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As Black History Month gets underway in the UK, NDS Athena SWAN Coordinator Emily Hotine puts racism under the microscope.

Black Lives Matter protest

It’s Black History Month and 2020 has been a historic year as the ongoing brutalisation of African Americans at the hands of the US police has been brought to the attention of the world. The US police have been murdering multiple black people in America, and while people have been taking to the street to protest these injustices, white supremacists have been instigating violence at protests and, in some cases, murdering protestors

The Black Lives Matter movement surged into the centre of media coverage and educated the world on the ways in which racism has never disappeared, but merely evolved. One example of this can be found in Lee Atwater, political strategist for the Republican Party, and the Republican Party’s Southern Strategy of the 1970s and 1980s. Atwater’s now infamous interview demonstrates this evolution as the tide of public opinion started to turn towards the ethos that racism is, in fact, bad:

“So you say stuff like forced busingstates' rights and all that stuff. You're getting so abstract now [that] you're talking about cutting taxes, and all these things you're talking about are totally economic things and a byproduct of them is [that] blacks get hurt worse than whites. And subconsciously maybe that is part of it. I'm not saying that. But I'm saying that if it is getting that abstract, and that coded, that we are doing away with the racial problem one way or the other. You follow me—because obviously sitting around saying, "We want to cut this", is much more abstract than even the busing thing.”

The rest of Atwater’s quote is littered with racial slurs. Atwater’s interview clearly shows the Republican Party aimed to appeal to southern voters through dog whistling, assuring them that their policies would continue the tradition of racism towards African Americans through codified language that could not directly be labelled as racist. It was a newer, more civilised brand of racism that informed policies on the war on drugsstate’s rights, and voter suppression. This strategy has continued beyond the 20th century and underlies the rhetoric of the modern Republican Party and Donald Trump.

But the UK isn’t America. And some people would claim that racism is an American issue, not a British one. I’m going to refute that by taking a look at the history of racism in science and the racism that exists in UK healthcare. 

Scientific racism

There is a long history of white scientists using biological phenomena to set white people and black people apart, referred to as “scientific racism”. Scientific racism was used to argue that black inferiority was biologically predetermined, which would then form the justification for slavery and economic and social oppression. One popular myth used by scientists was that black people had smaller brains than white people, which they argued proved inferior intelligence.

Polygenism, an aspect of scientific racism that was particularly popular in America in the nineteenth century, was the theory that each race originated separately from one another. Polygenism posited that the differences between races were grounded in biology and “warranted identification as separate species.” Conflating race and species in this way opened the door for scientists to dehumanise black people by comparing them to animals, particularly apes. One text that was guilty of this was Types of Mankind, an 1854 book by Josiah Clark Nott and George Robbins Giddon that implied black people were more closely related to chimpanzees than white people were. One illustration demonstrates the tendency to conflate race and species and use these "observed" traits to assert white dominance over black people. 

This association between black people and primates is one that has persisted to the present day, and black defendants in criminal cases are more likely to be likened to animals. This encourages racially-driven fear and dehumanises black people, which studies have shown causes discrimination against them. Scientific racism hasn’t gone away and we can see the legacy of scientific racism today in language around black athleticism, with people frequently regarding black success in this area as something biological or innate.

Modern scientists have refuted scientific racism. Angela Saini, British science journalist and author, argues in her book Superior: The Return of Race Science that scientists are quick to look to biology to explain our differences because it is familiar. We live in a society where race is seen as significant – as an indicator of who a person is and how you can expect them to behave. However, Saini draws attention to the fact that race is a social construct rather than a biological one:

“[Duana Fullwiley] noticed that all the scientists were routinely using racial categories not only to select their subjects, but to confidently pick out statistical differences between these racial groups. So, as Fullwiley observed, she asked each scientist she interviewed one simple question: ‘How would you define race?’ Not one of them could answer the question confidently or clearly.”

This idea of race as a social construct has become popular in the scientific community in recent years. What we have commonly come to accept as a definition of race relies predominantly on the colour of a person’s skin rather than concrete biological markers. When we view differences between races in this way – considering these differences to be ‘innate’ functions of biology – we are allowing ourselves to ignore the fact that we are in fact responsible for many of these differences and absolving ourselves of the responsibility to make changes in the hopes of creating a more equal society. 

Racism in medicine

Scientific racism was prevalent in Britain, and so is health inequality. Research has shown that the maternal mortality rate is almost five times higher for black women compared to white women. Further research is required to fully understand the cause for this disparity, but Deidre Cooper Owens, a professor in the history of medicine at the University of Nebraska-Lincoln, would argue that racial bias is responsible, saying that it “comes from a time when doctors had essentially been socialised not to respect black people as human beings[…]It’s about biased assumptions – and we doctors have the same biases as anyone else.”

Cooper Owen’s arguments are supported by further data on the diagnosis and treatment of black patients. In mental health, primary care doctors have more difficulties in diagnosing depression in black patients, confusing depression with other physical conditions such as diabetes. Data from 2004 found that the proportion of people aged 61-70 reporting fair or bad health was 34% for white English people, but 86% for Bangladeshi people, 69% for Pakistani people, 63% for Indian people, and 67% for black Caribbean people. Furthermore, black patients are less likely to be prescribed pain medication for non-definitive conditions (i.e. conditions that don’t have such objective clinical presentation and aren’t as easily confirmed with simple diagnostic tools). This disparity doesn’t exist for definitive conditions, implying that racial bias was a factor in the decision to prescribe pain relief. Evidently, the inequalities in diagnosis and treatment of black patients versus white patients exist across genders and age groups. These are not isolated incidents, but are symptomatic of a greater structural and systemic issue.

Where do we go from here?

There are clear racial inequalities in health in this country. It’s also clear that there are multiple other factors that affect health inequality, including socio-economic status and gender (Caroline Criado Perez’ book Invisible Women is a great source of information on the ways in which gender affects health inequalities). There isn’t enough data to be able to understand how these factors intersect, and it’s difficult to judge how much of these inequalities can be attributed to racial bias and discrimination. Regardless, we have an issue in this country that certain  people are receiving lower standards of care and are at higher risk of disease and death, and we’re not 100% sure why it’s happening, although it seems likely that racial bias and discrimination are playing a part Regardless of the reasons, it’s an issue that needs to be fixed.

Trying to fix it is going to be a challenge. It will require more research into the intersection of race, gender, socio-economic status etc., and it will require a greater look at system of educating doctors and employing them, which are areas I plan to dig into in the future. What seems clear is that we are in need of making significant structural changes in order to address these inequalities and build a system that is more effective and inclusive.

You can find the full version of this text in the next issue of Journal of the Nuffield Department of Surgical Sciences (JNDS).

NDS staff and students are invited to attend the NDS Race Forum on Thursday 22 October 2020. 

Sources/further reading

https://www.bbc.co.uk/news/world-us-canada-53273381

https://thegeopolitics.com/the-global-impact-of-the-black-lives-matter-movement/

https://www.thenation.com/article/archive/exclusive-lee-atwaters-infamous-1981-interview-southern-strategy/

https://www.theguardian.com/us-news/2020/sep/05/donald-trump-richard-nixon-southern-strategy

https://en.wikipedia.org/wiki/Lee_Atwater#%22Southern_strategy%22

https://www.thenation.com/article/archive/exclusive-lee-atwaters-infamous-1981-interview-southern-strategy/

https://www.theguardian.com/us-news/2020/sep/05/donald-trump-richard-nixon-southern-strategy

https://www.nytimes.com/2020/07/07/briefing/coronavirus-hong-kong-patrick-mahomes-your-tuesday-briefing.html

https://www.tandfonline.com/doi/full/10.1080/14649365.2014.994670

https://www.washingtonpost.com/outlook/2019/07/26/what-we-get-wrong-about-southern-strategy/

https://www.aclu.org/other/drug-war-new-jim-crow

https://www.dissentmagazine.org/article/laundering-racism-through-court-scandal-states-rights-federalism

https://www.nytimes.com/2020/03/18/opinion/trump-republicans-racism.html

https://www.jstor.org/stable/j.ctt1ch799s

https://time.com/5628283/trump-tweets-racist-white-america/

https://www.bbc.co.uk/news/world-us-canada-52905408

https://abcnews.go.com/US/man-helped-ignite-george-floyd-riots-identified-white/story?id=72051536

https://www.bbc.co.uk/news/world-us-canada-53579099

https://www.history.ucsb.edu/wp-content/uploads/History-of-the-Human-Sciences-2013-Keel-3-32.pdf

https://link.springer.com/book/10.1007/978-1-349-05452-7

https://www.wired.co.uk/article/superior-the-return-of-race-science-angela-saini

https://digitalcommons.pittstate.edu/cgi/viewcontent.cgi?article=1136&context=etd

https://www.psychologytoday.com/us/blog/the-big-questions/201101/the-dehumanization-black-people

https://www.nytimes.com/2018/06/17/opinion/roseanne-racism-blacks-apes.html

https://news.stanford.edu/pr/2008/pr-eber-021308.html

https://www.vox.com/the-big-idea/2017/6/15/15797120/race-black-white-iq-response-critics

https://www.theatlantic.com/national/archive/2013/05/what-we-mean-when-we-say-race-is-a-social-construct/275872/

https://africacheck.org/2015/03/12/analysis-black-brain-white-brain-the-new-wave-of-racist-science/

https://www.jstor.org/stable/pdf/41680221.pdf

https://www.theguardian.com/news/2018/mar/02/the-unwelcome-revival-of-race-science

https://www.nationalgeographic.com/magazine/2018/04/race-genetics-science-africa/

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/774D1CEE11E41D38C722905A47818E9A/9781139053556c41_p693-707_CBO.pdf/race_and_the_social_sciences.pdf

https://www.britannica.com/topic/race-human/Scientific-classifications-of-race#ref810758

https://www.smithsonianmag.com/science-nature/disturbing-resilience-scientific-racism-180972243/

https://www.cam.ac.uk/research/news/skulls-in-print-scientific-racism-in-the-transatlantic-world

https://www.jstor.org/stable/pdf/43606920.pdf?refreqid=excelsior%3Aa47de777ae98059c2d748217cd8665d0

https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202018%20-%20Web%20Version.pdf

https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202018%20-%20Web%20Version.pdf

https://www.bmj.com/content/368/bmj.m1058

https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0159224

https://www.theguardian.com/science/2016/aug/10/black-patients-bias-prescriptions-pain-management-medicine-opioids

https://www.sgul.ac.uk/news/mind-the-gap-a-handbook-of-clinical-signs-on-black-and-brown-skin

https://www.bmj.com/content/369/bmj.m2578

https://www.bmemedics.co.uk/post/interview-with-malone-mukwende-mind-the-gap

https://www.bmj.com/content/368/bmj.m212

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442603/

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