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Pediatric Dentistry Seminar, October 19, 2007. The role of race in scientific research. Victor J. Schoenbach, Ph.D. www.unc.edu/~vschoenb/ School of Public Health, Department of Epidemiology and Minority Health Project ( www.minority.unc.edu ).

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The role of race in scientific research

Pediatric Dentistry Seminar, October 19, 2007

The role of race in scientific research

Victor J. Schoenbach, Ph.D.

www.unc.edu/~vschoenb/

School of Public Health, Department of Epidemiology and Minority Health Project (www.minority.unc.edu)

The role of race in scientific research


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.)

The role of race in scientific research


Outline
Outline talking about –

  • Why study race?

  • What is race?

  • Race vs. ethnicity

  • Socioeconomic status

  • Racism and American apartheid

  • Diversity in the professions

The role of race in scientific research


Why we should not study race
Why we should not study race talking about –

  • Sordid history of race research -

    • Race “science”

    • Eugenics

  • Difficult (impossible?) to define – biological? cultural? political?

  • Not a biological construct

  • Neither scientifically nor anthropologically based

The role of race in scientific research


Why we should not study race1
Why we should not study race talking about –

  • 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)

The role of race in scientific research


Why we should study race
Why we talking about –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

The role of race in scientific research


What is race
What is race? talking about –

“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)

The role of race in scientific research


What is race1
What is race? talking about –

“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

The role of race in scientific research


What races exist
What “races” exist? talking about –

  • 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])

The role of race in scientific research


Historical view of race
Historical view of race talking about –

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)

The role of race in scientific research


Historical view of race1
Historical view of race talking about –

  • 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)

The role of race in scientific research


Historical view of race2
Historical view of race talking about –

  • 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)

The role of race in scientific research


Historical view of race3
Historical view of race talking about –

“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.”3737Allen IC. The Negro health problem. Am J Public Health 1915, reprinted in Gamble VN, 1989, 59-68, quoted in Oppenheimer 2001

The role of race in scientific research


Current understanding of race
Current understanding of race talking about –

  • “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)

The role of race in scientific research


President s cancer panel 1997
President’s Cancer Panel talking about –(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

The role of race in scientific research


Race vs ethnicity
Race vs. ethnicity talking about –

“‘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[sic] therefore inaccurate and misleading, yet studies persist in using this term.7” (Chaturvedi, International Journal of Epidemiology, 2001)

The role of race in scientific research


Race vs ethnicity1
Race vs. talking about –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)

The role of race in scientific research


Race vs ethnicity2
Race vs. talking about –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.

The role of race in scientific research


Hispanic ethnicity
Hispanic ethnicity talking about –

  • A cultural group – to a great extent share language, religion, customs, history, geography – but also very diverse

  • Hispanics include American Indians, Europeans, Africans, and Asians, perhaps even more than North Americans

  • Whites in Latin America also subjugated Indians and enslaved Africans

The role of race in scientific research


Referent group
Referent group talking about –

  • “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?

The role of race in scientific research


Ethnocentricity
Ethnocentricity talking about –

“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

The role of race in scientific research


Race ethnicity is largely a political construct
Race/ethnicity is largely a political construct talking about –

  • History – U.S. and everywhere else

  • “Race science” has followed history and political needs

  • Before 1930, “Polish”, “Jewish”, “Irish”, etc. were called “races”.

  • Classification schemes are political (e.g., “one drop rule” and contemporary) rather than scientific

The role of race in scientific research


Measuring race and ethnicity
Measuring race and ethnicity talking about –

  • How measure: Observation? Self-report?

  • How analyze multiracial category

  • Different races for different contexts?

  • Inconsistencies over time, between data sources

The role of race in scientific research


Socioeconomic status
“Socioeconomic status” talking about –

  • Closely tied to race and ethnicity primarily for historical reasons

    • History of most ethnic groups in U.S. – start as poor, suffer discrimination, advance, discriminate, become “white”

    • Extensive legal and extra-legal forces to keep African Americans down

The role of race in scientific research


Socioeconomic status1
Socioeconomic status talking about –

  • 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

The role of race in scientific research


Some reasons why ses hard to control for
Some reasons why SES hard to control for talking about –

  • Grade in school ignores quality of education

  • Income return on education differs

  • Prices paid by minorities differ

  • Family assets, expertise, information, access

  • Vehicles, appliances, needs

  • Public goods / community wealth and services

The role of race in scientific research


Ses not the whole story
SES not the whole story talking about –

  • America is more race conscious than class conscious (“classless society”, anti-Communist, anyone can succeed – historically true compared to Europe, but less so for nonwhites)

  • Race and ethnicity are often more visible, impede upward socioeconomic mobility

The role of race in scientific research


Racism and american apartheid
Racism and American apartheid talking about –

“The problem of the Twentieth Century is the problem of the color line …” (W.E.B. DuBois, The souls of black folk, 1903)

The role of race in scientific research


Racism and american apartheid1
Racism and American apartheid talking about –

Atlanta bus, 1956

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Racism and american apartheid2
Racism and American apartheid talking about –

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 2000www.splcenter.org

The role of race in scientific research


Racism and american apartheid3
Racism and American apartheid talking about –

Firebombed bus carrying Freedom Riders into Alabama in 1961

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Racism and american apartheid4
Racism and American apartheid talking about –

Civil rights workers James Chaney, Andrew Goodman, and Michael Schwernerdisappeared in Mississippi in 1964

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Racism and american apartheid5
Racism and American apartheid talking about –

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 2000www.splcenter.org

The role of race in scientific research


1963 bombing of the talking about –16th Street Baptist Church, Birmingham, Alabama

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Not shown
Not shown talking about –

  • Latinos

  • Asian Americans

  • Pacific Islander Americans

  • “White” ethnic groups

  • American Indians – the first immigrants

The role of race in scientific research


America is a hostile terrain for many groups talking about –

The Neo-Confederate movement

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Neo confederate hate groups 1
Neo-Confederate talking about –hate groups (1)

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Neo confederate hate groups 2
Neo-Confederate hate groups (2) talking about –

Source: Southern Poverty Law Center, Intelligence Report issue 99, Summer 2000www.splcenter.org

The role of race in scientific research


Diversity in the professions
Diversity in the professions talking about –

  • 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

The role of race in scientific research


Racism and american apartheid6
Racism and American apartheid talking about –

“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

The role of race in scientific research


Racism and american apartheid7
Racism and American apartheid talking about –

Colleges and universities in the South - including NC remain “segregated and unequal” – 1995 report issued by the Southern Education Foundation

The role of race in scientific research


Resegregation in American Schools talking about –(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

The role of race in scientific research


Resegregation in American Schools talking about –(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.

The role of race in scientific research


Resegregation in American Schools talking about –(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.

The role of race in scientific research


Racism and american apartheid8
Racism and American apartheid talking about –

  • 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

The role of race in scientific research


An american dilemma
An American Dilemma talking about –

  • Gunnar Myrdal’s classic study

  • A continuing reality

  • What does the future hold?

The role of race in scientific research


Selected bibliography
Selected bibliography talking about –

Bhopal, R. (1998). Spectre of racism in health and health care: lessons from history and the United States. BMJ 316: 1970-1973

Bhopal, Raj (2007). Ethnicity, race, and health in multicultural societies:

foundations for better epidemiology, public health, and health care. Oxford.

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, 1900-1940. 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.

The role of race in scientific research


Selected bibliography1
Selected bibliography talking about –

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;6:21-2

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 Consensus 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.

The role of race in scientific research


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