The role of race in scientific research

1. Pediatric Dentistry Seminar, October 19, 2007 The role of race in scientific research Victor J. Schoenbach, Ph.D. www.unc.edu/~vschoenb/ School of Public Health, Department of Epidemiology and Minority Health Project (www.minority.unc.edu) The role of race in scientific research

2. An epidemiologist is someone who doesn't know what he's talking about – and makes you feel it’s your fault.(adapted from the Internet) (So let’s all talk.) The role of race in scientific research

3. Outline • Why study race? • What is race? • Race vs. ethnicity • Socioeconomic status • Racism and American apartheid • Diversity in the professions The role of race in scientific research

4. Why we should not study race • Sordid history of race research - • Race “science” • Eugenics • Difficult (impossible?) to define – biological? cultural? political? • Not a biological construct • Neither scientifically nor anthropologically based The role of race in scientific research

5. Why we should not study race • Can’t really measure it • May stigmatize • May distract from more modifiable risk factors • May implicitly encourage assimilation of minority ethnic groups to the Western norm(Chaturvedi, 2001) The role of race in scientific research

6. Why we should study race • Public health: to eliminate “profound and consequential oral health disparities within the US population in relation to … race or ethnicity” (Oral health in America, 2000) – without data, disparities don’t “exist” • Scientific understanding: race is one of the strongest, most consistent predictors of health status The role of race in scientific research

7. What is race? “1. an ethnic stock or division of mankind; in a narrower sense, a national or tribal stock; in a still narrower sense, a genealogic line of descent; a class of persons of a common lineage. In genetics, races are considered as populations having different distributions of gene frequencies. 2. a class or breed of animals; a group of individuals having certain characteristics in common, owing to a common inheritance; a subspecies. (Source: Taylor EJ. Dorland's Illustrated Medical Dictionary. 27th ed. Philadelphia, W.S. Saunders, 1988, quoted in LaViest, 1996) The role of race in scientific research

8. What is race? “Persons who are relatively homogeneous with respect to biological inheritance. In a time of political correctness, classifying by race is done cautiously,1,2 although some organizations, e.g., the American Public Health Association, ask members to record their racial/ethnic group on membership forms.…” Last, John M. The dictionary of epidemiology 3rd ed. NY, Oxford, 1995 1 Cooper R, David R. 1986; 2 Osborne NG, Feit MD. 1992 The role of race in scientific research

9. What “races” exist? • African-American / Black / Negro / African – greater genetic diversity than any other “race” • Asian – enormous diversity of language, religion, culture, . . . (40% of world population) • American Indian – over 550 federally recognized tribes, languages, cultures (OMB categories, a “social-political construct designed for collecting data on the race and ethnicity of broad population groups in this country” [quoted from Oppenheimer 2001]) The role of race in scientific research

10. Historical view of race Racism as a political/social/scientific force in Western Europe arose from: (1) nation states, ethnic group identify; (2) subjugation of native Americans; (3) African slave trade. Modern racism then received a “scientific” rationale and justification (Cooper and David, 1986) The role of race in scientific research

11. Historical view of race • English colonization of Ireland – “savages”, “uncivilized”, “lazy”, “loose” • English colonists applied same characterizations to American natives and asserted that their “savagery” was inborn. • Africans were “heathens”, then biologically inferior, the “antithesis of the English colonists” (Oppenheimer 2001 citing Takaki and others) The role of race in scientific research

12. Historical view of race • 19th century – “scientific” evidence of heritability of morals, intellectual capacity, social differences between Blacks and Whites • Blacks have inherited immunity to malaria, typhoid, tonsilitis, mumps, influenza but more prone to TB • “Mixed race” Negroes especially vulnerable (Oppenheimer 2001) The role of race in scientific research

13. Historical view of race “Communicable diseases find their favorite propagating grounds in the dirty negro sections of our cities, and in insanitary negro homes in the country. From dirty homes, in these disease-infested sections, negro people come into intimate contact with white people every day that passes.…The fact is not pleasant to contemplate, but it is nevertheless true, that there are colored persons afflicted with gonorrhea, syphilis, and tuberculosis employed as servants in many of the best homes in the South. Various disease often spread this way.”3737Allen IC. The Negro health problem. Am J Public Health 1915, reprinted in Gamble VN, 1989, 59-68, quoted in Oppenheimer 2001 The role of race in scientific research

14. Current understanding of race • “Human variation is self-evident; the existence of definable groups, or races, is not.” • Geographic variation in gene frequency is mainly quantitative in nature. • Human variation is primarily discordant. • “Simultaneous treatment of many continuous variables … is the only appropriate method for studying human variation.” (Cooper and David, 1986) The role of race in scientific research

15. President’s Cancer Panel (1997) • “Race as used in the United States is a social and political construct derived from our Nation’s history. It has no basis in science or anthropology.” • “Biologically distinct races do not exist.” • “Neither is there a genetic basis for racial classification.” • “Racism, rooted in the erroneous concept of biological racial superiority, has powerful societal effects and continues to influence science.” From the letter of transmittal to the President from Harold Freeman, 1/30/1998 The role of race in scientific research

16. Race vs. ethnicity “‘Race’ had been associated with supposed biological variation, which to many observers essentially meant distinct genetic differences between groups. This notion has been discredited, with a clear demonstration that genetic variation between ‘racial' groups is small, and considerably less than that between individuals from the same supposed racial group.5,6 Racial categorization based on these criteria are[sic] therefore inaccurate and misleading, yet studies persist in using this term.7” (Chaturvedi, International Journal of Epidemiology, 2001) The role of race in scientific research

17. Race vs. ethnicity “In contrast ‘ethnicity', the increasingly preferred term, is a complex construct of, assuredly biology, but also culture, language, religion, and, importantly for epidemiologists, distinct health beliefs and health behaviours. Therefore ethnicity cannot be treated as if it were another epidemiological exposure, such as smoking or cholesterol levels, as it encompasses a range of exposures, both biological and environmental.” (Chaturvedi, International Journal of Epidemiology, 2001) The role of race in scientific research

18. Race vs. ethnicity “The [IOM] committee recommends an emphasis on ethnic groups rather than on race in NIH’s cancer surveillance and other population research. This implies a conceptual shift away from the emphasis on fundamental biological differences among ‘racial’ groups to an appreciation of the range of cultural and behavioral attitudes, beliefs, lifestyle patterns, diet, environmental living conditions, and other factors that may affect cancer risk.” Haynes MA, Smedley BD, eds. The unequal burden of cancer, quoted in Thomas SB, 2001. The role of race in scientific research

19. Hispanic ethnicity • A cultural group – to a great extent share language, religion, customs, history, geography – but also very diverse • Hispanics include American Indians, Europeans, Africans, and Asians, perhaps even more than North Americans • Whites in Latin America also subjugated Indians and enslaved Africans The role of race in scientific research

20. Referent group • “White” as the referent group (not a “racial/ethnic population”) – why? • First “race”? – African • Largest “race”? – Asian • First “race” in America? – American Indians • Who chooses? The role of race in scientific research

21. Ethnocentricity “Ethnocentricity is the inherent tendency to view one’s own culture as the standard against which others are judged.11… It will impinge on the design, aims, and methods of studies and the presentation and interpretation of results, making ‘value free’ observation impossible.11” Senior PA, Bhopal R, BMJ, 1994 11Bond J, Bond S. Sociology and health care. Edinburgh, Churchill Livingstone, 1986 The role of race in scientific research

22. Race/ethnicity is largely a political construct • History – U.S. and everywhere else • “Race science” has followed history and political needs • Before 1930, “Polish”, “Jewish”, “Irish”, etc. were called “races”. • Classification schemes are political (e.g., “one drop rule” and contemporary) rather than scientific The role of race in scientific research

23. Measuring race and ethnicity • How measure: Observation? Self-report? • How analyze multiracial category • Different races for different contexts? • Inconsistencies over time, between data sources The role of race in scientific research

24. “Socioeconomic status” • Closely tied to race and ethnicity primarily for historical reasons • History of most ethnic groups in U.S. – start as poor, suffer discrimination, advance, discriminate, become “white” • Extensive legal and extra-legal forces to keep African Americans down The role of race in scientific research

25. Socioeconomic status • More scientific, but hard to define, measure • Not part of routine data systems in U.S. • Typically oversimplified – education, income, occupation • Wealth disparities much greater than income disparities The role of race in scientific research

26. Some reasons why SES hard to control for • Grade in school ignores quality of education • Income return on education differs • Prices paid by minorities differ • Family assets, expertise, information, access • Vehicles, appliances, needs • Public goods / community wealth and services The role of race in scientific research

27. SES not the whole story • America is more race conscious than class conscious (“classless society”, anti-Communist, anyone can succeed – historically true compared to Europe, but less so for nonwhites) • Race and ethnicity are often more visible, impede upward socioeconomic mobility The role of race in scientific research

28. Racism and American apartheid “The problem of the Twentieth Century is the problem of the color line …” (W.E.B. DuBois, The souls of black folk, 1903) The role of race in scientific research

29. Racism and American apartheid Atlanta bus, 1956 Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

30. Racism and American apartheid Governor George Wallace, stood in the doorway of the University of Alabama to block its integration Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

31. Racism and American apartheid Firebombed bus carrying Freedom Riders into Alabama in 1961 Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

32. Racism and American apartheid Civil rights workers James Chaney, Andrew Goodman, and Michael Schwernerdisappeared in Mississippi in 1964 Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

33. Racism and American apartheid Civil rights activist Vernon Dahmer died defending his family from a nighttime firebombing by the Klan, Hattiesburg MS, January 10, 1966; he had been trying to register blacks to vote Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

34. 1963 bombing of the 16th Street Baptist Church, Birmingham, Alabama Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

35. Not shown • Latinos • Asian Americans • Pacific Islander Americans • “White” ethnic groups • American Indians – the first immigrants The role of race in scientific research

36. America is a hostile terrain for many groups The Neo-Confederate movement Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

37. Neo-Confederate hate groups (1) Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

38. Neo-Confederate hate groups (2) Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org The role of race in scientific research

39. Diversity in the professions • Where is it? • How long have we been talking about it? • How long will it take? • What will it take? • Scientists make policy as well as science The role of race in scientific research

40. Racism and American apartheid “As we enter the 21st century, institutional racism remains an insidious and largely unmeasured obstacle to improving and eliminating the disparate health status of African Americans in America.” National Colloquium on African American Health, National Medical Association, March 12, 2001 The role of race in scientific research

41. Racism and American apartheid Colleges and universities in the South - including NC remain “segregated and unequal” – 1995 report issued by the Southern Education Foundation The role of race in scientific research

42. Resegregation in American Schools(Harvard University Civil Rights Project, Orfield G, Yun JT, June 1999) • The American South is resegregating • Latino students are more segregated than African Americans • African American and Latino students are enrolled in suburban schools, but segregated • Most racial groups attend diverse schools; whites remain in overwhelmingly white schools The role of race in scientific research

43. Resegregation in American Schools(Harvard University Civil Rights Project, Orfield G, Yun JT, June 1999) • Spreading segregation has a strong class component. • Non-white schools tend to have concentrated poverty; white schools almost always enroll high proportions of students from the middle class. • Title I has had great difficulty achieving gains in schools where poverty is highly concentrated. The role of race in scientific research

44. Resegregation in American Schools(Harvard University Civil Rights Project, Orfield G, Yun JT, June 1999) • Desegregation usually puts minority students in schools which have better opportunities and better prepared peer groups. • Most white Americans believe that equal educational opportunity is being provided; national political leaders have largely ignored the growth of segregation in the 1990s. • Educational policy decisions (e.g., testing) could punish students in segregated schools. The role of race in scientific research

45. Racism and American apartheid • In 1990, one-in-four African American males age 20-29 years was under some form of criminal justice supervision – in prison or jail, on probation, or on parole. • In 1995, the figure was 32% on any given day The role of race in scientific research

46. An American Dilemma • Gunnar Myrdal’s classic study • A continuing reality • What does the future hold? The role of race in scientific research

47. Selected bibliography Bhopal, R. (1998). Spectre of racism in health and health care: lessons from history and the United States. BMJ 316: 1970-1973 Bhopal, Raj (2007). Ethnicity, race, and health in multicultural societies: foundations for better epidemiology, public health, and health care. Oxford. Chaturvedi, Nish. Ethnicity as an epidemiological determinant - crudely racist or crucially important Intl J Epidemiol 2001;30:925-927 Cooper R, David R. The biological concept of race and its application to public health and epidemiology. J Health Polit Policy Law 1986; II(1):97-116 Gamble VN, ed. Germs have no color line: blacks and American medicine, 1900-1940. NY, Garland, 1989 Haynes MA, Smedley BD, eds. The unequal burden of cancer: an assessment of NIH research and programs for ethnic minorities and the medically underserved. Washington DC, National Academy Press, 1999 Institute of Medicine. Unequal treatment in American health care, 2002 Jones, Camara Phyllis. Levels of racism: theoretical framework and a gardener's tale. Am J Public Health 2000;90:1212-1215. The role of race in scientific research

48. Selected bibliography LaViest, Thomas A. Why we should continue to study race … but do a better job: an essay on race, racism and health. Ethnicity and Disease 1996;6:21-2 National Colloquium on African American Health (Hood RG et al.) Racism in medicine and health parity for African Americans: “The slave health deficit” National Medical Association Consensus Paper, March 12, 2001 *Oppenheimer GM. Paradigm lost: race, ethnicity, and the search for a new population taxonomy. AJPH 2001;91:1049-1055 Orfield G, Yun JT. Resegregation in American schools. The Civil Rights Project, Harvard University, June 1999. www.law.harvard.edu/civilrights/publications/resegregation99.html Osborne NG, Feit MD. The use of race in medical research. JAMA 1992;267:275-279 Senior PA, Bhopal R. Ethnicity as a variable in epidemiological research. Br Med J 1994;309:327-30. Thomas SB, 2001. The Color Line: race matters in the elimination of health disparities. AJPH 2001; 91:1046-1048. The role of race in scientific research