Oral Epidemiology for Health Policy and
Administration (HPAA 228)
The role of race in scientific research
May 10, 2002
Victor J. Schoenbach, Ph.D.
vjs@unc.edu
School of Public Health, Department of Epidemiology
and Minority Health Project (www.minority.unc.edu)
5/10/2002
The role of race in scientific research
1
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.)
11/2/2001
The role of race in scientific research
2
Outline
• Why study race?
• What is race?
• Race vs. ethnicity
• Socioeconomic status
• Racism and American apartheid
• Diversity in the professions
11/2/2001
The role of race in scientific research
3
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
• Not scientifically nor anthropologically based
11/2/2001
The role of race in scientific research
4
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)
11/2/2001
The role of race in scientific research
5
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
11/2/2001
The role of race in scientific research
6
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)
11/2/2001
The role of race in scientific research
7
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
11/2/2001
The role of race in scientific research
8
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])
11/2/2001
The role of race in scientific research
9
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)
11/2/2001
The role of race in scientific research
10
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)
11/2/2001
The role of race in scientific research
11
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)
11/2/2001
The role of race in scientific research
12
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.”37
37
Allen IC. The Negro health problem. Am J Public Health 1915, reprinted in Gamble
VN, 1989, 59-68, quoted in Oppenheimer 2001
11/2/2001
The role of race in scientific research
13
Historical view 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)
11/2/2001
The role of race in scientific research
14
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
11/2/2001
The role of race in scientific research
15
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 therefore inaccurate and
misleading, yet studies persist in using this term.7”
(Chaturvedi, International Journal of Epidemiology, 2001)
11/2/2001
The role of race in scientific research
16
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)
11/2/2001
The role of race in scientific research
17
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.
11/2/2001
The role of race in scientific research
18
Hispanic ethnicity
• A cultural group – to a great extent share
language, religion, customs, history,
geography – but also very diverse
• Mixture of American Indians, Europeans,
Africans, and Asians, perhaps even more than
North Americans – doesn’t “race” matter if one
speaks Spanish?
• Latin America also subjugated Indians and
enslaved Africans
11/2/2001
The role of race in scientific research
19
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?
11/2/2001
The role of race in scientific research
20
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
11/2/2001
The role of race in scientific research
21
Race/ethnicity is largely a political construct
• History – U.S. and everywhere else
• “Race science” has followed history and
political needs
• “Hispanic”, but not “Polish”, “Jewish”, “Irish”,
etc. (before 1930 were called “races”)
• Classification schemes (e.g., “one drop rule”
and contemporary)
11/2/2001
The role of race in scientific research
22
Measuring race and ethnicity
• By observation vs. self-report
• Multiracial category
• Different races for different contexts?
• Inconsistencies over time, between data
sources
11/2/2001
The role of race in scientific research
23
“Socioeconomic status”
• Closely tied to race and ethnicity primarily for
historical reasons
• History of most ethnic groups in U.S. –
poverty, discrimination, advance,
discriminate, become “white”
• Extensive legal and extra-legal forces to
keep African Americans down
11/2/2001
The role of race in scientific research
24
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
11/2/2001
The role of race in scientific research
25
Some reasons why SES hard to control for
• Grade in school ignores quality of education
• Income return on education differs
• Prices paid differ
• Family assets, expertise, information, access
• Public goods / community wealth and services
• Vehicles, appliances, needs
11/2/2001
The role of race in scientific research
26
SES not the whole story
• America is more race conscious than class
conscious (“classless society”, antiCommunist, anyone can succeed – historically
true compared to Europe, but less so for
nonwhites)
• Race and ethnicity are often more visible,
impede upward socioeconomic mobility
11/2/2001
The role of race in scientific research
27
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)
11/2/2001
The role of race in scientific research
28
Racism and American apartheid
Atlanta bus, 1956
Source: Southern Poverty Law Center,
Intelligence Report issue 99,
Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
29
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 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
30
Racism and American apartheid
Firebombed bus carrying
Freedom Riders into
Alabama in 1961
Source: Southern Poverty Law Center,
Intelligence Report issue 99,
Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
31
Racism and American apartheid
Civil rights workers James Chaney, Andrew Goodman, and Michael Schwerner
disappeared in Mississippi in 1964
Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
32
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 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
33
1963 bombing of the
16th Street Baptist Church,
Birmingham, Alabama
Source: Southern Poverty Law Center,
Intelligence Report issue 99,
Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
34
Not shown
•
•
•
•
•
Latinos
Asian Americans
Pacific Islander Americans
“White” ethnic groups
American Indians – the first immigrants
11/2/2001
The role of race in scientific research
35
The Neo-Confederate movement
Source: Southern Poverty Law Center,
Intelligence Report issue 99,
Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
36
Neo-Confederate
hate groups
Source: Southern Poverty Law Center,
Intelligence Report issue 99,
Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
37
Neo-Confederate hate groups
Source: Southern Poverty Law Center,
Intelligence Report issue 99,
Summer 2000
www.splcenter.org
11/2/2001
The role of race in scientific research
38
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
11/2/2001
The role of race in scientific research
39
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
11/2/2001
The role of race in scientific research
40
Racism and American apartheid
Colleges and universities in the South including NC remain “segregated and
unequal” – 1995 report issued by the
Southern Education Foundation
11/2/2001
The role of race in scientific research
41
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
11/2/2001
The role of race in scientific research
42
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.
11/2/2001
The role of race in scientific research
43
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.
11/2/2001
The role of race in scientific research
44
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
11/2/2001
The role of race in scientific research
45
Selected bibliography
Bhopal, R. (1998). Spectre of racism in health and health care: lessons from
history and the United States. BMJ 316: 1970-1973
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, 19001940. 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.
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;6:21-29.
11/2/2001
The role of race in scientific research
46
Selected bibliography
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 Concensus 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.
11/2/2001
The role of race in scientific research
47