Structural Competency

Priscilla Wald’s erudite retelling of the Henrietta Lacks story locates individual-level decisions about bodies and cells in the shifting terrain of politics, political economies, and notions of selfhood. Wald takes us on a sweeping tour of philosophical and economic challenges to the idea of “the human” that emerged nodally and communally in the post–World War II period to address the central tensions of the HeLa cell line: how biotechnology can be at once life-saving and life-destroying, generative and cancerous, lucrative and oppressive. Wald then maps the development of collective consciousness about Lacks and her cells onto the emergence of the collective ethics of American studies. By doing so, Wald tells a vital prehistory of our field, one that reminds us again of the ways in which our interdisciplinary forebearers confronted canonical knowledge by developing and promoting new modes of pedagogy, scholarship, activism, and awareness. Wald ultimately challenges us to foster a future in which the stories we tell anticipate and contest the hierarchies that shape notions of health, illness, and common sense.

To be sure, the Lacks story represents a tragedy in which doctors appropriated cells without knowledge or consent and used them to produce a wealth of lucrative biotechnologies, from vaccines to gene-mapping techniques to in vitro fertilization. In its popular form, recently told by Rebecca Skloot in The Immortal Life of Henrietta Lacks and soon to appear in an HBO movie starring Oprah Winfrey, this is a narrative with clear villains and victims. Skloot, for instance, describes Lacks as a “poor black tobacco farmer” whose cells continue to personify embodied injustice: “Henrietta’s cells have been bought and sold by the billions, yet she remains virtually unknown.”¹

Wald complicates this linearity. There is “a strong sense of medical iniquity, with an emphasis on . . . racism,” she writes. “It has been, however, difficult to identify and name the specific malfeasance.”

This difficulty of identification and nosology is not because the malfeasance had no name. Rather, the apt name for this type of injustice was not wholly knowable or recognizable in the examination room in 1951. As Wald rightly argues, moments of clinical encounter between doctors and patients in Baltimore-area medical clinics were metonymic parts of much larger wholes. And recognition of the nature of the “malfeasance” would have required that biomedical actors connect the troubled racial politics of moments of encounter to larger structural politics of a system that mortared inequity and violence into the walls of buildings and the planning grids on which the buildings stood.

Much has improved since 1951. Yet complex tensions between individual-level and structural-level injustices remain at the fore of efforts to address disparities of race and health, and increasingly so. For instance, evidence for the pernicious health effects of what Johan Galtung called “structural violence” and what Stokely Carmichael called “institutional racism” has never been greater. We now know that structural violence and institutional racism directly alter biologies and health outcomes. Epigenetics research demonstrates, at the level of gene methylation, how living in a resource-poor environment can impact risk factors for cardiovascular disease for generations.² Meanwhile, neuroscientists demonstrate linkages between poverty, hampered brain development, and various forms of mental illness.³ And economists show that low-income minority persons can lower their rates of obesity, diabetes, and major depression by moving to safer, more affluent neighborhoods.⁴

In other words, we have never known more about how the pathologies of social structures affect the material realities of people’s lives. And we have never had more need for understanding how symptoms heretofore located on the bodies of marginalized persons reveal embodied clues about the racialized economies in which marginalized and mainstreamed bodies live, work, and attempt to survive. At the same time, at least in the United States, we have never invested less in infrastructure, or done less to correct fatal and fatalizing inequities. Income disparities grow, aided by tax codes that foster their expansion. Small cities across the country cut off power to streetlights, or funds for emergency responders, or public transport, leaving residents isolated in the dark.⁵ As U.S...