Race
Race is a fluid term lacking a single agreed upon definition. It boasts a long history, inextricably linked to health, medicine, and the body. As it refers to the parsing of people into groups, tribes, or clans, race has origins rooted in medical antiquity. In his well-known treatise Airs, Waters, and Places, Hippocrates of Kos, the so-called Father of Medicine, apprehended distinct races of people and posited their differences in physical appearance as a product of their customs and the geography and climate of the places they inhabited (Hippocrates 1849, 213, 218; Painter 2010, 9). While the Hippocratic notion of race is very different from our modern version of the term, both versions of the word group people based on their physical features (though we no longer attribute physical features to climates or habits). Today, consciously or unconsciously, we rely on assumptions that certain races of people have shared characteristic skin color, hair texture, eye color, eye and nose shape, and other phenotypical features. This mapping of race onto a person’s body by virtue of their physical features can be a matter of simple observation, but it paves the way for oversimplifications about entire groups of people. More to the point, it can harm, for it facilitates racial profiling and stereotyping. For example, criminality and athleticism—traits that have been “associated with Black American men” are more strongly associated with people who have so-called Afrocentric features—dark skin, a wide nose, wide lips, and coarse hair (Kleider-Offutt, Bond, and Hegerty 2017, 28).
Rather than trying to locate or create an ideal definition of race, this essay instead explores how race came to be mapped onto the body and why that approach for parsing race endures. It also interrogates how we arrived at the taken-for-granted associations between race and health that circulate in medical and scientific discourse and national discussions. Looking at race in this way is instructive for revealing the subtle and explicit ways we still think and talk about it with vocabularies rooted in biology, hence assumptions that race is tangible—a biological fact—rather than a social construction. It is important to recognize the pull of history—the difficulty of accepting new insights, even when they are supported by science—in order to understand why physicians, scientists, and those in allied health fields (groups ostensibly trying to improve health outcomes) still talk about race as biology in ways that can be harmful or in the very least to sanction the dangerous idea that there are innate biological differences between the races. Indeed, that history—and the urgency in challenging it—explains the centrality of race as a keyword for health humanities.
When François Bernier, a French physician and traveler, published New Division of the Earth in 1684, he elevated the role of the body in determining race. Indeed, Bernier pointed to corporeal features like skin color, lip shape, and hair texture as useful for classifying different types of humans into groups. This practice of explaining race via the human body was a departure from the conventional reliance on Biblical interpretation and conjecture, which was common in western Europe (Koslofsky 2014, 796). Some scholars have credited him with sketching out a hazy notion of the modern concept of race (Stuurman 2000, 2, 4, 5). Bernier’s influence, however, was but one of the many factors in the process of making and defining race; the concept Western medicine has inherited was (and is) a multisited, subjective, and collective process.
From the seventeenth century onward, European naturalists, physicians, and those in allied fields compared nose and skull shapes of one group against another, dissected layers of African skin, and displayed nonwhite peoples in European courts (Schiebinger 2013, 370; Koslofsky 2014, 799). This ability to see and parse race through the body was not only the purview of European thinkers on the continent. Joyce Chaplin compellingly demonstrates that while English settlers to mainland North America may not have invoked the modern concept of race, they relied on “bodily differentiation” among themselves, Native Americans, and the sub-Saharan Africans they encountered. There was already a practical way of seeing racial difference through comparison well before any kind of formalized corporeal definition of race emerged (Chaplin 2003, 193). The settler colonialists of the New World saw their bodies as situated between the weakness of Native bodies and the supposed hardiness of African bodies at a time when they were gaining control over North America and relying on slavery to do so. Racism may well, paradoxically, have preceded race as the justification for treating a needed labor force as less than human. Seeing and sensing race was tied up with conquest and commerce. Both brought different groups of people together in unprecedented ways that put the examination and comparison of bodies in the service of perceived social and economic exigencies.
With more access to different bodies came more strident claims that race (and by extension differences between races) was observable. Resulting in part from the work of physicians and anatomists, assumptions that race was an element of the human body became remarkably durable. Proslavery English commentator and one time resident of Jamaica, Edward Long encapsulated this sentiment in his 1774 History of Jamaica: “It seems now to be the established opinion, founded upon anatomical observations, that the black complexion of Negroes proceeds entirely from a reticulum mucosum, or dark colored network spread immediately beneath the cuticle of their bodies” (Long 1774, 49). Here was proof that Black racial traits existed and could be easily detected. As he detailed the features of an albino child, born to two Black parents, Long noted the complexion was of a “dead dull white,” but the “features” were “truly of the negro cast,” “the nostrils wide and lips thick and prominent” (Long 1774, 49). On the view that racial differences existed, Long quoted an ableist turn of phrase penned by the antislavery French philosophe Voltaire: “None but the blind can doubt it” (Long 1774, 335–36). For Long, and others (regardless of their stance on slavery), to say that race was discernable on the body was to state the obvious.
Much has changed over the course of three hundred or so years. Race is an arbitrary way of grouping people; many scholars across the humanities and sciences have repeatedly demonstrated that there is no biological basis for it. That said, how we understand what race is, how we account for the very real ways people perceive race and feel raced in their interactions with others, still carries strong associations with biology and the body. And the durability of these associations between race and biology is still too often sanctioned by modern biomedicine. Published scientific and medical research not only bears out this persistence but also reveals how race has become a precision term used to offer predictive insight into one’s health as well.
Its precision is implied in its use for the collection of important health data and vital statistics (Braun et al. 2007). Drug trials, medical research, mortality and morbidity, and disparities in health outcomes rely on race to bring clarity to trends found in data. In these contexts, it should be noted, capturing race does more to capture racism’s insidious influence on one’s health than illuminate any meaningful links between one’s race and their biology. Medical decision-making has also validated the notion of a biological basis for race. This is most evident in race correction algorithms in medical practice. The estimated glomerular filtration rate, or eGFR, which measures kidney function, has race correction built into it. Black patients have their results “corrected” due to data from 1999 that suggested that self-identified Black people had higher levels of creatinine. Measuring serum creatinine levels is an accessible way to estimate kidney function; higher detected creatinine typically signals a low eGFR. Low eGFR suggests deficiency in kidney function. For Black people, a multiplier is added, boosting the eGFR value. The result of this race correction is “higher reported eGFR values (which suggest better kidney function) for anyone identified as black” (Vyas, Eisenstein, and Jones 2020, 875). A growing number of scholars, across disciplines, have seized upon the very problematic nature of this assessment. “A patient with one Black parent and one White parent” would have different eGFR readings depending on whether or not they identified as White or Black; if they identified as both, the clinician would make the call (Amutah et al. 2021, 4). Not only does this example underscore what little precision race offers, but it also reveals how race harms rather than helps. In this case, a higher eGFR might suggest higher kidney function in a Black patient, potentially obscuring their illness—a concern that has been noted by practitioners in the medical profession, and other allied health fields (Vyas, Eisenstein, and Jones 2020, 875; Roberts 2021, 18). The attempts to replace eGFR and the larger questions about assessing what race an individual is bode well for sundering these associations between race and biology.
Confronting the historical associations drawn between race and the body helps to reveal the process of race’s social construction in a way that recognizes the less abstract ways the term came about. It is a way of acknowledging that race is not an element of biology, despite people mapping it onto the human body in the past and present (i.e., identifying someone as a “person of color” or POC to describe them). It is a way of showing its paradoxical existence as something geneticists and scientists will say has no biological basis and a thing that clinicians still use to make medical diagnoses and decisions. Reorienting our way of perceiving race is necessary, as many have argued, but it will be no small feat (Wald 2006). In the meantime, however, we can try to perceive race less as a real part of our biology and more as a proxy for illuminating the real effects of racism in our society.