Morbid Symptoms

Following up on a post earlier this week, the question of whether optimism should prevail about science’s ability to rescue us from our compounding crises of COVID-19 and climate change has been profoundly complicated by other forces that exist in our world.

Our health care system (and scientific/medical research) is driven almost exclusively by profit. The clean energy sector is dominated by anti-union green capitalists. Neither is positioned to prevent us from tumbling over the precipice into a “high-mortality event,” or pull us out of the depths of the one we are already in. We have ceded ground in our conception of the role of government, restricting our commitments in the realm of the public good to their Venn-diagrammed intersection with the universe of the privately-profitable.

What’s more, much “scientific research” itself has long played a role in perpetuating racial inequalities — whether it be the dubious claims of previous centuries’ phrenologists/eugenicists, or their modern equivalent in the social sciences, Charles A. Murray. The field of medicine is no exception: Black people can be treated as subjects for laboratory experiments but not as subjects deserving of sympathy. “How does it feel to be a problem?”, W.E.B. DuBois once asked about the racist tendency to shift blame for Black peoples’ suffering onto the very fact of their existence.

This “problem-people” logic is at work today in public opinion polling concerning high rates of hospitalization for COVID-19 among Black people, where a significant portion of those polled (and a majority of some subgroups like Republicans) faults their “choices and lifestyles.” Black people account for 13% of the US population but for 22% of all deaths where race was reported, per data compiled by Ibram X. Kendi’s Center for Antiracist Research at Boston University. Yet some medical professionals still seek to explain this as a question of either Black peoples’ individual behaviors or higher rates of comorbidities, as if these can be separated from the many social determinants of health (perhaps better understood as socio-political determinants).

Some doctors, thankfully, disagree. A friend recently forwarded a paper to me written by a group of epidemiologists entitled “Racial Capitalism within Public Health: How Occupational Settings Drive COVID-19 Disparities.” It is a testament to the importance of an approach to public health that actually interrogates the power structures of the world we live in. The authors examine existing workers compensation legal precedents developed around lung function which prejudice the standards towards a higher denial of claims by Black applicants. They then extend this analysis to COVID-19:

We argue that the most salient commonality among workplace settings most responsible for the spread of COVID-19 are the racial and ethnic demographics of their work forces and clienteles. We further argue that the greatly amplified transmission risk occurring in these settings is not because of an inherent vulnerability of Black, Brown or immigrant workers. Rather, a system of racial capitalism that preceded the pandemic structurally concentrates exposures and exacerbates COVID-19 risk for these worker populations, through replication of historical inequities and state-supported corporate neglect of worker protection. Moreover, we argue that epidemiology as a discipline has selectively produced and promoted quantitative findings to justify and further this system of racial capitalism. The inequities evident in the ongoing COVID-19 pandemic offer an opportunity to redress our role in producing racially disparate health outcomes.

It is refreshing to read doctors that, in the tradition of Frantz Fanon, are willing to diagnose the causes of our morbid symptoms rather than just chronicle them. Another such figure is Dr. Mona Hanna-Attisha, the Iraqi-American doctor who exposed the state-sanctioned poisoning of the Flint, Michigan water supply. Not satisfied with simply analyzing the elevated levels of lead in children’s blood, Dr. Hanna-Attisha also emphasized the decay of democracy which caused it: by 2013 half of Michigan’s Black residents were governed by un-elected emergency managers charged with enacting unilateral austerity, as opposed to 2% of white Michigan residents who live under such regimes.

In such an undemocratic context, comparisons to colonialism are not very far off-base. We could take the comparison further by recognizing the ways in which our health care system functions as an extractive industry, vacuuming wealth towards the top while impoverishing millions: health care debt and medical issues are the leading causes of personal bankruptcy filings in the US. Tens of millions of health care workers labor for poverty wages and have no union protections to speak of, while nursing home companies have quite literally made a killing off of COVID-19.

The illness, like the phone call, is coming from inside the house.