The Problem of Critical Race Theory in Epidemiology: An Illustration

In invited commentary on infectious diseases in JAMA Network Open, published September 25, 2020, Rohan Khananchi, Charlesnika Evans, and Jasmine Marcelin make several claims about systemic racism’s role in an infectious disease in “Racism, Not Race, Drives Inequality Across the COVID-19 Continuum.” I do not find the article compelling. However it is illustrative of the problems with this type of research.

Demographic disparities are not automatically indicators of racism. If one argues that racism drives demographic differences, then one cannot at the same time a priori define demographic differences as racism. That move conflates the dependent variable (difference/inequality) with the theorized independent variable (racism). The argument becomes circular/self-confirmatory/self-sealing. The argument commits the fallacy of misplaced concreteness by treating abstractions in a concrete way, as well as the ecological fallacy (I explain below). That the paper sneaks a claim of lack of fairness or justice into the situation by using the term “inequity” gives away the political agenda. The assumptions made in this article are unscientific.

If the paper were to proceed on a rational basis, it would define racism in a way that allowed for its evaluation as a causal factor (conceptualize/operationalize). The claim that race explains differences in human populations and/or laws/policies based on purported racial differences defines racism. What is the evidence that any human beings supposed in the literature were motivated by racist beliefs? Where are the laws and policies based on this belief? If there were laws/policies in place that segregated medical care on the basis of race, or forced blacks to live in impoverished communities, then institutional/systemic racism might play a contributing role in the demographic inequalities identified. But these systems were dismantled more than fifty years ago in America. Today it is illegal to discriminate against blacks on the basis of race.

The article states that “fundamental causes of COVID-19 inequity include systemically racist policies, such as historic racial segregation and their inextricable downstream effects on the differential quality and distribution of housing, transportation, economic opportunity, education, food, air quality, health care, and beyond.” To be sure, historic racial segregation was based on systematically racist policies. But the operative word here is “historic.” Past policies are not present policies. And while history is not irrelevant to understandings of the present, history is also not the present. Keep in mind that “inextricable” means impossible to disentangle. The pairing of “inextricable” with “downstream effects” is obscurantism. The authors assume as given a foundation that they must demonstrate. This is strange alchemy. An exercise in mystification.

The article continues, “Each of these factors is associated with the risk of COVID-19 exposure and severity through direct (e.g., work conditions, crowded housing, carceral overrepresentation) and indirect (e.g., limited access to health information or insurance; increased prevalence of comorbidities; cumulative life-course exposure to discrimination, low socioeconomic status, and other health risk conditions) mechanisms.” However, since the racial and ethnic differences are not about race, according to the article, but about racism, then one would expect to find white people living in these conditions do not suffer the same fate. But the article commits the ecological fallacy by substituting for the situations of concrete individuals aggregate demographic differences.

Controlling for cultural factors (but perhaps not all, since we can draw too fine a distinction between racial groups in this regard), is it true that whites living under near-identical conditions are differentiated from blacks vis-à-vis COVID-19? Do we suppose that “low socioeconomic status” whites living in conditions of crowded housing, with limited access of health information or insurance and increased prevalence of comorbidities, etc., have better outcomes than blacks living in these conditions? (If so, that might suggests actual racial differences). What is the measure of “life-course exposure to discrimination”? Again, that’s an awfully big assumption.

These types of studies are part of a general approach in academic work that operates from an epistemological frame (critical race theory) that manufactures an ontology built upon arbitrary abstractions. At the core of this is the problem of reification in science. Such work proceeds on assumptions that are far too sure of themselves. There is nothing in this article that presents racism as conceptualized and operationalized as either belief in genetic differences in human populations and/or laws and policies based on such purported differences. The structural problems identified are class-based and explicable in terms of the processes of capitalist accumulation. The term “socioeconomic status,” which eschews class analysis, should alert readers to the probable race-centric bias of the research frame. There may be cultural/ethnic differences, as well (for example diet and obesity), but these are unexplored in the study.

There is a twin tragedy with this approach that works to perpetuate capitalist class oppression. First, by obsessing over race, social class as a casual factor is relegated to the outskirts of social consciousness. The real dynamic working behind the scenes to produce differential health outcomes is thus mystified. Second, by obscuring class effects with the rhetoric of systemic racism, poor white people are disappeared. The situation is made to appear as if black people are the primary victims of social oppression, moreover victimized by a system privileging white people. In this way, the woes of the working class are denied and those who exploit and live off their labor, who are both black and white, are absolved of their responsibility in disparate health and other outcomes. Critical race theory works to disrupt class consciousness and entrench the capitalist mode of production.

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Andrew Austin

Andrew Austin is on the faculty of Democracy and Justice Studies and Sociology at the University of Wisconsin—Green Bay. He has published numerous articles, essays, and reviews in books, encyclopedia, journals, and newspapers.

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