Why Race-Based Health Disparities Have Little to do With Genetics

By Jonathan Kahn

In a recent article in Wired, science journalist Angela Saini discusses “the disturbing return of scientific racism.” The piece is drawn from her new book, “Superior: The Return of Race Science.” Scientific racism per se might be succinctly characterized as (mis)using science to assert essential biological bases for differences among socially defined racial groups. It has been used over 200 years to justify, and indeed promote, the subordination of certain racial groups as purportedly inferior to others.

Saini does an admirable job of tracing the roots of modern scientific racism and identifying its resurgence. Her story in the Wired piece, however, focuses primarily on the more obviously pernicious manifestations of scientific racism exemplified by Bruce Lahn’s work at the University of Chicago asserting a genetic basis for cognitive differences across socially defined racial groups. Saini effectively shows how other geneticists and social scientists dismantled these claims but frames its appeal in the widely held mistaken belief that “races have natural genetic propensities.”

The dangers of scientific racism, however, manifest not only in pernicious attempts to show superiority of inferiority among races. They also emerge more subtly and complexly in the well-meaning work of biomedical professionals seeking to explore broader racial differences, particularly in the field of health disparities.

The differences that cause race-based health disparities are not genetic, but they do emerge from a complex interplay of social and biological factors. It is in this interplay that the temptation arises to attribute disparities to genetics, which might seem more manageable and less politically fraught than attributing them to the messy realities of historical and ongoing social forms of discrimination.

As many of the grander promises of the genomics revolution have failed to materialize (curing cancer, diabetes, and so on) attention has increasingly turned to using genomics as a tool to redress racial injustice in health. A driving mantra in this enterprise has been “diversity.” Diversity is an organizing tenet of the NIH’s grand “All of Us” precision medicine program, seeking to enroll over one million Americans into a vast genomics database to propel health innovation to the next level (there is always a next level).

The tricky thing about diversity, however, is it that like health disparities, it is both a social and a biological concept. And so, when we talk about diversity in relation to health disparities, the door is opened to conflating and confusing social aspects of diversity (race) with biological aspects of diversity (genetic variation). Indeed, under the guise of “diversity,” the All of Us program is literally building race into its genetic data bank.

This is dangerous.

Unfortunately, this is exactly what we see happening in otherwise well-meaning initiatives such as the All of Us program. In seeking to “diversify” its research cohort, All of Us is appealing to groups primarily based on their racial identities. Specifically, it argues that a genetically diversified research cohort may contribute to alleviating the health disparities that afflict the socially defined racial groups from which they are trying to recruit.

It is well known that while humans are 99.5% genetically the same, some variation does occur clinally, that is, through gradual changes across geographic distance.

The idea behind the All of Us diversity initiative seems to go something like this: in order to discover meaningful genetic variants that contribute to disease, we need to have a research cohort that is genetically diverse; one way to increase genetic diversity of a cohort is to recruit from populations that have historically been geographically distant from each other; the way we think about geographic distance today is largely in terms of continents, so let’s recruit diverse continental ancestries. A big problem comes with the next step where programs such as All of Us move on to conflate socially identified racial groups with diverse continental ancestry.  Someone who “looks” Black comes to represent all of Africa genetically; someone who “looks” East Asian comes to represent all of Asia, someone who “looks” White comes to represent all of Europe, and so on.

This thinking is not without a certain scientific logic, but it sacrifices scientific rigor to social convenience. There is, for example, more genetic diversity across populations within the African continent than there is in the entire rest of the world. Moreover, assuming that people who socially code as “Black” or “Asian” are somehow genetically distinct erases more contemporary contributions to an individual’s genetic make-up. Also, this assumption implies a notion of some sort of underlying genetically “pure” African or Asian genetic prototype in a manner that directly reinforces the sort of genetic essentialism found in the work of researchers like Lahn.

Make no mistake, race-based health disparities are real and persistent. They matter. But they are overwhelmingly due to social, economic, political and historical forces. Genetics can only take us so far, and it can take us in the wrong direction if we use it as a substitute for or distraction from the legal, political, and economic initiatives that are needed to address the long, tangled history of racial oppression in this country.

 

Jonathan Kahn is a Professor of Law and Biology at Northeastern University School of Law.

 

The Petrie-Flom Center Staff

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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