“Pooling people in race silos is akin to zoologists grouping raccoons, tigers, and okapis on the basis that they are all stripey.” from Genes Don’t Cause Racical Disparities, Society Does
An article from The Atlantic, as quoted above, says this “Researchers are looking in the wrong place: White people live longer not because of their DNA but because of inequality.”
It’s NOT about race people!
Basically, billions of dollars have gone into funding studies that look at race as a basis for health disparities when, in fact, it is far more about living conditions. For years conventional wisdom has argued that there is really nothing we can do about these health disparities, because it’s really about biology. But a review of the literature showed none of that. Jay Kaufman, lead author of the study “The Contribution of Genomic Research to Explaining Racial Disparities in Cardiovascular Disease: A Systematic Review” says this:
“If you show that this is a predisposition that is genetically determined—black people just have this gene, there’s nothing we can do about it, this is just nature—then society is completely absolved. We don’t have any responsibility to solve this problem….If you show that it is because of racism and injustice and people’s living conditions, well, then, there is some responsibility and we have to do something about this.”
One of the things that we pay a lot of attention to in public health is something called the “social determinants of health.” The social determinants of health are defined as “the conditions in which people are born, grow, live, work and age, including the health system.” This takes into account not only your genetic code, but also your zip code.
Here is an example: Four years ago I did some consulting work in Washington state for community health workers. One of the classes that I held was in a public housing space in Tacoma, Washington. The space was beautiful. It was a ‘mixed use housing’ area which means that some people owned their homes while others rented. There was a beautiful playground, a clinic, an assisted living space, and a school down the road. But when I asked someone who lived there where residents purchased food, she looked at me and said “It takes three different bus rides to get to a grocery store.” This is what we call a “food desert.” Right across the street you could buy 1500 calories of junk for a dollar and yet it took a major part of the day to buy good food.
A researcher who goes into that community, a community largely made up of “people of color,” may find high rates of heart disease. But it has little to do with the color of their skin, and perhaps a lot to do with the fact that healthy food is so far away.
All of us, regardless of our station in life, interact with the world around us. And it is in this world that our health is created. So if we live in a neighborhood that has clean air, wide sidewalks, well-lit streets and play grounds, along with affordable farmers markets for fruit and vegetables, we have a far better chance at health than the person who has none of these things. Turns out that person is far more likely to struggle with asthma, lack of physical activity, obesity and poor nutrition. It also turns out that most of “those people” end up being people of color.
Where we live matters!
In the PBS series “Is Inequality Making us Sick?” questions about the social determinants of health are asked. Like the article in The Atlantic, the answers are troubling, because it’s a lot more to do with our neighborhoods and zip codes than our genetic codes. And that means we can do something about it.
All of this is best summed up in this statement:
“When it comes to why many black people die earlier than white people in the U.S., Kaufman and his colleagues show we’ve been looking for answers in the wrong places: We shouldn’t be looking in the twists of the double helix, but the grinding inequality of the environment.”
But, like almost everything, it is far easier to write about it, then to take concrete action and actually do something about it.
2 thoughts on “Raccoons, Tigers, and Okapis and How Where You Live Matters”
It IS daunting to think about changing something so entrenched as inequality. But concrete action, even in small steps, can come from eloquent musings such as this. Fabulous post.
When I lived in Honduras, it was easy to spot who would live longer. Did you live on a paved street or a dirt-filled alley? That influences the amount of people, young or old, dying of respiratory infections. Do you have access to potable water? Duh. No need to comment there! Do I understand the role of nutrition and medicine in making my life and my family’s life better? I had a good friend, a nursing assistant, who was diagnosed with diabetes in her early 40s. We had a dialogue one day at our debriefing meeting about how to help our friend who was very distraught about her diagnosis. EVERYONE came to the agreement after much dialogue that she needed to cut out Coca-Cola and switch to Sprite. I had to do some considerable thinking and careful speaking to show them that was no solution. These were better educated than most! Yes, diabetes and high blood pressure are endemic in the poor enclaves of Honduras, but I don’t know how much genetics plays a part in these very poorly educated areas.