Usually, researchers describe the health of different races and ethnicities regardless of their past. For example, infants born to black women are 1.5–3 times more likely to die than infants born to white women. Forty-two per cent of African Americans have been diagnosed with hypertension, compared with 28.8% of white people. And for all cancer types combined, the death rate in the United States is 25% higher for black people than white people.
Biological, environmental and socio-economic factors create the disparities. And Thomas LaVeist, the chairman of the International Conference on Health in the African Diaspora (ICHAD), which was held in Baltimore, Maryland, on 5–8 July, argues that the history of slavery and subjugation of a subset of black people also plays into health.
“My career has been about understanding the factors that produce health disparities, and I don’t know how you would engage that question without looking at the levels of second- and third-class citizenship that Africans have endured,” says LaVeist, who is also director of the Hopkins Center for Health Disparities at Johns Hopkins University in Baltimore, Maryland.
“We’re talking about a period that fundamentally redesigned the planet by moving a massive number of people from one side of the world to the other,” he explains. “After the slave trade ended, slavery continued until 1888, when Brazil was the last country to abolish it. And then there was a period of segregation and second-class citizenship up until the 1960s.”
On 8 July the ICHAD working group released a draft declaration for comment, to be finalized by late summer. Among other statements, this version states that the approximately 160 million descendants of the transatlantic slave system living in the Western Hemisphere tend to experience poor living conditions, higher levels of morbidity and less access to health care, and that the analysis of rigorously collected data should be used to define appropriate solutions for improving the health of this community.
Rather than compare data collected in nation-wide surveys, researchers should design studies that minimize confounding factors, says LaVeist. Such studies might compare health indicators, such as infant mortality rate, across different populations who are of the same class and inhabit the same neighborhood.
The studies presented at ICHAD reflected a comparative approach. For example, Pedro Ordunez-Garcia, of the Pan American Health Organization based in Washington DC, concluded that the narrow gap in hypertension prevalence between blacks and whites living in Cuba — as compared to the United States — reflects the importance of medical attention. Most people receive tests and treatment for hypertension in Cuba, a country renowned for its socialized health care, says Ordunez-Garcia.
Speakers also tended to emphasize socio-economic, environmental and dietary conditions rather than biological factors. Indeed, LaVeist calls the current attention to genetics in disease research overblown.
Although he admitted that the bulk of health disparities are socially determined, Rick Kittles, a geneticist at the University of Illinois College of Medicine at Chicago, urged his mainly black audience at ICHAD to not distance themselves from genetics research. In some diseases, such as breast and prostate cancer, genes may have an important role. Moreover, he added that doctors will increasingly use genetic tests to predict how patients respond to medicines. If those tests aren’t developed to assess the DNA of black people, he warns that this already underserved population might not benefit from advances in personalized medicine. “You might not like genetics,” he said, “but we need to be at the table.”