“A racist society will give you a racist science.”
— R. M. Young (1987). Racist society, racist science. In D. Gill & L. Levidow (Eds.) Anti-racist science teaching (pp. 16-42). London: Free Association Books.
In some of my previous writing, I have touched on the ways that I cannot ignore my positionality as a researcher. I have discussed how, as a disabled researcher, even my mobility has to be negotiated. I would extend that to the entirety of the knowledge production process, starting with the importance of introspection in the writing process.
I speak from my own experience and situation as a Black and disabled researcher who researches health care policy, health care geographies, and health care access. These issues are salient to the communities I belong to, and my interest in these questions is partly driven by my experiences and those of my loved ones.
It never escapes my notice that there is effectively no positive right to health care in the U.S.. Health care access is rationed by employment status (employer-sponsored insurance), income (Medicaid, CHIP), age (CHIP, Medicare), diagnostic and disability status (Medicaid, Medicare). The mere fact that the actuarial categories “pre-existing conditions” are applied to humans as readily as they are applied to cars signals to me that sick and disabled people are valued based on their ability to produce and consume under capitalism. Other measures used in health policy and planning, such as the Disability-Adjusted Life Years (DALYs), formalize and operationalize the devaluation of sick and disabled people relative to a putative ideal- able-bodied, “healthy”, youthful, and presumed male- based on subjective judgments by survey participants (Laurie, 2015).
“Controlling for Race?”
“Race is not a biological category that is politically charged. It is a political category that has been disguised as a biological one.”
— Dorothy Roberts (2011) Fatal Invention: How Science, Politics, and Big Business Re-create Race in the 21st Century. The New Press, New York. pp 4
In November 2018, I tweeted, “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?” Here, I was pointing to the refusal (yes, refusal) to say racism rather than “race” (because 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.
For example, Ruth Wilson Gilmore (2004) defined racism (specifically anti-Black racism) as, “state-sanctioned or extra-legal production and exploitation of group-differentiated vulnerability to premature death.” Yet, many studies of health disparities (1) flatten the socio-political process of racialization (i.e. deployment and operationalization of state categories of ‘difference’) and its outcomes to a single variable, and (2) do not address the role of the State.
Moreover, most public health programs equip their graduates with the same tools that built up the State that enacted eugenics on the population- notably statistics, the logic of managing populations from the spreadsheet, tabulating the populations that “count”. All of the above form the bases of biomedical knowledge production. Importantly, these curricula often do not address the history of the categories deployed in quantitative modelling, such as “race”, “ethnicity” or “socio-economic status.” For example, per Mazumder (2018), an estimated 60 percent of wealth inequality (“social mobility”) in the US is transmitted intergenerationally. How does a single variable capture that?
This is why I return to key texts like Dorothy Roberts (2011) Fatal Invention: How Science, Politics, and Big Business Re-create Race in the 21st Century or Nancy Krieger (2011) Epidemiology and the People’s Health: Theory and Context as I conceptualize disease processes as being profoundly social. Both Krieger and Roberts challenge biomedical paradigms and their limited emphases on individuals (which, under neoliberalism, often results in individual-level blame attribution for health outcomes, matched with techno-scientific and ‘behavioral’ or ‘lifestyle’ fixes) and embrace of reductionism (i.e. ‘phenomena are best explained by the properties assigned to their parts’). One outcome of this reductionism is a consistent failure to account for the influence of socio-political processes on inequitable health outcomes. This includes racialization and social sorting in social space (and place), which- in combination with environmental racism- renders marginalized groups disproportionately vulnerable to toxic exposures in their home/work/play/learning environments across the lifecourse, which then predispose them to chronic conditions like asthma, diabetes, and cardiovascular disease.
Moreover, for a complement to core social epidemiology and health geography, I recommend geographer James Tyner’s (2019) text entitled, “Dead Labor: Toward a Political Economy of Premature Death.” This text is firmly within what Krieger (2011) identified as the “social production of disease” or “political economy of health” social epidemiologic theories. A core premise is that, “analyzing and altering population distributions of and inequities in health and disease necessitates engaging with, if not confronting, extant political and economic systems, priorities, policies, and programs” (Krieger, 2011, 167). Tyner expresses this beautifully in his call for an ethics of care:
“As academics or activists, scholars or commentators, or simply citizens of a global community, we have the ability to promote- through our writings, our teachings, and our participation in the world around us- a different, less hostile, and violent world. Such an ethics of care centers on a radical rethinking of life, death, and dying: not only a commitment to the prevention of taking life and the building of a nonkilling society but also a commitment to the elimination of those practices and policies that disallow life to the point of death. In other words, it is insufficient to simply not kill or to prevent others (including the state) from killing: we must also cultivate an ethic of not allowing others to die prematurely.”
— James Tyner (2019) Dead Labor: Toward a Political Economy of Premature Death. University of Minnesota Press, pp xv
All in all, Tyner’s text is one of the best engagements of Marxist theory and the broader literature of biopolitics. In his attentiveness to multiscalar policies and practices contoured by historical and present iterations of state violence, Tyner sheds light on the way that the U.S. government’s (non)response to Puerto Rico post-Maria, as well as the ongoing slow death made manifest in Flint, Michigan’s water crisis and retrenched precarity among smallholders and workers in Mexico post-NAFTA reflects political economic conditions of premature death that cut across the “intersectional workings of class, sex, and ‘race’ (among other axes of difference) within capitalism” (xii). Essentially, in the absence of positive rights to employment or health care, or lack of economic protections under neoliberal and neocolonial trade policy, the most vulnerable are also the most predisposed to “excess” or “premature” deaths.
Furthermore, through the concept of “necrocapitalism,” Tyner lays out fertile ground for thinking through the political economy of premature death as it plays out at the axes of disability status, racialization as “Other”, citizenship status, and class. Under “necrocapitalism,” persons and bodies are valued and rendered vulnerable according to two criteria: productivity (willingness and ability to be exploited to produce profits) and responsibility (“ability to participate fully as producers and consumers in the capitalist system”, pp xiii). Necrocapitalism, the concept, picks up where Mbembe (2003) left off with “necropolitics” to foster greater engagement between Foucault, Agamben, Marx, and Marxian feminists and geographers for understanding (and preventing!) the social and spatial distribution of “premature”, “excess”, or preventable deaths.
At this juncture, I was tempted to revisit Ruth Wilson Gilmore’s work linking ‘surplus populations’ and structural unemployment within a matrix of state and state-enabled violence. If we consider who is subject to policing, we must consider the fact that Black, brown, poor, and disabled people are disproportionately targeted, and make up a disproportionate share of incarcerated people.
However the term “disproportionate” can be read in a misleading manner that suggests that “justice” lies in reforms toward making prison populations representative of the population. Real justice would confront state violence, rather than reconfigure or redistribute it. Prisons and other sites of incarceration essentially function to spatialize inequity, especially through rendering “surplus populations” (poor, disabled, homeless, Black, immigrants in devalued professions) invisible (c.f. Angela Davis, Mariame Kaba, Andrea Ritchie); moreover, their genesis in the policing practices used to subjugate enslaved Africans under a system of chattel slavery should inform our knowledge of the limits of “prison reform.”
- Gilmore, RW. (2004). Fatal Couplings of Power and Difference: Notes on Racism and Geography. The Professional Geographer. 54(1). https://doi.org/10.1111/0033-0124.00310
- Gilmore, RW. (2007). Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California. University of California Press
- Krieger, N. (2011) Epidemiology and the People’s Health: Theory and Context. Oxford University Press
- Laurie, EW (2015). Who lives, who dies, who cares? Valuing life
through the disability-adjusted life year measurement. Transactions of the Institute of British Geographers. 40. 75–87 doi: 10.1111/tran.12055
- Mazumder, B. (2018). Intergenerational Mobility in the United States: What We Have Learned from the PSID. The Annals of the American Academy of Political and Social Science. 680(1). https://doi.org/10.1177/0002716218794129
- Mbembe, A. (2003). Necropolitics. Public Culture, 15(1), Winter 2003, pp. 11-40
- Roberts, D. (2011). Fatal Invention: How Science, Politics, and Big Business Re-create Race in the 21st Century. The New Press, New York. pp 4
- Oliver, MN. (2008). Racial health inequalities in the USA: the role of social class. Public Health. 2008 Dec; 122(12): 1440–1442. doi: 10.1016/j.puhe.2008.05.014
- Tyner, J. (2019). Dead Labor: Toward a Political Economy of Premature Death. University of Minnesota Press.
- Young, RM. (1987). Racist society, racist science. In D. Gill & L. Levidow (Eds.) Anti-racist science teaching (pp. 16-42). London: Free Association Books.
- Planey, A, Thinking about Social Positionality & Social Determinants of Health (December 2017)
- Mclean, Shay-Akil, “How Race & Gender Interact To Shape Inequality” (March 2019)