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  • The Color of Breath
  • Coreen McGuire (bio), Jane Macnaughton (bio), and Havi Carel (bio)

Breath under the Skin

Pulse oximeters are technological devices that measure oxygen saturation in the blood using a small infrared light beam. Through measuring the rate of light absorption, they record a proxy measure of oxygen levels in the blood. Normally, if your blood oxygen levels were measurably low, you would know it. You would experience corresponding physical symptoms, such as shortness of breath or dizziness. And yet the Covid-19 pandemic has generated significant reports of “happy” or “silent” hypoxia: the previously little-known phenomenon of people with dangerously low blood oxygen levels who nonetheless function without shortness of breath.1

These cases highlight a central theme emergent from the Life of Breath project: that there is often a mismatch between objective and subjective measures of health, also known as symptom discordance. A person with low oxygen levels in their blood may present with no discomfort, while another with reasonable levels might complain of severe breathlessness.2 Symptom discordance also demonstrates the complexity of the sensation of breathlessness and underlines that the way we perceive breathlessness is constructed partly through physiological data but also through our individual context, personal experience, expectations, and individual psychologies.3

The recent uptake of oximeter use has helped to illuminate deeper problems with the ways we attempt to measure breathlessness through technologies. One of the most critical is that the infrared light is less effective on dark skin.4 The oximeter tends to overestimate oxygen saturation levels in non-white individuals, with the error degree increasing in correlation with the skin’s darkness.5 This is a pointed metaphor for how the pandemic has laid bare the racial and socioeconomic inequities that have tracked morbidity rates—and has shown simultaneously [End Page 233] how systemic racism causes literal suffocation. George Floyd’s cry of “I can’t breathe” echoed Eric Garner’s identical plea in 2014, both of which so vividly express the devaluation of black lives in the United States. This rallying cry for the Black Lives Matter movement has been amplified by both the global growth of the BLM protests and the breathlessness caused by Covid-19, disproportionately affecting black people and other ethnic minorities.6

Breath has long functioned as a metaphor.7 Now breathlessness is especially potent as a metaphor for the need for freedom from oppression. This is potently captured in Achille Mbembe’s essay “The Universal Right to Breathe,” in which he argues for breath as a key force for unification in a post-Covid-19 world.8 Noting the malign influence of capitalism which has “constrained entire segments of the world population, entire races, to a difficult, panting breath and life of oppression,” he insists that to survive this “constriction” we need to “conceive of breathing beyond its purely biological aspect, and instead as that which we hold in common, that which, by definition, eludes all calculation”: the universal right to breathe.


This universality is not acknowledged in clinical contexts, certainly. How we understand breath medically is subject to measurement and calculation—and this calculation undermines the universal in both obvious and subtle ways. Ingrained racial bias is not just skin-deep. It is embedded in the technologies behind technologies: that is, in the data itself. The New England Journal of Medicine recently published a list of race-adjusted algorithms to highlight the growing concerns with their uses given the “mounting evidence that race is not a reliable proxy for genetic difference.”9 Medical historians Lundy Braun and Coreen McGuire have shown how spirometric technology has historically been wielded to deepen and reinforce racial differences. Braun’s Breathing Race into the Machine revealed that the practice of “correcting” for race in spirometry, the study of lung function, promoted scientific acceptance of difference between racial groups, without due concern to the racial categories employed to organize this data in the first place, or to the way that social conditions and living conditions affect lung function.10 McGuire’s Measuring Difference, Numbering Normal developed this analysis by demonstrating the use of variable and inconsistent reference classes in spirometry with regard to women and...


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pp. 233-238
Launched on MUSE
Open Access
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