If racism, specifically anti-Black racism, is “state-sanctioned or extra-legal production and exploitation of group-differentiated vulnerability to premature death” then analysis of "health disparities" in public health should address the State- policies, practices, enabled harms
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Given the field of public health's genesis in "public hygiene" campaigns & other state eugenic projects (both positive and negative eugenics), it would be a challenging task for PH to seriously consider the State as complicit in harms borne by marginalized groups
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Most PH programs equip their graduates with the same tools that built up the State that enacted eugenics on the population- statistics, the logic of managing populations from the spreadsheet, tabulating the populations that "count"- the bases of biomedical research.
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This is a book topic. Maybe I should keep these thoughts to myself.pic.twitter.com/ZgMGpXG1Nv
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Anyway, I think about these things a LOT as I complete my coursework. I've taken some excellent courses in Epidemiology (including Spatial Epidemiology), Biostats, etc. I am well-trained. This is intentional on my part, b/c if I'm going to be "critical ___", I need to know ___
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It is not enough to take epi/biostats/health comm, though. We need to know history. We should all know that the first attempt at universal health care was during the Reconstruction, & it floundered b/c white doctors refused to treat freedmen.
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We should all know about the forcible sterilization of disabled, Black, indigenous people. "Mississippi appendectomies" are not in the past. CA prisons just stopped forcibly sterilizing incarcerated women, & up North, Native women are suing b/c they coerced into being sterilized.
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We, in PH, should also know about the socio-political place-making processes that shape where we live, acting as sorting mechanisms across the axes of race & class. Else "we" fall into geographic determinism- e.g. "the zip code you live in determines your lief expectancy"
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There are tweets on that topic BTW (1)https://twitter.com/Arrianna_Planey/status/1062395236536737794 …
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Here's another thread on how claims that "where you live [zip code, census tract, neighborhood] determines your life expectancy" are examples of both (1) ecological fallacy (2) geographic determinismhttps://twitter.com/Arrianna_Planey/status/1041565622411436032 …
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The dominant approaches to studying "health disparities" outside of social epidemiology are forms of statistical modelling, which, by nature, abstract the phenomena they study. E.G. how does one model socio-economic status?https://twitter.com/Arrianna_Planey/status/1041580994497798144 …
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How does one model the effects of being racialized in a racist society, when that process of racialization is spatialized, shaping exposures- environmental, stress, social- and is thus also embodied? How do you model that? Certainly not with logistic regressions.
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And the refusal (yes, refusal) to say *racism* rather than "race" (there is no "race" without racism) means that race-as-biological will be retrenched through simplified models that "adjust for race" without addressing racism's biological consequences (c/f Dorothy Roberts)
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And without grappling with the racist history of public health (e.g. below), I'm not sure that any real progress will be made. Meanwhile, "excess deaths" in Black, indigenous, Latinx communities will continue apace.https://twitter.com/Arrianna_Planey/status/1055244272079945728 …
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Another reason that modeling socio-economic status is this: In the US context, about 60% of wealth inequality ("social mobility") is transmitted intergenerationally. How do you reduce that to a variable in a model?https://journals.sagepub.com/doi/abs/10.1177/0002716218794129?journalCode=anna …
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Anyway, based on my experiences, I'm not convinced that the callousness and rot of racism is rooted out in public health. I've sat through biostats classes where my (white) classmates giggled as they analyzed datasets where Black PTs were 4x more likely to die of sepsis
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I even tweeted about it https://twitter.com/Arrianna_Planey/status/1031963037039841280 … It's almost as tho they did not grasp the gravity of it all- that each line in the spreadsheet was a life. Or perhaps the abstraction- the logic of managing the life of the population via the spreadsheet- inures them to the tragedy
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I'll append this
#thread with another thread from a couple of days ago, on racial (racist) essentialism in biomedical practice/research/educationhttps://twitter.com/Arrianna_Planey/status/1062396849758330881 …Show this thread -
& when we talk about ableism, eugenics, & the role of PH, it is important to understand that different disabilities were racialized+classed differently. EG diabetics were not forcibly sterilized, in part b/c those w/ access to a dx were white & higher-SEShttps://twitter.com/PensNeedles/status/1030100883722383361 …
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In health communication, we learn about blame attribution & how it differs based on the illness/disability & the person's assigned race & class status. White & high-SES diabetics with access to a dx were less likely to be blamed for their status than say, Black folks
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... never mind that diabetes is one of the top causes of disability in Black communities, & is linked to psychosocial stress + food insecurity exacerbated by racist residential segregation & racist wealth inequities transmitted intergenerationally
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(the last 2 tweets actually sum up my estrangement with white & non-Black disability advocates)https://twitter.com/Arrianna_Planey/status/1063865066007740416 …
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Anyway, this whole thread started with me sitting and thinking on one of the typical "disparity frames." To paraphrase: "Being Black is akin to having a felony when it comes to the job search."
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"Being Black is akin to having a felony when it comes to the job search." The unnamed referent is nearly always white. And the statement does not account for overlaps. Black folks are more likely to be criminalized by racist law enforcement, more likely to be incarcerated
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So, even as a Black person with no prior contact with the "criminal justice" system is less likely to be hired than a white person with a felony- all else equal (education levels, etc), we need to consider that the original phrasing implicitly conflates Blackness w/ criminality.
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Lemme end this thread with a perennial classic from the Onion poking fun at the "disparities frame": "New Study Finds Blacks More Likely"https://www.theonion.com/new-study-finds-blacks-more-likely-1819571950 …
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Last thought: while "disparities frames" are not meant to imply "essential" difference or deficiency, they often do so. - white/ness as unnamed referent - "other" as "disparate", having disparate outcomes relative to the referent - dominance of individual-level blame attributionpic.twitter.com/h8ayEC7vwh
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"Fatalities—premature deaths (Greenberg and Schneider 1994)—are not simply an objective function of any kind of power differential. There is no difference without power, and neither power nor difference has an essential moral value (Foucault 1977)." [Gilmore 2004, 15]pic.twitter.com/xJEVkdNNB9
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Follow up to that thread- this might be of interesthttps://mobile.twitter.com/JournalofEthics/status/1080849012700393472 …
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End of conversation
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