Invited Commentary: “Race,” Racism, and the Practice of Epidemiology

Extract

Imagine that you are an epidemiologist investigating the health status of the city Metropolis. You document that the east side of the city has twice the prevalence of disease X as the west side of the city. You become interested in the determinants of disease X. How will you proceed?

Most readers would agree that option 1 is the preferable response to the findings in Metropolis. That is because option 1 treats the large east-west difference as an important clue to understanding the etiology of disease X, and it attempts to vigorously explore the basis of that difference. Option 2, on the other hand, merely treats the east-west difference as a confounder in understanding other determinants of disease X. Under option 2, the basis of the large east-west difference goes unexamined and therefore is likely to remain unknown.

So consider now how we as epidemiologists typically deal with differences in health status observed by “race.” Race-associated differences in health outcomes are routinely documented in this country (1–4), yet for the most part their basis remains poorly explained. Instead of vigorously investigating the basis of these differences, we tend to simply adjust for race in our analyses or restrict our studies to a single “racial” group (5).