SECTION 1
Racism, Not Race, Causes Health Disparities
What Are Racial Health Disparities and Why Do They Exist? Racial health inequities exist and persist. According to the Kaiser Family Foundation, racial health disparities are the “higher burden of illness, injury, disability, or mortality experienced by one (politically and socially constructed) population group relative to another.”8 We use racial health disparities synonymously with racial health inequities, although we acknowledge there are subtle differences and that inequities is preferred by some because it draws attention to the power imbalance at the root of the issue.9 In the United States, this can be seen by the disparately high rates of cardiovascular disease, renal disease, diabetes, stroke, certain cancers, low birth weight, preterm delivery, and more between people of color (often Black) and white people.10 Biomedicine tends to interpret these disparities as evidence of fundamental genetic differences between socially constructed race categories. Yet, a growing body of evidence from medical journals emphasizes that these health disparities stem from inequalities in power and socioeconomics, not from genetics (for more on the body of evidence, see appendix 1). Dr. Joia Crear-Perry, a fierce physician advocate for Black maternal health equity, adapted the guiding mantra that “racism, not race, causes health disparities,” as seen in the following graphic to show the mechanisms of how racism causes health disparities.11 In Figure 1 on the next page, we adapted her model (on the left) to show how this works in clinical edu-
cation regarding the use of “race as biology” (on the right). In this section, we explain how racism causes health disparities, our model, and how we define the terms we are using. Rather than use heuristics and simplifications, it is critical that we as a medical profession address racism head on and in all its subtleties. Dr. Crear-Perry shows that health disparities start with root causes (racism and white supremacy, class oppression, gender discrimination, and exploitation) to create deep power and wealth imbalances across much of the systems that govern our lives, such globalization and deregulation, labor markets, housing policy, education systems, and much more.12 These, in turn, mold the social determinants of health by shaping who is paid how much and with what benefits or job security, who is allowed to live where, what quality of housing they can afford, what quality of education exists for them or their children, what quality of food is available, and much more. These mean that differential power distributes the social and environmental determinants of health differently, depending on who holds and doesn’t hold power. In the United States, this tends to fall primarily along race, class, and gender lines, with those who hold multiple marginalized identities, such as Black working-class women, even further marginalized. These social determinants of health lead both to an unequal distribution of disease and well-being (e.g., increased asthma rates in neighborhoods with poor quality housing and increased environmental exposures) as well as psychosocial stressors and unhealthy behaviors. For our focus as medical students, when clinical education and medicine at large conflate the social construct of race with biology, it entrenches racism
Toward the Abolition of Biological Race in Medicine
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