Volume 20, Issue 7, July 2020, Page 182-184.

Negative characteristics are sometimes attributed to racial groups on the basis of culture. Sometimes these cultural characteristics are invoked to explain racial disparities. Many antiracist activists and intellectuals argue that such attributions are racist and, in this respect, are no different than attributions of negative characteristics to a racial group based on biology. In a recent essay, Lawrence Blum provides a typology of different kinds of views that attribute negative cultural characteristics to racial groups. One (...) of the views that Blum identifies treats the relevant cultural characteristics as malleable but does not attribute those characteristics to existing structural factors. Blum characterizes this type of thinking as a form of racist thought. I argue that Blum is mistaken in doing so and that there are good reasons for academics not to treat cultural explanations for racial disparities as too taboo to even consider. (shrink)

BackgroundThere is little information on how adverse experiences in early life are associated with the risk of having a child with health problems and whether the health of racial and gender minority groups would be particularly compromised if they have developmentally disabled children.ObjectiveBy integrating life-course perspectives and the intersectionality framework, we examine the extent to which parents’ early-life adversities are associated with having children with DD or other health issues and whether the association between having DD children and parental (...) health varies across race–gender groups after accounting for ELAs.MethodsUsing data from Black and White parents from the Midlife in the US Study, we employed multinomial logistic regression models to investigate the degree to which ELAs are associated with parenting types and multiple regression models with a three-way interaction term to investigate whether the gender–parenting type association differs by race.ResultsWith more adversities, the probability of having children with health issues increases for all race–gender groups, but most dramatically for Black women. Having DD children is associated with more chronic illnesses and functional limitations for women than men, with the largest burden for Black women, yet neither gender nor racial differences in depressive symptoms. Our results highlight that while raising children with DD takes a toll on the health of all parents, the strain might be larger for Black mothers.ConclusionThe adverse effects of parenting a child with DD is more pronounced for Black women than for other race–gender groups indicating opportunities to promote community-based programs for these parents. (shrink)

Negative characteristics are sometimes attributed to racial groups on the basis of culture. Sometimes these cultural characteristics are invoked to explain racial disparities. Many antiracist activists and intellectuals argue that such attributions are racist and, in this respect, are no different than attributions of negative characteristics to a racial group based on biology. In a recent essay, Lawrence Blum provides a typology of different kinds of views that attribute negative cultural characteristics to racial groups. One (...) of the views that Blum identifies treats the relevant cultural characteristics as malleable but does not attribute those characteristics to existing structural factors. Blum characterizes this type of thinking as a form of racist thought. I argue that Blum is mistaken in doing so and that there are good reasons for academics not to treat cultural explanations for racial disparities as too taboo to even consider. (shrink)

Previous research has found that funding disparities are driven by applications’ final impact scores and that only a portion of the black/white funding gap can be explained by bibliometrics and topic choice. Using National Institutes of Health R01 applications for council years 2014–2016, we examine assigned reviewers’ preliminary overall impact and criterion scores to evaluate whether racial disparities in impact scores can be explained by application and applicant characteristics. We hypothesize that differences in commensuration—the process of combining (...) criterion scores into overall impact scores—disadvantage black applicants. Using multilevel models and matching on key variables including career stage, gender, and area of science, we find little evidence for racial disparities emerging in the process of combining preliminary criterion scores into preliminary overall impact scores. Instead, preliminary criterion scores fully account for racial disparities—yet do not explain all of the variability—in preliminary overall impact scores. (shrink)

Racial disparities in pain treatment are well documented. Such disparities are explained with reference to factors related to providers, health care structures, and patient behaviors. Racial differences in pain experiences, although well documented, are less well understood. Explanations for such differences usually involve genetic or psychological factors. Here, we argue that racial differences in pain experiences might also be explained by disparities in pain treatment. Based on what we know about the nature of pain, (...) particularly the cognitive and affective aspects of the phenomenon, it is likely that disparities in the treatment of racialized patients can lead to significant racial differences in pain experience that show up at the population level. We argue that the failure of research programs to consider this causal factor is an example of white ignorance. We also consider several implications of the link between racial disparities in pain treatment and racial differences in pain experience. (shrink)

With increasing complexity in the evolving structure of work in organizations, employees’ preferences for working from home (WFH) relative to working on-site can lead to systematic differences in perceived career implications. An emerging tension associated with WFH versus work-at-work is whether this locational divide is associated with concerns over career progression, especially among racial minorities. Here, we seek to determine whether Black employees, relative to their White counterparts, have more concerns over career progression relating to WFH compared with their (...) on-site colleagues. From a sample of employees in the May 2021 cross-section of the Survey of Working Arrangements and Attitudes (SWAA), we find that relative to higher (lower) income White employees, higher (lower) income Black WFH employees have significantly higher (lower) concerns over career progression than their on-site counterparts. These findings speak both to the nontrivial choices employees may be forced to make as the structure of work continues to evolve and consequences for racial inequality. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the (...) current way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

Depression is a widespread concern in the United States. Neuromodulation treatments are becoming more common but there is emerging concern for racial disparities in neuromodulation treatment utilization. This study focuses on Transcranial Magnetic Stimulation (TMS), a treatment for depression, and the structural and attitudinal barriers that racialized individuals face in accessing it. In January 2023 participants from the Twin Cities, Minnesota engaged in focus groups, coupled with an educational video intervention. Individuals self identified as non-white who had no (...) previous TMS exposure but had tried at least one treatment for their depression. Results revealed that the intervention did not notably change knowledge or stigma about TMS, but attitudes surrounding traveling for treatment changed. Notably, barriers like affordability, frequency of treatment, and lack of knowledge persist. Participants expressed a desire for more information, personal connection, and a tailored educational approach. The study suggests a need for multifaceted strategies to reduce disparities, focusing on education, community-based resources, and policy interventions. Immediate actions that can be taken include the creation of a TMS education program focused on patient engagement and awareness about TMS. (shrink)

Bioethics, Volume 36, Issue 7, Page 816-817, September 2022.

Some psychologists aim to secure a role for psychological explanations in understanding contemporary social disparities, a concern that plays out in debates over the relevance of the Implicit Association Test. Meta-analysts disagree about the predictive validity of the IAT and about the importance of implicit attitudes in explaining racial disparities. Here, I use the IAT to articulate and explore one route to establishing the relevance of psychological attitudes with small effects: an appeal to a process of “accumulation” (...) that aggregates small effects into large harms. After characterizing mechanisms of accumulation and considering some candidate examples, I argue that such mechanisms suggest how a contemporary attitude with small effects could figure in the explanation of large disparities, but they do not vindicate the importance of such an attitude since such mechanisms are typically also determined by competing causes. I close by sketching several strategies for advancing a defense of the relevance of attitudes with small effects. (shrink)

Background Inequities in COVID-19 outcomes in the USA have been clearly documented for sex and race: men are dying at higher rates than women, and Black individuals are dying at higher rates than white individuals. Unexplored, however, is how sex and race interact in COVID-19 outcomes. Objective Use available data to characterize COVID-19 mortality rates within and between race and sex strata in two US states, with the aim of understanding how apparent sex disparities in COVID-19 deaths vary across (...) race. Design and Participants This observational study uses COVID-19 mortality data through September 21, 2020, from Georgia (GA) and Michigan (MI). Main Measures We calculate age-specific rates for each sex-race-age stratum, and age-standardized rates for each race-sex stratum. We investigate the sex disparity within race groups and the race disparity within sex groups using age-standardized rate ratios, and rate differences. Key Results Within race groups, men have a higher COVID-19 mortality rate than women. Black men have the highest rate of all race-sex groups (in MI: 254.6, deaths per 100,000, 95% CI: 241.1–268.2, in GA:128.5, 95% CI: 121.0-135.9). In MI, the COVID-19 mortality rate for Black women (147.1, 95% CI: 138.7–155.4) is higher than the rate for white men (39.1, 95% CI: 37.3–40.9), white women (29.7, 95% CI: 28.3–31.0), and Asian/Pacific Islander men and women. COVID-19 mortality rates in GA followed the same pattern. In MI, the male:female mortality rate ratio among Black individuals is 1.7 (1.5–2.0) while the rate ratio among White individuals is only 1.3 (1.2–1.5). Conclusion While overall, men have higher COVID-19 mortality rates than women, our findings show that this sex disparity does not hold across racial groups. This demonstrates the limitations of unidimensional reporting and analyses and highlights the ways that race and gender intersect to shape COVID-19 outcomes. (shrink)

Bioethics, Volume 36, Issue 3, Page 336-345, March 2022.

As this nation embarks on new efforts to reform the U.S. health system, we face a critical unfinished agenda from the mid- 1960s: persistent racial, ethnic, and socioeconomic disparities in health and health care. Medicaid, Medicare, and Community Health Centers — public programs with very different legislative histories and financing mechanisms — were the first federally funded, nationwide efforts to improve health care access for low-income and elderly Americans. Members of racial and ethnic minority groups also greatly (...) benefited from these efforts because recipients of federal funds, such as Medicare, were required to comply with the newly passed Civil Rights Act of 1964, which barred racial discrimination. Unquestionably, government played a major role in the gains in health care access that have occurred in the last half century. Yet today all Americans do not have the same opportunities for health, access to care, or quality of care when they receive it. (shrink)

Policy often focuses on reducing health care disparities through interventions at the patient and provider level. While unquestionably important, system-wide reforms to reduce uninsurance, improve geographic availability of services, increase workforce diversity, and promote clinical best practices are essential for progress in reducing disparities.

While a significant body of bioethical literature considers how the placebo effect might introduce a conflict between autonomy and beneficence, the link between justice and the placebo effect has been neglected. Here, we bring together disparate evidence from the field of placebo studies and research on health inequalities related to race and ethnicity, and argue that, collectively, this evidence may provide the basis for an unacknowledged route by which health disparities are exacerbated. This route is constituted by an uneven (...) distribution of placebo effects, resulting from differences in expressions of physician warmth and empathy, as well as support and patient engagement, across racial and ethnic lines. In a discussion of the ethical implications of this connection, we argue that this contribution to health disparities is a source of injustice, consider ways in which these disparities might be ameliorated and suggest that this conclusion is likely to extend to other realms of inequality as well. (shrink)

“Structural racism in the COVID-19 pandemic: moving forward” offers a nuanced and important critique of racial and ethnic health disparities starkly illuminated by COVID-19....

This study explored the perceptions of ethics among long-term care employees (N275) in order to test two hypotheses. A cohort cross-sectional survey examined employees’ perceptions of an ethics environment, racial-ethnic, and position disparities (HO1; ANOVA), and, secondarily, ethics in relationship to select, research-grounded work features measured as manage disagreements, effectiveness, work satisfaction, and opinions of care, the latter including intention to remain (HO2; Pearson Correlations). Established questionnaires with robust psychometrics were employed. Response rate was 51%. Non-significant differences between (...) sample and population on key variables supported extrapolation of results. Statistically significant differences between racial–ethnic (p < 0.03; F 2.42) and work positions (p <0.0001; F 6.24) were revealed on ethics (3.16; HO1). Statistically significant relationships (p <0.0001; r = 0.26–0.68; HO2) between ethics and employees’ work features also were found, confirming both hypotheses. Perceptions of ethics based on racial-ethnic and position disparities, as well as the robust links with employee work features, offered potential avenues for decreasing disparities at work and improving the quality of long-term care. Noted further on ethics item scoring were relatively low scores indicating less involvement in, and access to, ethics discussions and decisions. In contrast, the literature review substantiated the importance of empowerment and retention, which were enhanced by employee involvement in work, notably, discussions and decisions. Thus, implications of ethics committees in long-term care sites as ways to potentially enhance employees’ work and quality of care, especially work satisfaction and retention, were explored; relevant concerns raised by the Covid pandemic were, briefly, discussed. (shrink)

Shortages of life-saving medical resources caused by COVID-19 have prompted hospitals, healthcare systems, and governmentsto develop crisis standards of care, including 'triage protocols' to potentially ration medical supplies during the public health emergency. At the same time, the pandemic has highlighted and exacerbated racial, ethnic, and socioeconomic health disparities that together constitute a form of structural racism. These disparities pose a critical ethical challenge in developing fair triage systems that will maximize lives saved without perpetuating systemic inequities. (...) Here we review alternatives to 'utilitarian' triage, including first-come first-served, egalitarian, and prioritarian systems of allocating scarce medical resources. We assess the comparative advantages and disadvantages of these allocation schemes. Ultimately, we argue that while triage protocols should not exacerbate disparities, they are not an adequate mechanism for redressing systemic health inequities. Entrenched health disparities must be addressed through broader social change. (shrink)

Bioethics, Volume 36, Issue 3, Page 260-266, March 2022.

In the United States, healthcare providers, institutions, and society have failed to ensure the conditions necessary for racial and ethnic minority communities to be in good health. Many scholars and federal government officials consider racial and ethnic disparities in health to be an injustice and have called for national attention and strategies to eliminate them. Several of these strategies, including cultural competency, focus on addressing deficiencies within the health care system. Cultural competency is the ability of a (...) healthcare provider to function effectively in the context of cultural differences with the clients they serve. Increasing cultural competency among healthcare providers has been shown to improve the quality of healthcare received by racial and ethnic minorities, which contributes to reducing health disparities. Achieving equity in the quality of healthcare received is a necessary strategy, but is insufficient for eliminating disparities in the health status of racial and ethnic minority populations. A growing body of literature reveals that health disparities are determined, not only by inequities in health care, but by social factors. The implication is that strategies that focus solely on healthcare perpetuate the misconception that health status is determined by access to or quality of healthcare. To eliminate racial and ethnic disparities in health status, the fundamental conditions for good health, which include but are not limited to healthcare equity, must be acknowledged and ensured for all people. (shrink)

Due to COVID-19’s strain on health systems across the globe, triage protocols determine how to allocate scarce medical resources with the worthy goal of maximising the number of lives saved. However, due to racial biases and long-standing health inequities, the common method of ranking patients based on impersonal numeric representations of their morbidity is associated with disproportionately pronounced racial disparities. In response, policymakers have issued statements of solidarity. However, translating support into responsive COVID-19 policy is rife with (...) complexity. Triage does not easily lend itself to race-based exceptions. Reordering triage queues based on an individual patient’s racial affiliation has been considered but may be divisive and difficult to implement. And while COVID-19 hospital policies may be presented as rigidly focused on saving the most lives, many make exceptions for those deemed worthy by policymakers such as front-line healthcare workers, older physicians, pregnant women and patients with disabilities. These exceptions demonstrate creativity and ingenuity—hallmarks of policymakers’ abilities to flexibly respond to urgent societal concerns—which should also be extended to patients of colour. This paper dismantles common arguments against the confrontation of racial inequity within COVID-19 triage protocols, highlights concerns related to existing proposals and proposes a new paradigm to increase equity when allocating scarce COVID-19 resources. (shrink)

Recent events have highlighted large-scale systemic racial disparities in U.S. criminal justice based on race and other demographic characteristics. Although criminological datasets are used to study and document the extent of such disparities, they often lack key information, including arrestees’ racial identification. As AI technologies are increasingly used by criminal justice agencies to make predictions about outcomes in bail, policing, and other decision-making, a growing literature suggests that the current implementation of these systems may perpetuate (...) class='Hi'>racial inequalities. In this paper, we argue that AI technologies should be investigated to understand how they recognize racial categories and whether they can be harnessed to fill missing race data. By bridging this gap, we can work towards better understanding racial inequalities in a wide range of contexts, most notably criminal justice. Using a multidisciplinary perspective, we rethink the design and methodology used in facial processing technology (FPT) based on supervised deep learning model (DLM) image classification. By modifying standard FPT pipelines to tackle multiple sources of DLM bias, we propose an experimental methodology based on ethical AI principles to generate binary (Black and White) racial categories using mugshots. We go beyond simply reporting DLM accuracies and address fundamental issues such as generalizability and interpretability by using a “self-auditing” approach. First, we evaluate the inference performances of 42 fine-tuned DLMs using unseen test images from the same dataset but subject to varying data augmentations. Next, to interpret and validate our methodological approach, we apply gradient-based saliency maps to assess the consistency of facial region relevance and attribution. Finally, drawing upon insights from three areas (computer science, sociology, and law), we investigate the efficacy of our DLM-based method as a tool for detecting racial inequalities in criminal justice. (shrink)

Purpose The online economy has not resolved the issue of racial bias in its applications. While algorithms are procedures that facilitate automated decision-making, or a sequence of unambiguous instructions, bias is a byproduct of these computations, bringing harm to historically disadvantaged populations. This paper argues that algorithmic biases explicitly and implicitly harm racial groups and lead to forms of discrimination. Relying upon sociological and technical research, the paper offers commentary on the need for more workplace diversity within high-tech (...) industries and public policies that can detect or reduce the likelihood of racial bias in algorithmic design and execution. Design/methodology/approach The paper shares examples in the US where algorithmic biases have been reported and the strategies for explaining and addressing them. Findings The findings of the paper suggest that explicit racial bias in algorithms can be mitigated by existing laws, including those governing housing, employment, and the extension of credit. Implicit, or unconscious, biases are harder to redress without more diverse workplaces and public policies that have an approach to bias detection and mitigation. Research limitations/implications The major implication of this research is that further research needs to be done. Increasing the scholarly research in this area will be a major contribution in understanding how emerging technologies are creating disparate and unfair treatment for certain populations. Practical implications The practical implications of the work point to areas within industries and the government that can tackle the question of algorithmic bias, fairness and accountability, especially African-Americans. Social implications The social implications are that emerging technologies are not devoid of societal influences that constantly define positions of power, values, and norms. Originality/value The paper joins a scarcity of existing research, especially in the area that intersects race and algorithmic development. (shrink)

This article examines how people of color can biologically inherit the deleterious effects of white racism. Drawing primarily on the field of epigenetics, I demonstrate how transgenerational racial disparities are in fact racist disparities that can be manifest physiologically, helping constitute the chemicals, hormones, cells, and fibers of the human body. Epigenetics can be used to demonstrate how white racism can have durable effects on the biological constitution of human beings that are not limited to the specific (...) person who is the target of white racism, but instead extend to that person's offspring. In this way, the field of epigenetics can help philosophers and others understand the transgenerational biological impact of social forces such as white racism. It reveals that the damage done by white racism is more extensive than critical philosophers of race might have realized, and also that interventions against white racism must address not just the economic, geographical, social, and psychological, but also the biological aspects of human existence. In particular, the article examines racist disparities in preterm birth rates and argues that the scope and significance of prenatal care for African American women must be expanded intergenerationally and include wide-scale forms of racial justice. (shrink)

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in (...) both urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny (...) assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

We propose that marketing of unhealthy foods and beverages to Black and Latino consumers results from the intersection of a business model in which profits come primarily from marketing an unhealthy mix of products, standard targeted marketing strategies, and societal forces of structural racism, and contributes to health disparities.

This paper provides an analysis of U.S. farmland owners, operators, and workers by race, ethnicity, and gender. We first review the intersection between racialized and gendered capitalism and farmland ownership and farming in the United States. Then we analyze data from the 2014 Tenure and Ownership Agricultural Land survey, the 2012 Census of Agriculture, and the 2013–2014 National Agricultural Worker Survey to demonstrate that significant nation-wide disparities in farming by race, ethnicity and gender persist in the U.S. In 2012–2014, (...) White people owned 98% and operated 94% of all farmland. They generated 98% of all farm-related income from land ownership and 97% of income from farm owner-operatorship. Meanwhile, People of Color farmers were more likely to be tenants rather than owners, owned less land, and generated less farm-related wealth per person than their White counterparts. Hispanic farmers were also disproportionately farm laborers. In addition to racial and ethnic disparities, there were disparities by gender. About 63% of non-operating landowners, 86% of farm operators, and 87% of tenant farmers were male, and female farmers tended to generate less income per farmer than men. This data provides evidence of ongoing racial, ethnic and gender disparities in agriculture in the United States. We conclude with a call to address the structural drivers of the disparities and with recommendations for better data collection. (shrink)

This essay argues that the concept of ‘racial capitalism’ can help us understand the connections between seemingly disparate parts of Voltaire’s extensive corpus of work. It contends that even though the Enlightenment’s racial politics abounded with contradictions and ambivalences, Voltaire stood out from his contemporaries. While the connections between his polygenism – the theory that humans of different races were created separately – and material investments in colonial commerce have long been debated by radical historians, this essay suggests (...) that Voltaire’s views about race’s relationship to labour were transformed by France’s colonial losses during the Seven Years’ War. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny (...) assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

Medical-legal partnerships (MLPs) have the potential to address racial health disparities by improving the conditions that constitute the social determinants of health. In order to live up to this potential, these partnerships must intentionally incorporate seven core racial justice principles into their design and implementation. Otherwise, they are likely to replicate the systemic barriers that lead to racialized health disparities.

The government recognizes that social factors cause racial inequalities in access to resources and opportunities that result in racial health disparities. However, this recognition fails to acknowledge the root cause of these racial inequalities: structural racism. As a result, racial health disparities persist.