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Disparity Ideology, Coronavirus, and the Danger of the Return of Racial Medicine

Why "race" is less useful—both empirically and politically—than ever as a proxy for the social conditions of poverty, lack of healthcare, and mass inequality.

A man wearing and selling masks for 5 dollars along Adams Blvd and Figueroa St. during the Coronavirus Pandemic in Los Angeles on Thursday, April 02, 2020. (Photo by Keith Birmingham/MediaNews Group/Pasadena Star-News via Getty Images)

A man wearing and selling masks for 5 dollars along Adams Blvd and Figueroa St. during the Coronavirus Pandemic in Los Angeles on Thursday, April 02, 2020. (Photo by Keith Birmingham/MediaNews Group/Pasadena Star-News via Getty Images)

In the past few days, liberal Democrats Sen. Elizabeth Warren, Rep. Ayanna Pressley, and Rep. Alexandria Ocasio Cortez, academics Ibram X. Kendi and Keeanga-Yahmatta Taylor, and New York Times columnist Charles Blow separately have issued calls for special focus on black Americans' particular vulnerability to Covid-19, apparently based on a generic presumption that blacks are likely to have it (whatever it is) worse. 

Meanwhile, the non-profit news outlet ProPublica published a report seeking to ratify the claim of special black suffering even in the absence of solid evidence. Yet why do they presume that? And what do they and others, especially those who don't intend to argue that blacks or other nonwhites are inferior, mean when they refer to "race" as a factor contributing to vulnerability to Covid-19, or to anything else for that matter? Sometimes it's just an empty piety, as in the presidential debate-stage pledges made by Warren, Pete Buttigieg, and Tom Steyer to fight "systemic racism," without any of them ever once suggesting what that notion might mean concretely. Sometimes the reference is a condensation of clichés that evoke a history of racial injustice, or a condensation of shibboleths like "when America has a cold, black people have the flu" and canary-in-the-coalmine analogies. Sometimes, often I suspect, speculation or assertion that race is a causal factor in producing some, usually undesirable, outcome is a proxy for reference to a variety of material conditions, like poverty, economic inequality, and stressors related to them that can undermine health—such as overcrowding, inadequate shelter, malnutrition, unemployment, to name only a few—that have, or seem to have, disproportionate impact on blacks or other racially defined populations. Even the possibility that living in a race-conscious society may impose additional burdens on black Americans' health does not override the fundamental significance of the overarching regime of inequality.

"Especially if our concern is to combat healthcare inequalities, it seems less clear than ever that the 'blacks have it worse' trope does us much good. The problem lies in the irrationality and injustice of a for-profit healthcare system and its market-driven rationing of access to care at every step."

The last usage is understandable as a shorthand, but only so long as people understand that they're using it as a shorthand. But I fear that that understanding is steadily being eroded in American intellectual life and public commentary, partly under the pressure of always resurgent racialist determinism, which now takes happy-face forms in commercially propagated pop narratives purporting to locate genetic "heritage" and popular hype about supposedly race-targeted pharmaceutical interventions. There is a danger that expressions of much more open and virulent forms of resurgent racialism may be sanitized, even abetted, by the circumstance that nowadays the inclination to treat "race" as a natural category, one capable of exerting independent effects, is as likely to come from those who presume to be advocates for the concerns of what were described a generation or two ago as "historically underprivileged minorities" as from open racists. 

Many readers are likely familiar with the sordid history of racial medicine in the U.S. and elsewhere (as discussed in Alan H. Goodman's 1997 essay "Bred In the Bone") and its particularly toxic links in the past to anxieties about contagion and public health. I trust that those like Warren, Pressley et al. currently calling for a special focus on racial impacts consider themselves advocates of social justice, but it's not too difficult to anticipate how "blacks have it worse" could become in the hands of ugly political forces vying for ascendancy in this country as elsewhere "blacks [or immigrants, or whatever statistically reified populations] are the source of the problem." As I read Kendi's historical brief for the importance of racial medicine, I mused about one of its 19th century accomplishments, discovery of drapetomania, a "disease of the mind" that afflicted slaves with an irrational inclination to "run away from service," diagnosed by a slave-owning Louisiana physician in the 1850s. And that was a century and a half before Pfizer, Merck, and GlaxoSmithKline were around to market treatments for it.   

Also, one of the most prominent expressions of the "blacks have it worse" argument in the racial medicine field's heyday was Frederick L. Hoffman's 1896 study, Race Traits and Tendencies of the American Negro, which he conducted for the Prudential Life Insurance Company as part of its effort to circumvent anti-discrimination enforcement by showing that blacks were uninsurable actuarially. Hoffman demonstrated statistically that blacks have it so much worse that they would eventually die out as a population because they weren't fit biologically to live outside slavery. 

It cannot be stressed enough that race is not a natural category; it is a fiction, an entirely made-up idea with no grounding outside of abstract and arbitrary taxonomies—elaborate just-so stories—of human difference. Black people, therefore, cannot be disproportionately vulnerable as a generic category of racial taxonomy. As an aggregate statistical category, black people may appear especially vulnerable on average to Covid-19, for example, in relation to some other aggregate statistical categories to the extent that individuals classified or recognized as black are disproportionately poor and beset with risk factors associated with poverty. The heightened vulnerability would not be a function of being classified as black, per se. It is easy in the dubious shorthand of our prevailing race discourse to lose sight of the reality that racism is simply and quintessentially the belief that race is not merely a statistical reification but instead refers to populations defined by actual biological difference. And that belief is quintessentially racist whether or not it is linked to claims regarding inferiority or superiority. That is, racism is the belief that race is a category that defines and encapsulates natural populations. It does not. A claim that black people are especially vulnerable, as black people, to Covid-19 or any contagion is as preposterous as a claim that unicorns are especially vulnerable.

The reflex to assume that "blacks have it worse" as an interpretive frame of reference can seem reasonable insofar as that assumption reflects a particular understanding of the dynamics of inequality, and especially the rhetorical frames propelling those dynamics, through much of 19th and 20th century U.S. history. However, in the contemporary U.S.—in large measure because of the legislative and social movement victories won in the 1960s and beyond—"race" is less precise and self-evident than it once was, both empirically and politically, as a proxy for those objectionable social conditions, an explanation of the dynamics generating them, or indication of a path toward overcoming them. 

"A claim that black people are especially vulnerable, as black people, to Covid-19 or any contagion is as preposterous as a claim that unicorns are especially vulnerable."

Especially if our concern is to combat healthcare inequalities, it is not at all clear that the "blacks have it worse" trope does us much good. The problem lies in the irrationality and injustice of a for-profit healthcare system and its market-driven rationing of access to care at every step along the way, whether or not those falling through the cracks are more likely to be recognized as black than otherwise.

And politically, at a moment when the shared danger of pandemic screams of the need for broad solidarity, insistence on that trope could hardly be more tone-deaf. It reveals the extent to which the logic of a neoliberal politics of race relations engineering and its singular normative ideal of group parity even within a larger system of intensifying inequality shapes the political imaginations even of those who wish to be seen as progressives. It is worth recalling that Warren during her campaign emphatically opposed universal student loan forgiveness and insisted on a partial, means-tested benefit because, she claimed, a universal approach would not sufficiently narrow the racial wealth gap.

It is the putative excesses of inequality that left identitarians like Warren, Pressley, et al. oppose, those that stem from exclusion on the basis of race, gender, or sexual orientation, etc. Inequalities produced by capitalist markets being capitalist markets—i.e., the inequalities that affect most of us as working people— are just fine, maybe even the stuff of feminist or anti-racist success stories.  That is a politics that cannot help us struggle for the egalitarian society we deserve.

Adolph Reed Jr.

Adolph Reed Jr.

Adolph Reed Jr. is Professor Emeritus of Political Science at the University of Pennsylvania and an Organizer for Medicare for All-South Carolina.

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