Welcome back. We're still in week five, talking about measuring things.

And in this module, we're going to talk about measuring the important construct of race. What is race? Why does it matter? And so forth. The take home message that I'm going to give you right now, is that race is a social construct. When it comes to health and medicine. It is only very rarely a biological construct and so I want to talk about that in this module. As you know you have assigned readings, those are hopefully helpful to you. There are some other readings I'd like to suggest to you and those are papers and chapters by two scholars, J Kaufman and Richard Cooper. And these two often write together, and in my view they write some of the best work on how to think about race, the idea of race, when thinking about race and health, and race and medicine practice, these things. And so these chapters, these works of Kaufman and Cooper are not assigned. But you can feel free to search for them. and if you're interested in going further in this topic, than I have time to address today, here, then Kaufman and Cooper are highly recommended. So, the basic question is, what is race? Well, as you know, we're all a part of the same human species. And some will say there's different groups of the human species that can be defined by racial groups and, the question, though, is what does this mean? Is race something that's internal, determined, genetic? is it something innate in us? or is it something that we learn, that's part of us, that other people perceive of us often by the way we look or talk or things like that. That is, things related to culture. And culture is an interesting idea, and it's all those things in music, in art, in food, and daily practices. This is the idea of culture. So, when it comes to race, in measuring race and social epidemiology, the key question is, is race, that's something that's biologic in our DNA and innate to us, or is race something in our culture.

In particular how others view us. And we'll come back to that in a few moments. So, what is race? A social, not a biological construct. On the whole, there is more variation of people within a given race than there is of people between races. It is the social perception of differences between races that drives discrimination And often differences or disparities in health outcomes. Ethnicity and culture are what shape these social views. So race matters, and it certainly matters in places like the United States because of the historical legacy of how different groups by racial standards: Native American, African-American, so forth. How these different groups were viewed and treated in the social system. So race matters because it offers opportunity structures or not given someone's sort of appearance, given their phenotype and cultural practices. But it's important to remember that there are only a few diseases that are actually linked to one's, you know, biology. sickle cell anemia is one, and it's not always true, but it's much more prevalent in African Americans than white Americans. So, we can ask, why do we measure race at all? If I argued to you that race is a social construct. If it's part of the ethnicity and cultural structure, why bother? one argument is look, you can't change race so, why bother measuring it? It's not as if I can make my skin dark or your skin light or whatever it might be. Rather we are what we are. And since you can't change it, why bother. Further that argument can be extended and say, look, when you talk about race, when you research race, when you say that there's different health outcomes by racial groups, then what we're doing is reinforcing this idea of race as something that's innate and biological. That's a problem. But the other argument is, on the other hand, if you will, that if we don't measure race, we don't measure health outcomes by race, we can't evaluate progress. Particularly in the United States with civil rights legislation, we want to see

is the change in the social system having the desired impact. And so, we're sort of stuck. If we do measure it, we can reinforce it, but if we don't measure it, we can't assess progress. Or lack thereof. So what are the racial categories? Well in the US census, which is a pretty good place to look how the United States government is thinking about race over time we see that many different words have used. That is the idea of race has evolved over time. Early censuses used the term colored. Then there was negro or black in the 1970 census. Later on, questions of African American. Today, there are many racial questions. Oriental, Asian, Pacific Islander. What are these questions, how have they changed? This is a whole body of research that's fascinating. And the key point, again, is that the idea of race is not constant. It changes with cultural values. One point I wanted to bring up with you is to call into question something that is rarely considered, and that is, what is white? If we say, these people are African-American, and these people are Latino, or Asian descent, we can also, and probably should also, ask what does white mean. There's some lovely scholarship on this topic. And one book that I've enjoyed and encouraged my own students to read is a book by Nell Painter and it's called The History of White People. And it's of course out in 2010. There's a couple a really good quotes that I'll just offer, share with you at this moment. Not until the 18th Century did an obsession with whiteness flourish, with the German invention of the notion of Caucasian beauty. This theory made northern European into Saxons, Anglo-Saxons and Teutons, envisioned as uniquely handsome natural rulers. The key point here is prior to this period there was no sense of Anglo-Saxon. People were from just different parts of the world. It was geographic based, instead of race

based. Further in her text Painter goes on, whiteness was an ideal that excluded not only blacks, but also ethnic groups not Protestant Northern European background. The Irish and Native Americans were out. Later so were the Chinese, Jews, Italians, Slavs, Greeks, all deemed racially alien. It's important to recognize that when Italian immigrants first came to America, they were not viewed as white persons, same with the Irish. And if you look closely at this slide you can see that there's a drawing and this drawing depicts the, sort of, idea of a black Irish person. And the idea is that race, for this seemingly, now, white person was viewed as non-white, historically. Again, race is cultural, race is ethnicity, it's evolving. It's useful to look at exactly how to measure race since we're talking about measurement. And for better or worse, the US Census has a reasonable approach. It's not perfect. but it's worth knowing about it, in order to say that, my data conform with the Census data. The US Census now asks the idea of race in two parts. The first is technically about ethnicity. Where they're asking about Hispanic origin, or Hispanic descent. So that's sort of a yes or no question, you can see it's more complicated. But it's basically yes or no, are you Hispanic origin. And after that, these are ordered, then the questions on race come up. And are you white, black, are you Asian, Indian, Chinese and so forth. And then you can write in your own race. So the idea here is that one's race is a self-identification. Someone says that I am white, I am black. It's not that they're being judged by others in the sense of saying you are white, you are black, you are Native American, but rather I am. But there are complicating factors. First. What does self identification mean? It may not be meaningful to all people in all ways. So that's a problem. Second, in the most recent censuses one can check multiple boxes for race.

So if I find myself to be African American and white, I can and probably should check both boxes. But what does this mean when it comes to analysis? If someone checks two boxes, are they both? Are they neither? Is it white and others? Is it black and others, and so forth? This creates great complications, and you're welcome to look into some of the literature on how this is worked on. We can ask our own President, what would he check? And this sort of typifies, at least for me, what does it mean to be an African American, to self identify race? It's not straightforward. There are alternative methers, measures, and in the chapter that I assigned for you for this lecture. You can see that there is work on how to measure racism. Why would we want to do that? Well, if you are, say, African American in the United States, and going to some sort of grocery store or some sort of retail outlet, and you find that you're being observed for fear of shoplifting, that might raise your blood pressure. So, is your blood pressure high because you're African American something innate or is it high due to racial discrimination and stereotyping? That's the social construct idea. And the way to measure these things is very difficult. Very subtle, but the readings will hopefully offer some guidance for you. Let's sum up. I want to emphasize that for social epidemiology, race is a social construct. Not an innate biological construct. It's also a very complicated self-identification. Multiple check categories. And these are very difficult things. And of course when you think about race across the world, outside the United States, it's even more complicated. So, push come to shove, I want to encourage you to be cautious and humble, when you measure race. When you think about race, when you read other people's work into this topic. [SOUND]