Recent literature has increased the focus on health disparities related to racism, not race, as a major cause of illness. Since the inception of Western medicine, however, there has been an effort to identify genes specific to certain races that would explain why minority populations, including Black, Indigenous, and people of color (BIPOC), have a higher disease burden than White populations.
I attended PA school from 1998 to 2000, and even then our lectures frequently discussed how certain populations are more likely to have certain diseases, including heart disease, diabetes, and hypertension. We know that it is true, but we also know that race is a non-scientific construct, widely based on racist beliefs. I recall a Black classmate who would mumble to those of us around him during lectures, “oh great, here’s something else that is wrong with me.” His comments were certainly reflective of the false and unscientific beliefs that race is a cause of illness.
The issue of how to view the impact of institutional and individual racism on the health of BIPOC has gained increased attention, including exploring new and novel ways to think about racism and health. A Baylor College of Medicine blog post from 2020 illustrates some new and creative thinking on this topic. Blogger Haley Jackson Manley, research assistant in the Center for Medical Ethics and Health Policy at Baylor College of Medicine, shared her insightful take in that post:
“It’s more than just semantics that irks me when people talk about racism as a pandemic. A pandemic implies an outbreak. A disease that is fleeting and may be new or has seasons, such as the flu. Racism is not that. Racism is not new. It’s unceasing with no treatment or vaccine in sight. A more appropriate diagnosis would be racism as a chronic disease, like cancer or diabetes. But this particular chronic disease does not destruct the body of the individual who is infected. Instead, in America, its effects are felt throughout the entire African American community and are not only physical but also emotional and social.”
This really got me thinking about the concept of racism as a chronic disease that affects the physical and mental health of BIPOC. But it also posed questions about how to view this perspective. For example, if we accept that racism is a chronic illness, it leads me to wonder who then has the illness. We know that BIPOC are most affected by racism. But are such populations the ones with the disease or is it those who have racially biased beliefs and actions?
Just because BIPOC bear the brunt of demonstrated negative health impacts from racism, does that really equal having the illness? For example, if an authoritarian parent berates and abuses their child, and causes the child harm, who has the disease in that case? It hardly seems reasonable to describe the harmed child as the diseased party. Instead, it’s the parent with the illness.
But racism can be more subtle. Certainly, explicit racist behavior would lead us to conclude that the source of the behavior is the root cause of the illness. But what about when implicit and unconscious bias and racism is the root of the problem? Research repeatedly demonstrates that implicit and unconscious biases are pervasive among all humans. It also tells us that it predictably affects the health of minority populations. So, does that mean that all humans who hold implicit biases should be viewed as having a disease? Or is implicit bias itself a disease?
I’m inclined to think that it is, depending on how we define disease. Part of being a human being is dealing with our own inevitable disease states, ranging from rhinitis to cancer, from COVID-19 to depression. A reasonable assertion would be that our implicit and explicit biases may need to be viewed as a disease state because of the known negative health impacts they have on others.
Finally, what about society itself? Can a society with various cultures have a disease? It makes sense to me that societies can indeed be ill, with the illness caused by collective biases, hatred, ignorance, and racism. In the end, we know that the primary sufferers of racism are BIPOC. But asserting that they are the ones with the disease feels like a blaming-the-victim exercise, something that medicine knows much about. What really matters, however, is the chronic occurrence of ignorance, hatred, explicit and implicit bias, and historic prejudice within the medical community that dates back to its origins. This has resulted in premature death and unequal burden of illness and misery on BIPOC. Our job as PAs, nurse practitioners, and other health care providers is to understand how racism impacts us and our patients and establish ways to mitigate this impact. The job of medicine is to address how explicit, or even implicit biases, have made those of us with racial biases sick as well.