Assessing ‘Race Norming’ & Analyzing the Long Legacy of Medical Racism

Black lives continue to navigate systematic racism in their everyday lived realities. Race norming shapes treatment and access to healthcare resources for Black patients. These practices need to end; medical research must look at race in conjecture with the socioeconomic, cultural, and environmental factors to devise newer ways of assessing disease outcomes.

Medical Racism

As the world reels from the devastation caused by the repetitive waves of the COVID-19 Pandemic, the repercussions paint an uneven tale. A study depicted how the hospitalizations and mortality rates were significantly higher among people of color than their white counterparts. In the United States, Black people have died at the rate of 1.4 times more than White people. Medical outcome and the dominant discourse in biomedicine is intertwined with race.  It raises pertinent questions on the impact of the assumption of race as a biological variable in medicine when it is a social construct. The history of medicine in America is marked by racism and violence. Medical education in the US exploited enslaved Black people’s bodies as ‘anatomical material’ in the 19th century. Historian Dierdre Cooper Owens has shown how the 19th century celebrated founder of American gynaecology James Marion Sims, relied on experimentations on enslaved women and their labour in his clinics to arrive at his discoveries. 

In American medicine, we observe crystallization of medical racism. It refers to the existing structures of racism hurled against people of color present in the medical system. Medical racism also encompasses societal and environmental factors which make the Black population vulnerable, and biases harboured by healthcare providers against people of colour.  A significant factor of medical racism is found in the practice of ‘race norming’.

Assessing ‘Race Norming’: The NFL debacle

Also termed as ‘race correction’ or ethnic adjustment, race norming involves the correcting or adjusting medical assessment scores like risk calculations of diseases to account for the race of the patient. Undoubtedly, this spells out serious consequences for people of colour. In recent news, the NFL had pledged to do away with ‘race norming’. The league’s testing assumes that Black people start with a lower cognitive baseline because of the higher rates of dementia in the Black population. Thus, it prevented Black players from qualifying for settlements in the NFL for post-concussive syndromes and other related head injuries.

Former athletes Kevin Henry and Najeh Davenport sued the NFL in August 2020 over race norming practices and denial of awards. Had they been white, they would have qualified for it. Initially, the act of race norming was part of federal policy for affirmative action. It dates back to the 1980s when the US Employment Services prescribed the usage of General Aptitude Test Battery to state employment services. Race Norming in cognitive assessments began in the 1990s to aid in treatment of dementia patients but has served to disproportionately determine payout in the NFL

The US Department of Labor urged employers to adjust test scores of Black people as they often performed worse than whites. This was indicative of other socioeconomic factors like poverty, stress, and systematic racism which prevented them from performing well. Race norming in employment assessments was made illegal with the passage of the Civil Rights Act of 1991. As Kenan Malik observes, the imposition of race norming perhaps had ‘best intentions’, and ‘conservative pressure’ compelled George Bush to outlaw it. However, it got absorbed in the medical discourse, which further naturalised the assumption that Black bodies are different. Race norming soon got adopted in giving out medical diagnoses. As Davenport had said, “When they use a different scale for African Americans versus any other race… That’s literally the definition of systematic racism.” Henry and Davenport’s lawsuit was dismissed in March but following the mounting pressure from media, petitioners, and the country’s increased focus on racial inequality pushed the NFL to announce that they would stop using race norming. 

(Mis)Diagnosing Black Bodies

Moving beyond cognitive scoring, a partial list of 13 tools has been recognized in other medical specializations by Jones and residents Darshali Vyas and Leo G. Eisenstein that uses race correction. These measures have proven to hinder Black patients’ adequate care and at the right time. Take the example in nephrology. In order to determine the health of kidneys, doctors make use of a patient’s glomerular filtration rate or eGFR. Based on racial stereotypes which animalise Black bodies, biased research concluded that higher levels of creatinine are present in Black people as they are more muscular than white people. It fails to study the possible explanation behind it and instead resorts to racist tropes, which have been deployed to justify the enslavement of Black people. An analysis inferred that one million Black adults will be advised to take medication for kidney disease if the racial correction from an algorithm is used to diagnose kidney disease. This carries serious implications for Black kidney patients needing transplants as it determines timely treatment, quality of kidneys received, etc.

In American cardiology, a similar calculation is performed with the Get with the Guidelines–Heart Failure Risk Score to assess the risk of death upon hospitalisations. The scale shows lower risk levels for non-white patients but the American Heart Association does not clarify this adjustment. Consequently, studies have demonstrated that Black and Latinx patients were less likely to be admitted for heart failure care. 

Lundy Braun’s research on the racial history of the spirometer- an apparatus that measures respiratory function- is again a testament to the fact that race is interwoven in American medical discourse. The race adjustment found in spirometers stems from Thomas Jefferson’s “discovery” that lung capacity is lower among enslaved Black people when compared to whites. When the race adjustment was removed from the pulmonary function test (PFT), the percentage of patients with pulmonary defects jumped to 81.7 percent from 59.5 percent. Hence, a significant number of Black individuals were either being undertreated or receiving no treatment. The presence of the feature of race norming paints a grim picture for Black lives. 

Conclusion  

The past year witnessed one of the most significant movements in US history with the Black Lives Matter in the wake of police brutality. Black lives continue to navigate systematic racism in their everyday lived realities. Race norming shapes treatment and access to healthcare resources for Black patients. These practices need to end; medical research must look at race in conjecture with the socioeconomic, cultural, and environmental factors to devise newer ways of assessing disease outcomes, as argued by Dr Leonard E Egede. To conclude, a group of researchers writes, one needs to ask ‘Why should race variables be used, if at all?’ Medical science shall strive towards health equity and not entrench the existing disparities that further inflict violence on the marginalised. 

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Deepsikha Dasgupta completed her undergraduate degree in Sociology at the Presidency University, Kolkata. Her research interests include social anthropology, religion, gender, and medical anthropology. She is currently a postgraduate student at South Asian University, New Delhi.

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