8. Health Activism Health Activism 1. Racism in medicine and medical experimentation 2. Anti-Racist Activism 3. Internationalist Health Activism WARNING: some of this material is really disturbing. John Brown escaped slavery and published an autobiography about being enslaved on a Georgia plantation in the 1820s. His “owner” “lent” him to a physician, Dr. Thomas Harvey who in the name of “medical experimentation” disfigured him in the process of trying to uncover whether Black skin was “thicker.” The Euro-American white male as the “Universal Standard” Medical racism began in an imperial context In the 18th and 19th centuries, white social scientists measured the cranium size, weight genitalia, fingernails, etc. of the bodies of Black and Indigenous peoples Science and medicine already had existing knowledge of anatomy of white bodies But this science was about categorizing and classifying racialized Others as different and inferior From “Science Won’t Save us” by Caleb Luna Research further institutionalized, and continues to institutionalize whiteness as the ideal standard. The Tuskegee Syphilis Experiment lasted for 44 years (1932-1972), and never offered the African American men enrolled treatment. The research aim was not to study the progression of syphilis, for this was already researched and understood. It was motivated by a desire to understand the (presumed biological) difference between whites and African-Americans. Photo source: https://www.jble.af.mil/News/Photos/igphoto/2000114935/ Power structures (along gender, race, class lines) Become naturalized and internalized “Doctor knows best” James Jones: “Ironically, by working on the Tuskegee Syphilis Study, a thoroughly racist experiment, Nurse Rivers stuck mighty blows for desegregation and made a place for herself (and by extension, her race) in the liminal space between black professionalism and the world of white medicine.” James Jones (cont’d) Her work on the Tuskegee Study only occupied about half of her time The rest of her time she devoted to public health works that greatly benefited the African-American families throughout Macon County. Over time, the two roles she performed melded in her mind and she saw herself as the nurse who took care of everyone Historical legacies: (a) Distrust in medical authorities among African-Americans (b) The persistence of racism and anti-blackness in the medical profession 2. Anti-Racist Activism Racial difference in disease But what about human biological variation? Some single gene disorders, like sickle cell anemia and thalassemia strike disproportionately in some racial or ethnic groups. But less clear cut is the medical significance of more subtle gene variants that influence a multitude of conditions Some scientists worry that emphasizing biological differences will increase stigma and lead to inferior health care. Others see exploration of difference as a way to ultimately improve treatment for some groups of patients Joel Buxbaum, Scripps Research Institute of La Jolla, CA “A call to ignore [race] in diagnosis and treatment is a call to ignore biology” (particularly looked at in area of drug metabolism) Less well documented and more controversial: so called “life-style diseases,” e.g. hypertension, cardiovascular disease. Teasing apart “genetic difference” from “other risk factors” is difficult. Race and the social determinants of health the universal body vs. racial typologies vs. human biological variation Unnatural Causes: When the Bough Breaks The Mystery: Why do African American women at every socioeconomic level have higher rates of pre-term birth and infant mortality than white women who haven’t finished high school or Black women who immigrated here from other countries? Both the documentary and the comic illustrate how a lifetime of exposures to racism can literally get inside the body and affect the health of our newborns. Birth outcomes are affected by the negative impact of racism over one’s lifetime, not just during pregnancy. Racism in America is an added source of chronic stress for people of color. By improving material conditions (including greater access to health care) and giving people hope for a more just and equitable future, the civil rights and anti-poverty movements of the 1960s and 1970s reduced the health gap between African Americans and whites. Structural Violence Paul Farmer with a patient Individual suffering in a globalized context Larger forces (political, economic, etc.) working to constrain individual agency Leads to an unequal distribution of risk among populations How can health practitioners apply these ideas to their work? Former student, Nathalie Posever Harvard Medical School Obstetrics Mini Essay Rubric Criteria Ratings Pts Is the mini-essay written clearly and coherently? Do I understand the sentences? Does it make sense logically? Can I follow along? O pts 2 pts Full Marks No Marks 2 pts 1 pts Can someone not taking the class understand it? Are all the terms described and defined so that someone NOT taking the class could still understand it? Full Marks O pts No Marks 1 pts Does the essay answer the question? O pts 2 pts Full Marks No 2 pts Marks Is textual evidence provided appropriately? 2 pts Full Marks O pts No Marks 2 pts Does the mini-essay reflect understanding of the course materials: lecture, readings and other material? 3 pts Full Marks O pts No Marks 3 pts Total Points: 10
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