The COVID-19 pandemic is raising renewed interest in the relationship between race and disease. Specifically, African Americans have poorer health than white Americans, and they die more readily.
There are over 80,000 excess deaths of African Americans each year, meaning that many African Americans died who would not have died had they died at the same rate as whites. And true to form, African Americans are suffering disproportionately from COVID-19, dying at a much higher rate than whites.
A tragic situation, but there might be a silver lining. Discussion about why this is happening to African Americans centers around the social conditions of African Americans.
Our history is full of propositions that African Americans are defective human beings, prone to diseases. It goes back to slavery, where pseudo-science was used to prove why blacks were slaves and whites were not.
Genes do play a role in some diseases. For example, sickle cell disease is more common in people of African, African American, or Mediterranean heritage; and Tay-Sachs disease occurs more frequently among people of Ashkenazi Jewish or French-Canadian heritage. The keywords here are “more common” and “more frequently.” These disorders can occur in any ethnic group.
Looking at skin color differences, disease, human evolution, even genetic traits, we learn there is not one characteristic, one trait, or even a single gene that distinguishes all members of one “race” from another. There exists, as the late Stephen J Gould put it, “no ‘race’ gene present in all members of one group and none of another.” The Human Genome Project, completed in 2003, revealed that the human species could not be divided into biological races.
Yet race still matters. Just because race does not exist in biology does not mean it is not very real, helping to shape life chances and experiences. Most social scientists take the position that, while there is no biological basis for race, races are social categories that have an important impact on people’s lives and their health as well.
But despite the results of the definitive Genome Project, researchers are using millions of NIH dollars to find biological racial differences in disease, nowadays using ancestry as a proxy for genes. Now we have race-based medicine, which is fueled by the development of race-specific medication. The Food and Drug Administration has approved a drug for the treatment of heart failure in a single race, African Americans. The problem here—and there is always a problem with this stuff—is that the clinical trial, the test, for this drug was not up to modern scientific standards and should be dismissed out of hand.
We know that socioeconomic status (read “social conditions”) is a fundamental cause of health disparities, meaning it influences multiple diseases through multiple risk factors, and it affects access to resources that can assist in avoiding health risks to lessen the effect of the disease once it occurs. Further, scholars agree that racial inequalities in health occur primarily because racism is a fundamental cause of racial differences in SES, and because SES is a fundamental cause of health inequalities.
Current public discussions around the racial disparities around COVID-19 tend to emphasize social conditions (SES). Let us hope that this understanding will stick and carry over to health disparities in general. The alternative is race-medicine, which keeps trudging along. Social Conditions, Not Genes
