Mapping "Race": Critical Approaches to Health Disparities Research

Chapter 11: Jedi Public Health: Leveraging Contingencies of Social Identity to Grasp and Eliminate Racial Health Inequality

163 ArlineT. Geronimus Eliminating racial health inequality remains seemingly impervious to efforts and intentions. Of significance in addressing this dilemma is the concept of race and how this concept is and can be linked to health. Historically, public health has conceptualized race either as static, essentialist characteristics (genetic, behavioral, cultural, or social attributes and predispositions) or as entrenched conditions (poverty and social disadvantages related to the legacies of slavery and systematized racial segregation). However, increasingly, public health researchers are approaching race dynamically. Some are looking at how ongoing and new social processes maintain race as a lived experience with health impacts, and how dominant structural and cultural processes— and the social, physical, and policy environments they create—work through a complex interplay of psychosocial, physiological, and molecular mechanisms to produce population variation in morbidity and mortality (Geronimus and Thompson 2004; Geronimus et al. 2010; Schulz et al. 2005). In addition, race is being considered beyond the Black-White dichotomy to encompass a set of social relationships that emanate from pervasive ideologies that advantage dominant groups at the expense of others and that occur at all socioeconomic levels and in the minor ethnic, religious, or nativity divisions within racial groups (Geronimus 2000; Geronimus and Thompson 2004; James 1993; Pearson and Geronimus 2011; Viruell-Fuentes 2007). In the United States, recent decades have witnessed growing income inequality, large waves of immigration, newly emergent or intensified xenophobia, and tensions around whether our vision for a postracial society should be race-blind or multicultural. In this context, by acknowledging that marginalization of any Jedi Public Health Leveraging Contingencies of Social Identity to Grasp and Eliminate Racial Health Inequality Chapter 11 164 Arline T. Geronimus identified social group may have population health repercussions, by broadening the theories of how such marginalization is enacted to impact health in a growing set of groups, and by viewing marginalization and its consequences as dynamic and relational, the field can move beyond the impasse occasioned by static and binary conceptions of how race and health are entwined (see also Garcia, this volume; Geronimus 2000; Geronimus and Thompson 2004; James 1993, 1994; Pearson 2008; Pearson and Geronimus 2011; Viruell-Fuentes 2007). Despite these promising theoretical developments, public health research and practice continue to operate from the traditional assumption that a person ’s race is fixed. This assumption is most widely recognized in the form that genetic predispositions are the starting point for understanding racial disparities . This viewpoint has been critiqued by social epidemiologists and population geneticists (for example, Cooper et al. 2003; Graves, this volume; Lewontin 1972). Now, most agree that the notion that everyone with the same phenotypic characteristics used to assign race—most notably skin color—would have the same health outcomes invariant to social and physical environments, access to resources, or the nature and timing of critical exposures is untenable. Now, those interested in the role genes play in population health are increasingly emphasizing the environment side of gene-environment interactions. Others are moving into areas such as epigenetics or human stress genomics, wherein the regulation of gene expression is viewed as dynamic at the molecular level (Kuzawa and Sweet 2010),1 or are focusing on telomere length in a subset of leukocytes called peripheral blood mononuclear cells (PBMC), a measure of biological aging that appears to be sensitive to stressful life conditions (Epel et al. 2004; Geronimus et al. 2010).2 The Role of Stress Physiology While embracing race as a social construction and assuming population differences in health along racial lines reflect social patterning, objective and subjective experiences that are socially patterned on the population level ultimately work via physiological processes and mechanisms to influence morbidity and mortality. Increasingly, public health researchers posit that prolonged psychosocial or physical challenges to metabolic homeostasis in marginalized groups can increase disease susceptibility, promote the early onset of chronic conditions (Geronimus and Thompson 2004; Geronimus et al. 2007; James 1994; Steptoe et al. 2006), and accelerate aging via a process of “weathering”—the cumulative biological impact of chronic exposure to and coping with subjective and objective stressors (Geronimus 1992, 2001; Geronimus et al. 2006; Geronimus et al. 2010; McEwen 1998; Sapolsky et al. 2000). Everyday challenges Jedi Public Health 165 shaped by social disadvantage may trigger chronic activation of stress processes to the health detriment of disadvantaged racial, ethnic, socioeconomic, gender, residential, or geographical ancestry groups. On a biological level, persistent high-effort coping with acute and...