The Cruel Optimism of Racial Justice (21st Century Standpoints) by Nasar Meer

Author:Nasar Meer [Meer, Nasar]
Language: eng
Format: epub
Publisher: Policy Press
Published: 2022-03-21T18:30:00+00:00

Centring the social determinants

Let us then re-centre what we call the ‘social determinants’ of health. By this is meant the need to maintain a broad focus on the underlying determinants of susceptibility to the virus and not allow the physiological risks to be separated from their social exposures. It demands that we take both a historical view and also a more conceptually discerning approach to seemingly self-evident data and its use in public health and policy responses.18 This begins by appreciating something of the longstanding relationship between medical knowledge and race, which has developed into a broader account about how we think of health and well-being, and the kinds of differential outcomes that we routinely see. For example, it is sometimes said the genetic condition of sickle cell anaemia is a predominantly ‘Black disease’,19 which suggests that a discrete relationship exists between a racial category and biology. Or, it is observed, that because there are higher levels of hypertension among African Americans when compared with White Americans,20 a physiological explanation emerging from the group category is self-evident. A further illustration might be elevated levels of psychosis and poorer mental health among some minority ethnic and racial groups, something reflected in the over-representation of members of these minoritised groups in mental health institutions.21

If we take each example in turn, we can see why we must wholly reject attributions of a causal relation between ethnic and racial categories and disease uncoupled from their social exposures, and instead be willing to be guided by an understanding of the sociological conditions in the environment that frame such conditions. Beginning with sickle cell anaemia, it is clear that this condition results from genetic alteration in levels of haemoglobin protein in the red blood cells, which become brittle and sickle-shaped. Yet, on inspection, we find that it correlates with a legacy of exposure to a particular kind of malaria (falciparum), to which people with sickle cell anaemia are actually more resistant. Since malaria is (or has been) a significant cause of death across continents, from West Africa to the Mediterranean coastline, as well as in India, we can observe a historical gene–environment interaction – or a ‘selection pressure’ (environmental factors influencing’ the process of natural selection) – which continues to carry this sickle cell gene even though it is sometimes harmful.22 As a consequence, we find cases of sickle cell anaemia among a wider variety of population groups than may commonly be anticipated, including White groups.

Turning to higher levels of hypertension, an important relationship between social stigma and anxiety that affects hypertension is illustrated in a study by Gravlee,23 who makes a useful distinction between cultural and biological dimensions of skin colour in Puerto Rico. He does so in order to explore the relationship between biological and environmental indicators of race by first studying local ways of talking about skin colour and how skin colour shapes Puerto Ricans’ exposure to racism and other social stresses. To measure this, he developed a survey to compare blood pressure to the significance of colour, as local people understood colour.

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