Racial classifications, biomarkers, and the challenges of health disparities research in the African diaspora.

Author:Best, Latrica E.

The notion of "racial diseases "--that people of different races suffer from peculiar diseases and experience common diseases differently--is centuries old. It is tied to the original use of biology in inventing the political category of race.--Dorothy Roberts, Fatal Invention


Despite more than two centuries of scholars from diverse disciplines deconstructing and debunking the validity of the existence of human biological races, the use of biological data to investigate purported racial differences in disease etiology and public health persists in genomic, medical and social science research. Biological race, it has been said repeatedly, is not real. Society, however, has made race real through laws, public policies, and social practices designed historically for the primary purpose of circumscribing and controlling the lives of people of color (Freeman, 2003; Haney-Lopez, 2006; Roberts, 2011; Smedley & Smedley, 2005). Biomedical research has played a central role in this process by validating and perpetuating the racial calculus and taxonomies born in the era of racial slavery. In recent decades, genomics, which initially held the promise of ending the pattern and practices of racializing medical science, has resurrected the idea that biological race serves as a useful variable in biomedical research (Roberts, 2011). The social history and purported scientific uses of the concept of race thus contribute to its survival and endurance. Black Studies professor George Lipsitz uses the phrase the possessive investment in whiteness to account for the persistence and consequences of the use of race as a cultural artifact and social construct to provide distinct advantages for whites in housing, education, employment and income (Lipsitz, 2006). Few, however, apply this analysis and explanation to biomedical research and genomic science. Yet the common belief that science is objective and thus immune from societal issues and pressures ignores that scientists and science are products of the cultural ethos of the present and the accumulated legacies of the discipline's past. What arguably is least acknowledged in accounting for the persistence of race in biomedical research is the role of U.S. government policies in mandating and supporting the use of racial classifications.

In the discussion that follows, we describe the federal government's role in defining race and its implications for medical research. We then examine the use of biological markers in biomedical and social science research, and their misuse in hypertension studies to posit ill-defined concepts of biological race to account for health disparities to the detriment of other explanations. A discussion on the Slavery Hypertension Hypothesis follows as an exemplar of the complex problems identified in the prior section. In conclusion, we offer a few thoughts about the role of black scholars in shaping future research on health inequities.

Racial Classifications and Government Policy

Race made its first appearance as a federal classification system in the 1790 census. In the ensuing two centuries, official racial designations increased from three (white, slave, other) to fifteen on the 2010 census form (Bhatnagar, 2007; Hickman, 1996; Racebox.org, 2014). Throughout this period the term and category "white" did not change. Blacks, on the other hand, have been variously identified as slave, free, colored, mulatto, Negro, and African American. The fact that the 2010 Census form provides a combined ten sub-categories for the self-identification of Asians (5.1% of U.S. pop.) and Pacific Islanders (0.2% of U.S. pop.), and none for whites who comprise 78% of the population, is indicative of the pervasive social consciousness that accepts the category as homogenous and the terms "white" and "Caucasian" as self-evident (U.S. Census Bureau, 2014). The classifications Chinese and Indian (Native American) first appeared on the census in 1870. Japanese was added in 1890, and Mexican, Korean, Filipino, and Hindu appeared in 1930. In the past fifty years the decennial forms incorporated new categories (Pacific Islanders) and attempted to refine the collection of data pertaining to persons of Asian geographic origins or Hispanic ethnicity with sub-group labels such as Hmong, Laotian, Thai, etc. for the former, and Cuban, Puerto Rican, Colombian, etc., for the latter (Borak, Fiellin, & Chemerynski, 2004; Hirschman, Alba, & Farley, 2000; Racebox.org, 2014).

A noticeable omission in the past twenty years is any attempt to provide sub-groupings to classify recent immigrants from Africa who may differ significantly from African Americans in ethnicity and from an epidemiological standpoint. From 2000 to 2010, the African-born population doubled from 881,300 to 1.6 million (Immigration Policy Center, 2012). Twice as many Africans arrived in the U.S. during the last decade than during three centuries of the transatlantic slave trade. Nigeria, Ethiopia, Egypt, Ghana, and Kenya comprise the top five countries of origin for African immigrants. It should be noted Egyptians in the U.S. are classified as white despite the fact some self-identify as black. It also is noteworthy that with the exception of Nigeria and Ghana, the other countries on the list were not sources of the estimated 46 different ethnic groups that came from West and Central-South Africa to the U.S. during the slave trade (Heywood & Thornton, 2011). Yet like the designation "white," which, according to the logic of the system, should include a multitude of ethnic sub-groups originating in Europe and the Mediterranean, "black" remains undifferentiated when it comes to identifying recent African immigrants or black immigrants from the Caribbean and Latin America. Thus when race is used as a referent and variable in biomedical research to distinguish and describe populations that are the subjects of comparative research in hypertension, diabetes, cancer or other diseases, the lack of rigor in both classification and nomenclature has major implications for the analysis and reporting of data and findings.

The centrality and significance of federal racial classifications in biomedical research cannot be overemphasized. Current U.S. government policies require the use of federal classifications to structure and report the results of all government-funded research. The passage of civil rights laws in the 1960s provided the rationale and justification for the use of standardized data sets in order to monitor and enforce legal compliance with anti-discrimination regulations. In 1977 the Office of Management and Budget (OMB) issued Directive No. 15, which mandated the adoption of the standards "to provide for the collection and use of compatible, nonduplicated, exchangeable racial and ethnic data by Federal agencies" (U.S. Census Bureau, 2005). In the late 1980s, the National Institutes of Health (NIH) argued for the use of Directive No. 15 guidelines to identify and document problems of discrimination in clinical research and healthcare. In the 1990s the Centers for Disease Control (CDC) drafted a statement on the "Use of Race and Ethnicity in Public Health Surveillance" that included a disclaimer about the validity of biological race but argued nevertheless for improved standards in collecting racial data (CDC, 1993). The Food and Drug Administration (FDA) followed suit with requirements for new drug applications to present effectiveness and safety data on racial sub-groups (FDA, 1998). And in 1998 the U.S. Surgeon General's Office issued similar guidelines to use OMB Directive No. 15 classifications to administer its Healthy People 2010 program objectives (US Department of Health, 2000). These agency guidelines have been updated at various times since 2000. The controlling authority for the regulations resides within the OMB, which includes in its 2003 update the following disclaimer: "The categories represent a social-political construct designed for collecting data on the race and ethnicity of broad population groups in this country, and are not anthropologically or scientifically based" (emphasis added) (OMB, 2003). Notwithstanding these caveats and countless similar statements by scientists and scholars over the decades, theories of biological race have remained standard and pervasive features of biomedical and genomics research.

Although the stated intent of the government's classification and collection of racial data in biomedical research is to document and reduce health disparities in the nation, the use of race as an independent variable to structure government-funded research belies its history as a social construction that has changed and evolved over the centuries. While the widely accepted conception of whiteness treats it as a fixed and immutable racial category, even the most cursory reading of the history of U.S. immigration laws reveals it to be a fluid concept affected by the vagaries and vicissitudes of popular culture and American nativism (Jacobson, 1998; Tehranian, 2000). Most problematic is the notion of blackness--which began its history with the official designation of "slave" in the first U.S. Census. As a result of the popular theory of genetic dominance embodied in the notion of hypodescent (the "one drop rule" that classifies anyone with a known black ancestor as "black"), the standard definition of blackness commonly accepted since the late 17th century defies any logic but that deemed essential to American apartheid and antiblack racism (Hickman, 1996; Khanna, 2010). Moreover, until the civil rights era and the government's adoption of the self-designation African American, all other federal classifications on the decennial census forms (black, mulatto, colored, Negro) originated in the era of slavery.

Efforts to address current social inequality and health inequities experienced by people of color clearly are needed. Yet the failure to recognize how the continued...

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