Correcting for Race

When asked recently what the impact of an overturned Roe v Wade would have on his state’s high maternal mortality rates, Louisiana Sen. Bill Cassidy — who is also a physician — responded: “About a third of our population is African American; African Americans have a higher incidence of maternal mortality. So, if you correct our population for race, we’re not as much of an outlier as it’d otherwise appear. For whatever reason, people of color have a higher incidence of maternal mortality.”

Given the context, Senator Cassidy likely meant to “correct for race” by utilizing statistical methods to adjust for different human experiences. He was suggesting eliminating Black Americans from consideration.

That’s too bad, since the simple removal of African Americans from the health calculus wouldn’t actually solve the problem; White Americans have plenty of health struggles too — including maternal mortality with Hispanic/Latina mothers doing much better despite being significantly more likely to be poor.

As a population health scientist, I understand and appreciate how interpersonal racial discrimination and structural racism combine to cause high rates of Black American maternal mortality. Because I’m also a public policy professor, I understand and appreciate how Cassidy’s statement reflects both interpersonal and structural racism.

How much better if by “correct for race” Bill Cassidy meant investigating and addressing the needs of Black American women? After all, as a doctor and senator, he is a dual public servant who should work to understand and improve the health and social conditions of all his patients and constituents.

A good starting place would be openly acknowledging that the “whatever reason” he mentions is racism. As a medical doctor he must know the overwhelming research demonstrating that racially discriminatory medical treatment contributes to longstanding, preventable, racialized health inequities. As a legislative policymaker, he should know how racially- biased policies have informed structurally racist social systems, which contribute to increased disease susceptibility and vulnerability for people of color.

Native American genocide, Black American chattel slavery, and racialized differential immigration policy are historical examples of structural racism. Segregated housing and education, biased criminal justice and policing, racially restrictive voting policy, biased employment practices, racialized economic inequality as well as racially discriminatory medical practices are contemporary manifestations of structural racism. Through structural racism, US history and culture have allowed privileges associated with “whiteness” and disadvantages associated with “color” to endure and adapt over time. The health consequences for populations confronting these systems are well documented with people of color disproportionately bearing the burden of poor health.

But structural racism also impacts White Americans.

The US does poorly in maternal and infant health indicators compared to all other high-income nations, some medium income ones, and even a few poorer countries. We do worse or no better than Poland, Costa Rica, and Cuba. Statistically removing Black Americans from these comparisons does not meaningfully improve the US’s relative standing. This means that the “whatever” of racism is bad for all Americans in ways that renders Cassidy’s suggestion — to just take Black Americans out of the data — ultimately ineffective. One explanation suggests that, among some Whites, racial resentment drives opposition to education, Medicaid provision, policies to prevent gun violence, and economic opportunity. In short, fears of racial demographic change increases nostalgia for white racial exclusivity even if that belief comes at real material costs. These, when combined with more access to increasingly potent synthetic drugs, result in bad health for White Americans.

He may not have intended to do so, but Senator Cassidy has provided a jumping off point for conversation on critical opportunities for racial reckoning and reconciliation.

Improving health inequity should be based on the radical notion that all people are fully human and have a basic right to participate in planning and constructing societal institutions and the narratives reflecting their motivating interests and perspectives. In this just society, the degree to which preferred groups disproportionately reap the benefits of success while other groups disproportionately bear the burdens of failures would be reduced, including health.

So, yes Senator Cassidy, if correcting for race means racial equity, then let’s get to it!

Jay Pearson is an associate professor at Duke University’s Sanford School of Public Policy and a population health scientist trained in health behavior, social epidemiology and health demography.