structural inequity framework highlights race as a social construction that has embodied and experienced consequences rather than as a biochemical (genetic) characteristic inherent to individuals or groups. We are still contending with inequities and harms resulting from the historical construction of race as a “natural,” medicalized category that explains health, illness, and care disparities.
Yet precisely because race is a social concept with consequences lived by individual people who are part of communities, the humanities offer a way to address race as a public health threat with deep historical roots, to gather perspectives from people living in diverse communities, to identify community assets, and to imagine and build an equitable future for all. Health humanities offers us materials and methods for thinking critically about health and race, contextualizing data and patterns, learning from multiple perspectives, and productively dialoguing.
First, a note on dialogue about challenging subjects like racism: it’s important to recognize that everyone brings different life experiences with them, and that these experiences as well as peoples’ identities will affect how they are able to receive and how they perceive the content. Respect for different identities or ways of being in the world is paramount. Equally important are promotion of self-care and holding space for all individuals in group settings. A guide to nonviolent communication and discussion practices is here.
Here are three starting points for dialogue and collective action for communities and organizations working to address inequity from the ground up. The text below and linked material contain content about racism and racialized experiences that may distress some readers.
I. Into the Past: Inventing Racialized Bodies
Today’s federal categories of race, which medicine and population health research adopt, descend from Enlightenment taxonomies and colonial politics. In Who’s Black and Why, scholars Henry Louis Gates, Jr. and Andrew S. Curran republish essays from 1739 that pinpoint imperial definitions of blackness in scientific terms. Such constructions served the interests of a global chattel slavery industry and profitable cash crops produced by enslaved labor. Poor health and illness caused by the conditions of enslavement were attributed to individuals and groups by means of biased measurement that was repeated and seemed to serve as empirical evidence. What is the enduring effect of this racist bias in health science? Consider the use of scientific measurements of blood oxygenation in enslaved people in Samuel Cartwright’s medical article (1851) and the development of an enduring medical technology, the spirometer, which continues to be calibrated differently according to race, according to scholar Lundy Braun in Breathing Race into the Machine (2021). This has serious therapeutic consequences.
Critical thinking about historical patterns also enables us to ask counterpoint questions. Were there any alternative or even antiracist ideas about the causes of health disparities? Survivors of enslavement wrote about their illnesses as conditions caused by inadequate basic needs and healthcare, violence, and stress, like Frederick Douglass (1845) and Harriet Jacobs (1861). In 1906, Harvard-trained sociologist W.E.B. DuBois researched social determinants of health to oppose the dominant theory of somatic “inferiority” of Black Americans.
Historical inquiry contextualizes current health disparities, and also provides precedents for antiracist responses to them.
II. Current Perspectives on Race and Health
Literature invites people to consider health, illness, and the social factors impacting them to gain new perspectives outside their own worldview. Rhetorical analysis also asks us to pay attention to who is speaking, on what occasion, to whom, and for what purpose. Critical race theory in literary studies is a rigorous method of structural analysis that, in part, privileges the perspectives of people of color who have been silenced and marginalized in print and public discourse. It prioritizes individual and community points of view to counter the dehumanization of describing health through statistics alone (see, for example, ethicist Keisha Ray, “Going Beyond the Data” [2021]). Overall, storytelling enables people to speak and listen with attention to the social identities that permeate everyone’s health and illness, and creates a forum for personal and shared testimonies.
Racism has of course affected not only enslaved people of African descent, but also immigrant and indigenous communities. Here are three texts with prompts for discussion on specific health issues and their intricate relationship to racial identity:
The short story “Stars” by Ye Chun details the experience of Luyao’s stroke and aphasia as a new mother and new American; how does this story call out anti-Asian bias in US treatment regimens? How does the story affirm Luyao’s therapeutic inventiveness and make a case for person-centered, linguistically-consonant care?
In her memoir The Scalpel and the Silver Bear, Lori Arviso Alvord, the first Navajo woman surgeon, narrates her navigation of structural barriers to access education and medical education outside her reservation home, which is a legacy of colonial oppression of indigenous peoples. How does her perspective on Navajo health change when she returns to her home community to treat people with biomedical methods? How do Navajo concepts of community and social practices enable Dr. Alvord to innovate surgical outcomes to benefit all patients?
In “Greens,” a personal nonfiction essay, Kiese Laymon describes his own eating disorder and the addictions of his family members in Mississippi. He uses the second person “you,” to address his narrative to his mother. In an interview, he describes using this technique to intentionally speak to vulnerable Black people. How does this essay highlight the theme of physical and behavioral responses to racism? What points are asserted through its rhetorical structure in terms of whose health story is being told, to whom, and for what purpose(s)?
Finally, taken together, what do these three narratives suggest about health issues and/or assets among diverse US communities?
III. Envisioning Equitable Futures
Critical thinking about racialized experiences of health in the past and present enable us to imagine an equitable future for all. Science fiction abounds with dystopias that paint a bleak picture of the future, which often amplify acute present problems. The film Black Box (2020, dir. Emmanuel Osei-Kuffour) dramatizes a mother’s abuse of futuristic biotechnology in Black male bodies in response to losing her son. Chang-Rae Lee’s speculative novel On Such a Full Sea (2014) projects a future in which Chinese refugees of environmental toxicity produce consumer luxuries in a depopulated US city for wealthy gated communities hoarding medical treatments while rural areas must rely on veterinarians for human healthcare; see Phillip Barrish’s essay “Speculative Fiction and the Political Economy of Healthcare” (2019) for an argument about the power of the humanities to enable structural analysis of health inequity.
Dystopian fiction extrapolates the consequences of existing social inequity in order to urge reform. But speculative fiction also creates space for the ethical imagination of societies that have eliminated disparities and that structurally support health and wellbeing for all. Speculative world-building and constructing alternative realities can inform productive dialogue and collective action. Afrofuturism in particular reimagines the past, present, and future as a survival tactic. For example, in Medicine and Ethics in Black Women’s Speculative Fiction, scholar Esther L. Jones shows that the fiction of Octavia Butler, Nnedi Okrafor and Nalo Hopkinson “authoriz[e] black womanist methods and strategies of healing in hostile environments while at the same time imagining new ethical norms” that extend to all vulnerable people (147). According to Walidah Imarisha, an editor of the anthology of speculative tales by activists Octavia’s Brood: Science Fiction Stories from Social Justice Movements, “Whenever we try to envision a world without war, without violence, without prisons, without capitalism, we are engaging in speculative fiction. All organizing is science fiction.”
The humanities play an essential role in dismantling structural inequity and addressing race-based health disparities. For more projects on health humanities as public health initiatives, see Translational Humanities for Public Health.