I began to wonder how relevant race identification is in providing competent healthcare to patients as I started reading “A Short History of the Race Concept” by Michael Yudell. It’s a short, well-written chapter from Race and the Genetic Revolution that discusses the role science has placed in forming and redefining the idea of race in science through the 18th to 20th centuries. To summarize Yudell’s point, race is a socially-constructed concept without any biological meaning as evidenced by genomic sequencing, which was first discovered by Francis Collins and Craig Venter in 2000.
Now to translate into English: all humans’ DNA is 99.9% identical, meaning we all have the same genes.
Yes, we all have different genotypes (variations) that express our individual traits. For example, all humans have the same genes that code for hair. But hair comes in all types of colors and textures because there are different alleles of the same gene. The same holds true for skin tone. Yet, there are no genetic variation categories that individuals from different “races” fall under. Genetic variations are fewer in small geographic areas but greater in large geographic areas. There is no uniform genetic identity across continents, such as Europe, Africa, and Asia. I am a visual person and like images so I am going to include a figure from an article from SCIN of Harvard below to illustrate.
I am not trying to give a crash course edition of Intro to Genetics here. I am pondering why race is still considered a risk factor for various diseases. If science has demonstrated that there is no biological framework to support the concept of race, then why is it still considered part of the necessary medical information healthcare providers utilize in diagnosing and treating? Race is a social construct, yet so much of medicine and healthcare status is impacted by race. There is no question that race and ethnicity have a dynamic relationship that is shaped by geographic location, culture, and politics. However, it is continuously demonstrated that socioeconomic factors surrounding the social implications of race lead to disproportionately high morbidity and mortality for minorities by sustaining inequitable access to resources. If this is the case then race is not an inherent risk factor of disease but rather, racial inequity is a social determinant of health.
I am not arguing genetics and ancestry do not play a role in diseases, but rather that race should not be used as a proxy for these factors. The practice of utilizing race as a biological construct exacerbates health disparities and results in poor health outcomes for marginalized populations. Risk factors for disease are related to genetics, biology, lifestyle choices, and other social determinants – such as the experience of racism, socioeconomic status, and education level. Poor health outcomes in minority communities are related to these social determinants to health and a very flawed healthcare system. Simply put, race is not a risk factor for diseases. Racism is.
Photo credit: https://www.genome.gov/genetics-glossary/Race