Last April, the New York Times reported a sharp up-tick in infant mortality rates in the South, a rise that was especially pronounced within the state's disproportionately poor African American population.
Photo: Richard Anderson
As state officials and experts struggled to make sense of the data that had been collected by state agencies, they came to disparate conclusions. Some charged that the differences resulted from cutbacks to state-funded prenatal medical care. Others, however, explained the increase in deaths not as a function of healthcare access but as a function of character--of willpower.
"The mothers in general, black and white, are not as healthy," a Mississippi doctor told the Times, pointing to increases in obesity, diabetes, and hypertension across racial categories. But he rejected the notion that the state's infrastructure was responsible. "Some women just don't have the get up and go," he said.
Despite the doctor's inclusion of whites, the "some women" he referenced tended to be poor and black, the article notes--implying a link between race and gumption. And that's a cause for concern.
"Both the promise and the pitfall of statistics is that they can show where resources need to be directed or problems addressed, or they can be used to perpetuate negative stereotypes" says Susan Craddock, associate professor of gender, women and sexuality studies and affiliate in the Institute for Global Studies.
Craddock has found that policy makers, using categories of race and nationality, have justified unfair practices under the guise of protecting the public health. It's not a new phenomenon, she says. During a 19th-century epidemic of bubonic plague, health officials in San Francisco singled out Chinese immigrants and their neighborhoods--where the disease was rampant--as the source of the contagion. "Disease became a way of pathologizing the Chinese, a political tool used to differentiate the immigrant community," says Craddock. "This was clearly part of a larger anti-immigrant discourse."
Similar attempts in the 19th century to link other immigrant groups, especially Jews and Eastern Europeans, to disease and pestilence fill the pages of medical history books, Craddock says. "If they are diseased, they are to be feared," she says. And, it seems, if they are feared, they are diseased.
The link between disease and discrimination is a phenomenon Craddock is monitoring in Minnesota. Right now, Twin Cities public health officials are trying to intervene in the high incidence of tuberculosis among members of the Somali immigrant community. Statistics from the Centers for Disease Control and Prevention show that TB infections run highest among immigrants to the U.S--a fact that has led some policy makers to advocate restrictions on the immigration of people from certain regions of the world, or greater surveillance before and after they enter the United States.
But other research suggests that many immigrants acquired tuberculosis after their arrival in this country, raising the possibility that living conditions in their adopted land are responsible for the outbreak. Craddock and her colleague John Song recently launched a study to ask members of the Somali community about their experiences with tuberculosis. They hope to provide a more accurate picture of transmission and appropriate response. Among other things, their work will raise questions about whether Somalis' living conditions and limited access to good health care bear some blame for the current TB epidemic.
Craddock is concerned that in the absence of such research public health agencies might adopt policies that "essentially stigmatize and police immigrant groups rather than focusing on the economic and social factors that create vulnerability." What too often happens, she notes, is that "those institutions that should be ameliorating problems are too often propagating them." She hopes that her research will help to counter that trend, sparking awareness in public health officials about which concerns are reasonable--and which are not.
By Jack El-Hai and Danny LaChance