|Year : 2021 | Volume
| Issue : 1 | Page : 101-103
Susceptibility and immunity: Race or racism?
Shibu Sasidharan1, Harpreet Singh Dhillon2, Shalendra Singh3, M Babitha4, Gurpreet Dhillon5
1 Department of Anaesthesia and Critical Care, Level III UN Hospital, Goma, DR Congo
2 Department of Psychiatry, Level III UN Hospital, Goma, DR Congo
3 Department of Neuro Anaesthesia, AFMC, Pune, Maharashtra, India
4 Radiodiagnosis Ojas Alchemist Hospital, Panchkula, Haryana, India
5 Department of Pediatrics, Military Hospital, Jammu, Jammu and Kashmir, India
|Date of Submission||14-Jan-2021|
|Date of Decision||24-Feb-2021|
|Date of Acceptance||06-May-2021|
|Date of Web Publication||07-Jul-2021|
Dr. Shalendra Singh
Department of Anaesthesia and Critical Care, Level III UN Hospital, Goma
Source of Support: None, Conflict of Interest: None
As the world navigates through this unprecedented time of the COVID-19 pandemic, everything has been pushed to a staggering halt. What catapulted is the health-care services as increasing number of patients flocked for medical care after being diseased by the virus. Even in the eye of such a peril, there have been major misconceptions and misunderstandings about racial disparities and the illness. Black people immunity is one such. This article tries the unravel the history, understanding and science of black immunity for the benefit of health-care providers to iron out the ethical dilemma and bias that impacts the quality of care.
Keywords: Immunity, race, susceptibility
|How to cite this article:|
Sasidharan S, Dhillon HS, Singh S, Babitha M, Dhillon G. Susceptibility and immunity: Race or racism?. Indian J Cont Nsg Edn 2021;22:101-3
|How to cite this URL:|
Sasidharan S, Dhillon HS, Singh S, Babitha M, Dhillon G. Susceptibility and immunity: Race or racism?. Indian J Cont Nsg Edn [serial online] 2021 [cited 2021 Dec 1];22:101-3. Available from: https://www.ijcne.org/text.asp?2021/22/1/101/320817
| Introduction|| |
All human beings share the very same physiology. We are all vulnerable to similar illnesses, and we respond to the same medications. However, responses to treatment differ from person to person. Yet, there are unique medical issues that affect the race of colour. Lately, there is the growing consciousness that the health of black community is not a racial issue but a human issue. In this paper, we try to dispel a few myths about black immunity and the science and research on the same.
These racialised associations, new and old, have historical roots and have been the subjects of scholarly critical analysis for decades. Claims of 'Black immunity' and the 'Chinese' or 'Wuhan' virus are not wholly distinct. Rather, they are two sides of the same coin. These claims have erased the suffering of marginalised people and continue to do so. As these individuals succumb to disease, they are inevitably blamed, if not entirely feared and demonised as vectors of disease. These pervasive ideas of racialised disease are dangerous for our health.
Even today, medical students and nurses are taught to quickly associate disease with racial and ethnic identity. Sickle cell anaemia is associated with African Americans, Cystic Fibrosis with European descendants and Tay-Sachs disease with Ashkenazi Jews. While these shorthand associations facilitate consultation speed and efficiency, they are dangerous and sometimes fatal.
| Racial Disparities in People of Colour: History and Humanitarian Aspect|| |
Perceived discrimination has been associated with lower levels of healthcare-seeking and adherence behaviours, and research in the United States, South Africa, Australia and New Zealand has revealed that discrimination makes an incremental contribution in accounting for racial disparities in health. Segregation affects health by restricting socioeconomic attainment through limiting access to quality educational and employment opportunities.
We are frequently prejudiced by the race, which is characterized by superficial trait factors such as skin colour, hair colour and form. Furthermore, race is often substituted for the deeper inherent differences including vulnerability, immunity to diseases and response to drugs.,, Race is a socially constructed contextual variable with no inherent biological characteristics, whereas racism refers to a social system that promotes prejudices, discriminations and differentiations, leading to racial group inequity.
The issue that people of colour and Whites are fundamentally different is highly debatable, however, its attestation, at least in medical practice, can be dated back to physician John Lining during the 1748 yellow fever epidemic in Charleston, South Carolina. This belief was further consolidated during the 1793 yellow fever epidemic in Philadelphia, Pennsylvania by Benjamin Rush. Rush further related the black colour, big lips and flat nose as symptoms of leprosy.
Hoffman and Trawalter pointed out the permanency of opinions that hold Blacks and Whites to be fundamentally and biologically diverse. Their study highlighted that this understanding roots in privileges made by 'scientists, physicians and slave owners alike to justify slavery'. In some disturbing and alarming findings stated in the study, one includes about the widespread belief among white medical residents and laypeople 'that Black people have thicker skin than do White people or that Black people blood coagulates more quickly than White people blood'.
The most infamous example of racism in medicine was the Tuskegee study which consisted of a longitudinal non-therapeutic trial (1932–1972) involving deliberate non-treatment of African-American men with late-stage syphilis to study the natural course of disease in and around Tuskegee, Alabama.
The disparities are stark when even the Centre for Disease Control and Prevention Website acknowledges that racial disparities exist, and Black women are 3–4 times more susceptible to pregnancy-related deaths. Although statistically, these figures must be correct, these could have been portrayed in some other manner.
The Food and Drug Administration in 2005 approved a combination of isosorbide dinitrate and hydralazine hydrochloride (BiDil) for congestive heart failure as the first race-specific drug with the peculiar tag of special efficacy in blacks. This gave rise to the notion as if the basic pathophysiology of congestive cardiac failure in Blacks people is somehow different than that of Whites although the manufacturers of the drug were never clear of the exact mechanism behind the difference in efficacy. Nevertheless, it strengthened the assumption that Black people are genetically different than Whites.
Ebola Virus Disease (EVD) was also considered to be disease amongst the Black people., This rooted from the fact that, amongst the latest health issues, a total of 28,616 cases of EVD and 11,310 deaths were reported, and the maximum cases were in DRC, Guinea, Liberia and Sierra Leone.,
The fundamental question is whether race-specific medical conditions exist and if it is, does it divide humankind into biologically distinct entities. It is difficult to answer but at the same time, equally important to decipher as its ramifications have caused racial disparities and inequalities in health care and medical treatment. In many ways, racism has been the cause of health disparities more than race itself being a factor influencing health and illness. Attributing race to health disparities is in a way a form of 'victim blaming'.
| Implications|| |
Although statistics and reports are concentrated from the United States, it is not unique in the country. Similar patterns of racial health disparities are found in other countries such as the United Kingdom, Australia, Canada, New Zealand, South Africa and Brazil. Leadership on racial equity to address health disparities in the United States could have positive national effects and additional potential effects on stigmatised racial populations worldwide.
There is increasing discussion about this increased prevalence of disease in Blacks to genetic susceptibility. Experts use the term “genetic” susceptibility to refer to genetic factors that may make someone more or less vulnerable to different diseases. Some diseases, such as cystic fibrosis and alpha-1 antitrypsin deficiency, are caused entirely by genetic factors. In most other diseases, such as asthma and COPD, it is interactions between a person's genes and environmental factors, such as allergens, irritants, smoking, diet, nutrients, drugs, infections and injuries that can lead to the conditions. Therefore, it may be concluded that health disparities amongst different racial groups may be most often driven by social, economic and political factors than the genetic makeup of the individual themselves.
The Kaiser Family Foundation explains racial health disparities as the higher burden of illness, injury, disability or mortality experienced by one (politically and socially constructed) population group relative to another. This racial health disparity can be attributed to higher mortality and morbidity in race of colour than white population.
For example, death rates from the following illnesses were two times higher amongst African-Americans than amongst White Population:
- Kidney disease and hypertensive renal disease
The difference is staringly evident when we take into account cardiovascular disease for their contribution of the largest share of in mortality (34.0%). The other diseases that contribute into this list are infections (21.1%), trauma (10.7%), diabetes (8.5%), renal disease (4.0%) and cancer (3.4%). Comparable dissimilarities exist in infant mortality and life expectancy. In 2004, the infant mortality rate amongst African-Americans was 2.4 times the rate of other groups, as compared to 2.3 in 1990.
| Recommendations|| |
- We need to consciously address the contexts, which have portrayed the phylogenetic differences as genotypically different
- Rather than relying on the association between disease and race, which is at best arbitrary, more attention should be directed towards understanding social and economic factors, which often in the first place, lead to disparate disease burdens in different races
- Empowerment programmes – Empowerment programmes aiming at emboldening patients to proactively participate in the health care along with cultural competency programmes for health-care providers can be the key.
| Conclusion|| |
While it is tempting to find associations between diseases and races to facilitate generalisation of efforts, a critical appraisal of the sociopolitical contexts can give better perspectives.
The theories of Black immunity are a product of centuries of inequality, racialising medical issues and experimentation and the medical system being predominantly governed by White People. The ground reality is, regardless of the diagnosis, Black People are at least equally if not more, susceptible and vulnerable.
The racialising of diseases might worsen the already at-risk communities of colour to enhanced risks by diverting attention and funds from the appropriate authorities. We must uproot the myth of labelling diseases and immunity with race. The stakes are entirely too high. Finally, COVID-19 has proved that viruses do not discriminate.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
Note: According to census data, 'Black' and 'White' are acceptable terms used to denote race in US.
| References|| |
Fausto-Sterling A. The Bare Bones of Race. J SAGE 2010;38:657-94.
Braun L, Fausto-Sterling A, Fullwiley D, Hammonds EM, Nelson A, Quivers W, et al
. Racial categories in medical practice: How useful are they? PLoS Med 2007;4:1423-8.
Gravlee CC. How race becomes biology: Embodiment of social inequality. Am J Phys Anthropol 2009;139:47-57.
Jones CP. Invited commentary: “;Race,” racism, and the practice of epidemiology. Am J Epidemiol 2001;154:299-304.
Rush B. Inquiries and Observations: Containing an Account of the Bilious and Remitting and Intermitting Yellow Fever, as it Appeared in Philadelphia in the Year 1794; 1796. Available from: https://books.google.com/books?hl=en&lr=&id=M6IRAAAAYAAJ&oi=fnd&pg=PA5 &dq=(11.+Rush+B.+An+Account+of+the+Bilious+Re-+mitting +Yellow+Fever+as+It+Appeared+in+the+City+of+Philadelphia+ in+1793.+Edinburgh,+UK:+John+Moir%3B+1796.+)+& ots=ANSd5HK2f9 and sig= BvH1IgnGLBSQrOGRfoHChy64SNs. [Last accessed on 2020 Nov 22].
Society BR-T of the AP, 1799 Undefined. Observations Intended to Favour a Supposition that the Black Color (as it is called) of the Negroes is derived from the LEPROSY. JSTOR. Available from: https://www.jstor.org/stable/1005108. [Last accessed on 2020 Nov 22].
Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences 2016;113:4296-301.
Reverby SM. “Special treatment”: BiDil, Tuskegee, and the logic of race. J Law Med Ethics 2008;36:478-84.
Clinics CM-G-CCN, 2019 Undefined. Maternal Quality Outcomes and Cost; Available from: https://www.ccnursing.theclinics.com/article/S0899-5885(19)30011-5/abstract. [Last acessed on 2020 Nov 22].
Bibbins-Domingo K, Fernandez A. BiDil for heart failure in black patients: Implications of the U.S. Food and Drug Administration approval. Ann Int Med 2007;146:52-6.
Sasidharan S, Civilization RD-HP of, 2020 Undefined. Ebola, Measles, COVID-19 And Insurgency – The Multiple Fronts of War in the Democratic Republic of the Congo. Available from: https://www.termedia.pl/EBOLA-MEASLES-COVID-19-AND-INSURGENCY-THE- MULTIPLE-FRONTS-OF-WAR-IN-THE-DEMOCRATIC- REPUBLIC-OF-CONGO,99,41471,0,1.html. [Last accessed on 2021 Jan 06].
Sasidharan S, Dhillon HS. Ebola, COVID-19 and Africa: What we expected and what we got. Dev world bioeth. 2021;21:51-4.
Sasidharan S, Singh V. MB-DW, 2020 Undefined. COVID 19 – A Report from the Democratic Republic of the Congo. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436544/. [Last accessed on 2021 Jan 06].
Not Equal: Racial Disparities In Addiction/Substance Abuse Treatment: 2020. Available from: https://www.addictionresource.net/racial-disparities-addiction-treatment/. [Last accessed on 2021 Jan 10].
Williams DR, Wyatt R. Racial bias in health care and health: Challenges and opportunities. JAMA 2015;314:555-6.
Artiga S, Orgera K. Key Facts on Health and Health Care by Race and Ethnicity; 2019. Available from: https://www.kff.org/racial-equity-and-health-policy/report/key-facts-on-health-and-health-care-by -race-and-ethnicity/. [Last accessed on 2021 Jan 10].
Fogo A, Breyer JA, Smith MC, Cleveland WH, Agodoa L, Kirk KA, et al
. Accuracy of the diagnosis of hypertensive nephrosclerosis in African Americans: A report from the African American Study of Kidney Diseases (AASK) Trial. Kidney Int 1997;51:244-52.
Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med 2002;347:1585-92.
Keppel K, Bilheimer L, Gurley L. Improving population health and reducing health care disparities. Health Aff (Millwood) 2007;26:1281-92.
Sasidharan S, Harpreet Singh D, Vijay S, Manalikuzhiyil B. COVID-19: Pan(info)demic. Turk J Anaesthesiol Reanim 2020;48:438-42.