Racial Classifications, Biomarkers, and the Challenges of Health Disparities Research in the African Diaspora.

The notion of "racial diseases "--that people of different races suffer from peculiar diseases and experience common diseases differently--is centuries old. It is tied to the original use of biology in inventing the political category of race.--Dorothy Roberts, Fatal Invention Introduction Despite more than two centuries of scholars from diverse disciplines deconstructing and debunking the validity of the existence of human biological races, the use of biological data to investigate purported racial differences in disease etiology and public health persists in genomic, medical and social science research. Biological race, it has been said repeatedly, is not real. Society, however, has made race real through laws, public policies, and social practices designed historically for the primary purpose of circumscribing and controlling the lives of people of color (Freeman, 2003; Haney-Lopez, 2006; Roberts, 2011; Smedley & Smedley, 2005). Biomedical research has played a central role in this process by validating and perpetuating the racial calculus and taxonomies born in the era of racial slavery. In recent decades, genomics, which initially held the promise of ending the pattern and practices of racializing medical science, has resurrected the idea that biological race serves as a useful variable in biomedical research (Roberts, 2011). The social history and purported scientific uses of the concept of race thus contribute to its survival and endurance. Black Studies professor George Lipsitz uses the phrase the possessive investment in whiteness to account for the persistence and consequences of the use of race as a cultural artifact and social construct to provide distinct advantages for whites in housing, education, employment and income (Lipsitz, 2006). Few, however, apply this analysis and explanation to biomedical research and genomic science. Yet the common belief that science is objective and thus immune from societal issues and pressures ignores that scientists and science are products of the cultural ethos of the present and the accumulated legacies of the discipline's past. What arguably is least acknowledged in accounting for the persistence of race in biomedical research is the role of U.S. government policies in mandating and supporting the use of racial classifications. In the discussion that follows, we describe the federal government's role in defining race and its implications for medical research. We then examine the use of biological markers in biomedical and social science research, and their misuse in hypertension studies to posit ill-defined concepts of biological race to account for health disparities to the detriment of other explanations. A discussion on the Slavery Hypertension Hypothesis follows as an exemplar of the complex problems identified in the prior section. In conclusion, we offer a few thoughts about the role of black scholars in shaping future research on health inequities. Racial Classifications and Government Policy Race made its first appearance as a federal classification system in the 1790 census. In the ensuing two centuries, official racial designations increased from three (white, slave, other) to fifteen on the 2010 census form (Bhatnagar, 2007; Hickman, 1996; Racebox.org, 2014). Throughout this period the term and category "white" did not change. Blacks, on the other hand, have been variously identified as slave, free, colored, mulatto, Negro, and African American. The fact that the 2010 Census form provides a combined ten sub-categories for the self-identification of Asians (5.1% of U.S. pop.) and Pacific Islanders (0.2% of U.S. pop.), and none for whites who comprise 78% of the population, is indicative of the pervasive social consciousness that accepts the category as homogenous and the terms "white" and "Caucasian" as self-evident (U.S. Census Bureau, 2014). The classifications Chinese and Indian (Native American) first appeared on the census in 1870. …