Hi History of the e African Amer erican Exper erien ence e in - PowerPoint PPT Presentation

Hi History of the e African Amer erican Exper erien ence e in Hea Healthcare: e: Colorblindness, Raci cism and “Object ctive” Measures of Health and Performance ce Julia Cummiskey, MPH, PHD Julia-Cummiskey@utc.edu

Huffington Post. https://www.huffpost.com/entry/bmi-scale-racist-health_l_5f15a8a8c5b6d14c336a43b0

https://themighty.com/2020/07/bmi-measure-racist-sexist-harming-black-women/

August 30, 2020

"The practice of the Negro doctor will be limited to his own race, which in its turn will be cared for better by good Negro physicians than by poor white ones. But the physical well-being of the Negro is not only of moment to the Negro himself. Ten million of them live in close contact with sixty million whites. Not only does the Negro himself suffer from hookworm and tuberculosis; he communicates them to his white neighbors, precisely as the ignorant and unfortunate white contaminates him. Self-protection not less than humanity offers weighty counsel in this matter; self- interest seconds philanthropy . The Negro must be educated not only for his sake, but for ours. He is, as far as the human eye can see, a permanent factor in the nation.” The Flexner Report, 1910

Campbell KM, Corral I, Infante Linares JL, Tumin D. Projected Estimates of African American Medical Graduates of Closed Historically Black Medical Schools. JAMA Netw Open. 2020;3(8):e2015220. doi:10.1001/jamanetworkope n.2020.15220

Meaning ”The study’s findings suggest that consideration should be given to the creation of medical education programs at historically Black colleges and universities in an effort to increase the number of African American graduates from medical schools and the number of African American physicians in the workforce.”

“Some caregivers I spoke with sounded exhausted to field questions about pulse ox biases. They were beleaguered, no doubt, by a thousand other COVID-19 contingencies and more obvious manifestations of inequities. Even if they had never noticed glitches, it could be painful to wonder. Others I spoke to argued that any racial discrepancies at all were simply unacceptable. When people rely on devices for a snapshot, just as with Kodak film, shouldn’t everyone’s picture be equally clear? Anything less widens room for mistakes that may amplify existing inequalities. It creates a situation where hospital care teams need to work around the subtle racial biases of their tools.” Amy Moran. “How a Popular Medical Device Encodes Racial Bias.” Boston Review, August 5, 2020. http://bostonreview.net/science- nature-race/amy-moran-thomas-how-popular-medical-device- encodes-racial-bias

John Hutchinson 1811-1861

“One outcome of global standardization projects is the common practice of ‘race correction’, also called ‘ethnic adjustment’. Most commercially available spirometers internationally ‘correct’ or ‘adjust’ for race in one of two ways: by using a scaling factor for all people not considered to be ‘white’; or by applying population-specific norms. To enable the spirometer, the operator must select the race of an individual, as well as indicate their age, sex/gender and height. How race (or population) is determined varies, with most operators either asking patients to self-identify or ‘eyeballing it’. Interviews with users of the spirometer indicate that many operators are unaware that they are automatically activating race correction when they select a patient’s race. Because ‘correction’ is programmed into the spirometer by the manufacturer, it can be difficult to disable.” Braun, Lundy. "Race, ethnicity and lung function: a brief history." Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR 51, no. 4 (2015): 99.

“The history of lung function suggests that we should be approaching spirometry differently. Rather than using race in a routinized way that reflects assumptions of genetic difference, we should be asking different research questions about the lived experience of race. Research and clinical practice needs to devote more careful attention to the social nature of racial and ethnic categories and draw on more complex explanatory frameworks that incorporate disproportionate exposures to toxic environments, differential access to high-quality care and the daily insults of racism in every sphere of life that manifest biologically.” Braun, Lundy. "Race, ethnicity and lung function: a brief history." Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR 51, no. 4 (2015): 99.

Fearing the Black Body: The Racial Origins of Fat Phobia by Sabrina Strings

“[D]uring the nineteenth century, the era in which scholars have shown the anti-fat sentiment in the United States was on the rise, the fear of racial Others played a critical role in the growing horror surrounding corpulence.” Sabrina Strings, ”Fat as a Floating Signifier: Race, Weight and Femininity in the National Imaginary”

“Evaluating the inadequate and questionable data about race, weight and Covid-19 complications with these insights in mind makes it clear that obesity — and its affiliated, if incorrect implication of poor lifestyle choices — should not be front and center when it comes to understanding how this pandemic has affected African-Americans. Even before Covid-19, black Americans had higher rates of multiple chronic illnesses and a lower life expectancy than white Americans, regardless of weight. This is an indication that our social structures are failing us. These failings — and the accompanying embrace of the belief that black bodies are uniquely flawed — are rooted in a shameful era of American history that took place hundreds of years before this pandemic.” Sabrina Strings, “It’s not obsesity killing black people. It’s slavery.”

“The same level of BMI can carry different connotations of risk in different ethnic groups, with BMI likely being an inconsistent measure of obesity in in Māori/Pacific patients.” Moharram MA, Aitken-Buck HM, Reijers R, et al. Correlation between epicardial adipose tissue and body mass index in New Zealand ethnic populations. The New Zealand Medical Journal. 2020 Jun;133(1516):22-32.

Further Reading: • Lundy Braun. “Spirometry, Measurement, and Race in the Nineteenth Century.” journal of the History of Medicine and Allied Sciences 60, 2 (2005). • -- Breathing Race into the Machine: The Surprising Career of the Spirometer from Plantation to Genetics . Minneapolis: University of Minnesota Press, 2014. • Stephen Epstein. Inclusion: The Politics of Difference in Medical Research . Chicago: University of Chicago Press, 2007. • Amy Moran-Thomas. “How a Popular Medical Device Encodes Racial Bias.” http://bostonreview.net/science-nature-race/amy-moran-thomas-how-popular-medical-device- encodes-racial-bias • Sabrina Strings. Fearing the Black Body: The Racial Origins of Fat Phobia . New York: NY Press, 2019. • -- “Fat as a Floating Signifier: Race, Weight, and Femininity in the National Imaginary.” In The Oxford Handbook of the Sociology of Body and Embodiment, 2019. • -- “It’s not obesity killing black people. It’s slavery.” https://www.sltrib.com/opinion/commentary/2020/05/26/sabrina-strings-its-not/

“Race is a social construction with no biological basis, whereas racism refers to a social system that reinforces racial group inequity. Racialization is the process by which meaning and value are ascribed to socially determined racial categories, and each racial category occupies a different position in the social hierarchy. For Jee-Lyn García, example, being Black (a race category) does not tell us Jennifer, and Mienah Zulfacar Sharif. "Black much about one’s health risks. However, being Black in lives matter: a America (a racially stratified society) has negative commentary on racism and public implications for educational and professional health." American trajectories, socioeconomic status, and access to health journal of public health 105, no. 8 care services and resources that promote optimal health, (2015): e27-e30. which in combination, may reduce or exacerbate health risks. In a racially stratified society, White lives are inherently valued over Black lives.”

A Syllabus on the History of Anti-Black Racism in Medicine, from the African American Intellectual History Society https://www.aaihs.org/sylla bus-a-history-of-anti-black- racism-in-medicine/