Embodiment of social inequality causes health disparities

Krieger, N. 2012 Methods for scientific study of discrimination and health: An ecosocial approach. American Journal of Public Health 102(5):936-945.

In this paper, Krieger explains how discrimination based on racial/ethnic origins affects health of the racial/ethnic minorities.  She uses a bio-cultural approach to understand the interactions between social aspects (social structure, economic and social derivation, individual’s life-long experience of racism, and individuals’ cognitive aspects) and biological aspects of race (physical traits and exposures to toxins, hazards, and pathogens).  This approach incorporates the temporal (life-cycles starting in utero to the end of life) and spatial (from individual to global level) aspects that affect minority health.  While incorporating the wide variety of aspects of minority individuals and societies into her theoretical framework, she focuses on the causal relationship between discrimination and health, so she sees health inequality is manifestation of social inequality.

But we really need to look at these tables from her paper to understand the social context.

Table 1 Analyzing US Racial/Ethnic Health Inequities in Context

There are more African Americans living at poverty level, unemployed, and without health insurance compared to European Americans.  Infant mortality rate is much higher among African Americans, and more African American self-report having poor health status.  Minority groups are underrepresented in the congress and state legislature.

Table 3 Postelection National Poll Results for Statement on Racial Discrimination, November 3-7, 2010

However, so many white Americans and Tea Party and Republicans agree that “Today discrimination against Whites has become as big a problem as discrimination against Blacks and other minorities.”

The core concept in her approach is embodiment of social inequality.  I believe the concept of embodiment came from habitus, idea developed by Pierre Bourdieu, a French social theorist who also talked about social capital.  Embodiment is one of the core aspects of habitus, and I believe it means that people’s e experience, material word, and social structure are incorporated deep into one’s cognition.  Krieger develops this concept further to reflect biological aspects related to health inequality.  Because of discrimination, racial minorities are more likely to be exposed toxins, hazards, and pathogens and surfer from economic and social deprivation and inadequate medical care, so racial minorities are more likely to have worse health condition.

I believe embodiment is the concept that we should explore in our research and could be very useful to analyze social determinants of health.  For example, we can use this idea to analyze the relationship between fast food culture and health.  In the U.S. fast food restaurants are fun place for kids and provide quick and inexpensive food for teenagers and adults.  It is culturally acceptable to go to fast food restaurant regularly, if you do not have time and money.  The food tastes good for kids and fills adults’ stomach for a long time.  Over time, we develop the taste for fast food, and going to fast food restaurant became an integrated part of people’s life and cognition.  People who grow up with fast food restaurants now have children and take them there regularly.  It is not surprising if these children prefer French fries over vegetables.  Because of targeted marketing and economic condition, low-income individuals, and many of them are racial/ethnic minorities, are more likely to be exposed to these high fat high calories diet.

While she focuses on racial discrimination as one of the causes of health inequality, her ecosocial approach seems to be a holistic framework for analysis of social determinants of health.  Human and our societies are very complex, we need a framework as holistic as possible to capture multidimensional aspects of human societies (social determinants of health, racism, etc.) and human biology (health).

Because her focus in this paper was explaining the causal relationship between discrimination and health, she did not explain how this framework can be used to reduce health inequality.  If we can identify the social issue related to racism and health that we hope to fix, how can we use this approach to develop a strategies for intervention?

Regions based on social structure

Burton, M., C. Moore, et al. (1996). “Regions based on social structure.” Current Anthropology 37: 87-123.

In this post, I reviewed an article that proposes a new method of regional classification based on social structure, a method that try to incorporates history of migration and effects of environment.  I think this article is interesting for two major reasons.

First, they use scoring system based on social organization and kinship terms and categorized the societies into either patricentric or matricentric.  Patricentric societies are organized around males through patrilocal residence, patrilineal descent, and polygyny.  On the other hand, matricentric societies are characterized with matrilocal post-marital residence, matrilineal descent, and monogamy.  They say “gender is a defining feature of culture regions.”

I believe that the theoretical work by cultural anthropologists needs to be incorporated into anthropological genetics studies.  If polygyny or sex-biased gene flow has played an important role influencing sex-biased demographic patterns have been investigated using X chromosome data (e.g. here, here, and here), but human geneticists should work more closely with cultural anthropologists and exchange their ideas.

Second, they identified five culture regions in the Old World and six regions in the New World.  Their regional classification system is very different from any other system.  For the Old World, they have 1) Sub-Saharan Africa, 2) Middle Old World, 3) Southeast Asia and the Insular Pacific, 4) Australia, New Guinea, and Melanesia, and 5) North Eurasia and Circumpolar.  In the Middle Old World region, they include North Africa, the Middle East, South and Central Asia, China, and possibly southern Europe.  In the North Eurasia and Circumpolar region, they have Europeans, Japanese, Koreans, Siberians, and Eskimos.  Although their method is typological, since they look for homogeneity within a region and difference between regions, they emphasize lack of clear boundaries.

Human geneticists often have assumptions of how humans groups are organized and often use ethnolinguistic groupings as sampling units.  Then, they often find population clusters that correspond to major geographic groups (E.g. here) or linguistic families (E.g. here).  We need to ask what the correlations between population clusters and major geographic groups or between population clusters and linguistic families are telling us.  Burton and his colleagues tell us that there is another way of classify human groups (populations or societies), that reflect histories of migration.

Race: a social destruction of a biological concept

Sesardic, N. (2010). “Race: a social destruction of a biological concept.” Biology and Philosophy 25(2): 143-162.

Anthropologists, other social scientists, philosophers, and human population geneticists have argued that there is no genetic basis for racial classification, but in this article, Sesardic (2010) argues that non-genetic basis of human race arguments are not supported by the recent multilocus genetic data.  The point that he is making is not existence of human biological race, but questioning the scientific basis for the non-existence of biological race arguments.

Like Pigliucci and Kaplan, Sesardic starts out with a problem of defining race, but he mainly focus on examining how philosophers and others, who argues no genetic differences among human groups, define race to illustrate the way they define race are not supported by recent genetic data showing genetic differences among human groups. 

Sesardic argues that if frequencies of alleles on one locus are used for racial classification, individuals cannot be classified correctly into right racial categories, but if multilocus genetic data are used as demonstrated by Risch and his colleagues and Rosenberg et al (2002), many individuals can be classified into racial or geographical categories correctly.  Similarly, if forensic anthropologists look at many skeletal traits, they can accurately infer the racial identity of individuals. 

As Sesardic suggested, no genetic difference argument is not supported by many genetic and osteological studies.  However, we should avoid a naïve conclusion.  The multilocus genetic data showing genetic differences among human groups should not be used to argue the existence of human biological race (note that Sesardic is not arguing this).  We have to consider evolutionary and historical process as well as sampling and statistical effects that cause the clustering of human groups illustrating genetic differences.

On the concepts of “tribe” and “tribal society”

Fried, M. H. (1968). On the concepts of “tribe” and “tribal society”. Essays on the problem of tribe. J. Helm. Seattle, University of Washington Press: 3-20.

Fried addresses the problem concerning the concept of tribe and classification of ethnic unit.  There are three important points that anthropological geneticists must consider when we are analyzing the genetic variation of modern populations.

First, similar to the concept of “race”, “tribe” is typological way of categorization of human groups based on language, culture, and political organization.  However, he thinks tribe is a very fluid entity with no clear boundary and inter-tribal marriage is common.  Self-identification is problematic, because mixed individuals have to choose the tribal affiliation, if the policy allows them to be a member of only one tribe.  Also, two linguistically distinct groups can form a tribe 

Second, tribes can be heterogeneous groups because of various factors, but not necessary because of cultural changes occurred as the ‘tribal societies’ come to contact with western societies.

Third, many tribes were formed from previously unorganized groups responding to the external pressures, such as European colonization and expansion of modern state/nation.

Since this paper was published, anthropologists began to avoid using the term, tribe.  Today, anthropological geneticists and human population geneticists rarely use the term, but the way they view non-Western societies are similar to the problematic concept of tribe that Fried questioned in this article.

How is race and ethnic identity socially constructed?

Vail, L., Ed. (1989). Creation of tribalism in South Africa. Berkeley, University of California Press.

Wilmer, F. (1997). “Identity, culture, and historicity: the social construction of ethnicity in the Balkans.” World Affairs 160(1): 3-16.

Many human geneticists and social scientists agree that racial/ethnic identity is socially constructed.  But how is racial/ethnic identity socially constructed?

According to Vail (1989) and Wilmer (1997), identity is constructed through socialization, acculturation, education, and retelling of history.  These processes take place in school as well as family settings, especially when there are external pressures, such as colonization and modernization. 

What are the implications for human genetic and anthropological genetic studies?  We use the ethnic groups or populations, often defined by the language they speak, to categorize people for collecting samples and population genetic analyses, but the ethnic group may not have existed several hundred years ago.  Ethnic groups were reorganized throughout human history.

Relationship between genetic variation and racial/ethnic identity (instrumentalist paradigm)

Eriksen, T. H. (2001). Ethnic identity, national identity, and intergroup conflict. Social identity, intergroup conflict, and conflict reduction. R. D. Ashmore, L. Jussim and D. Wilder. Oxford, Oxford University Press: 42-68.

Eriksen is an instrumental theorist, and he believes that culture and ethnic identity is fluid.  According to Eriksen, in the instrumental theoretical framework, ethnicity and identity can be explained as follow (direct quote from Erikson, 2001);

1)      Although ethnicity is widely believed to express cultural differences, there is variable and complex relationship between ethnicity and culture; and there is certainly no one-to-one relationship between ethnic differences and cultural ones.

2)      Ethnicity is a property of a relationship between two or several groups, not a property of a group; it exists between and not within groups.

3)      Ethnicity is the enduring and systematic communication of cultural differences between groups considering themselves to be distinct.  It appears whenever cultural differences are made relevant in social interaction, and it should thus be studied at level of social life, not at the level of symbolic culture.

4)      Ethnicity is thus relational and also situational: ethnic character of a social encounter is contingent on the situation.  It is not, in other words, inherent.

These explanations should apply to racial identity as well. 

Then, how can we apply this concept of race/ethnicity and identity to human genetic and anthropological genetic research?  I replaced the word ‘ethnicity’ by ‘identity’ and ‘culture’ by ‘gene’ to explain nature of relationship between identity and genetic variation.

1)      Although many people believe that there is some kind of relationship between gene/biology and racial/ethnic identity, there is variable and complex relationship between genetic variation and identity, and there is no one-to-one relationship between gene and identity.

2)      Although applying a concept of deme to human subgroups is difficult, deme is more similar to actual human groups or societies than Mendelian population.  By thinking human groups as demes, we can study a property of a relationship (eg. gene flow) between different groups.

3)      Identity is developed through the enduring and systematic communication of genetic and phenotypic differences between groups considering themselves to be distinct.  Aside from the genetic variants for disease causing genes, genetic differences are made relevant in social interaction, and the relationship between genetic variation and race/ethnicity should be studied at level of social life.

4)      Identity is relational and situational: the relationship between genetic variation and racial/ethnic identity is contingent on the situation.  Identity is not inherited, socially constructed.

I think this is pretty good.  Does anyone have comments?