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A Universal Equation for Understanding Racial Health Inequity Reproduction: A Basis for Discussion
By Christopher Williams, Public Health Liberation Founding Director
Public Health Liberation fully accepts the belief of critical race theorists that structural racism flourishes throughout American society. We have developed a universal equation to further understanding of this principle in public health. A core tenet of our philosophy is that the unfulfilled promise of racial justice more than 50 years after the Civil Rights Movement compels us to demand greater attention and resources to accelerate racial health equity. First, reproduction of racial violence must be viewed within a capitalist framework because capitalism is the engine of society. American life revolves around capitalism - the private exchange of goods and services driven by divisions of labor and ownership of the means of production. Where there is market failure, then typically government has had to intercede as with housing and food subsidies. Yet, this does not erode common faith in capitalism as the superior type of economy for organizing society. No alternative such as communism is reasonably feasible in modern society. A critique whether capitalism should maintain this status is beyond the scope of this article. However, we recognize the enduring devastation of its hyper self-interest and moralistic agnosticism. It is disappointing that the historical and contemporary violence against and forced migration of American Indians (e.g. war and resettlement) and African Americans (e.g. slavery and gentrification) has not been centrally situated in the current debate on racial health justice. Equally, forms of liberation such as the Montgomery Bus Boycott and sit-ins that defined the passive resistance of the Civil Rights Movement were lessons in the importance of affecting the material benefit gained from racial discrimination.
Ontological Position: Public Health Realism
This discourse assumes a key ontological position of public health realism. Borrowing from political science, public health realism posits central principles within the public health economy, defined as the broad base of structural determinism to include government, academia, corporations, and social institutions. 1) Human beings and the institutions within which they operate and represent are inherently egoistic and self-serving. Self-interest overcomes moral imperatives that require deep and sustained work to realize racial health equity. 2) The lack of common rule-making and an enforcing authority governing racial health inequity reproduction across economic, political, clinical, and social domains creates conditions for each agent to be responsible for its own survival and to pursue power and resource accrual. The state of health inequity relies on an anarchy among agents within the public health economy. 3) The demands of the moral imperative and public health social contract to meaningfully address the social determinants of health and other structural factors such as racism directly compete with self-interest. Human suffering and vulnerability are often used instrumentally to achieve maximum benefits that flow to that agent or class of agents. 4) The holistic environment that constitutes all sources of racial health reproduction lacks universal values or interests. Self-interests lead to circular reasoning or self-justification. Purported appeals to universal interests and values are aligned with self-interests and the concomitant perceived or actual material benefits. 5) There is no order in the public health economy. Order is anarchy defined by power. This power is fundamentally driven by material goals and is undergirded by fierce competition. Morality arises from self-interest in the public health economy, not the other way around. As a general principle, accelerating racial health equity is not sought if “there’s no money in it.” 6) Dominant powers within the public health economy – these are its principal proponents and benefactors – seek to maintain their power position and hence promote their self-interests through direct or facilitated control of the public health economy. If there is internally - or externally-driven disruption to the public health economy (e.g. calls for redistributive justice and resources), then dominant powers seek to arrange for an efficient return whereby their dominance is preserved. In fact, the aftermath could be more advantageous to dominant powers if they manage to appropriate new resources (e.g. government funding) for applied racial health equity through a power struggle with other dominant and secondary powers. Theirs is a zero sum game because resources are finite and power is paramount. Dominant powers may use universal values such as health equity, but public health realism never assumes that such moral stances subsume self interest in material and power accrual. It neither assumes that reducing racial health inequity is the main goal, even if the rhetoric suggests otherwise.
Formula
Racial health reproduction is the product of a undetermined constant of inherited racism times the quotient of the product of desire for change and material benefit and constraints.
Racial Health Inequity Reproduction Formula (Public Health Liberation)
Assumptions
Inherited and Internalized
1) Because structural racism is common, it can be expressed as a constant. There is no generally agreed-upon definition of structural racism. It is discursive in the same way that racism broadly is discussed. Its metaphysical nature does not lend itself to ready application as with other constants in physics such as Planck's constant or the gravitational constant. However, the fact that structural racism is not a natural phenomenon, rather a social phenomenon, does not make it any less relevant or useful. The constant of racial reproduction can be understood as the racial violence that American society inherited and is unconcerned or unwilling to attenuate. It is internalized and deeply entrenched, even perceived to be irrevocable. Changes to the constant is most disruptive to racial reproduction within the public health economy and garner the most vocal, ardent support among dominant powers. Here, you might think of de facto residential or increasing school segregation, both social determinants of health. We should seek to understand the influence of structural determinism throughout the public health economy. Although the mathematical formulation can heavily rely on scientists, it broadly encompasses a summation of proportional effects.
We encourage public health leaders to convene a national conference to set about the work of defining structural racism as a numerical constant to help advance scientific knowledge. Such an endeavor would require expertise from varying fields of science and community health. It would require that we define an epoch that has a beginning and an end. There appears to be six epochs of racial stratification in the US, at least through the lens of African American experiences: British colonial America, slavery, Reconstruction, Jim Crow, Civil Rights, and Retrenchment (current). Attendees can use the literature to understand racial reproduction within an epoch. The inequity that persists helps to form the constant. This value should be based on conservative estimates. The core tenet of Public Health Liberation philosophy is to accelerate health equity. Once the constancy of the constant is challenged through a dialectic form of social change (change from within) and once it exceeds the confidence intervals, then racial reproduction enters a different epoch. We assume a lower constant over time, but cannot guarantee progression.
Immediate Locus of Control – Desire for Change, Material Benefits, and Constraints
Public Health Liberation seeks the elimination of racial health inequity. Although we do accept public health realism, including the role of self-interest, anarchy, and subsumed mortality, we also recognize the commitment to work tirelessly within our immediate locus of control.
2) Desire for Social Change - All social movements for racial equity begin with the desire for change. The greater the systematic oppression, the longer the latency period before seeds of liberation, agitation, and resistance bear fruit, at least this is the arc of history. In other words, if racial health equity is what we seek, then we must endeavor to change minds not just within the oppressed population (public health liberation theory), but throughout the public health economy. Achieving racial health equity is formed by a praxis that may be perceived as conflict-driven and provocative. That is the point – to disrupt dominant powers’ hold on the public health economy and affect their calculus of self-interest through public accountability. The desire for change is formed through coalition-building, tools of persuasion, and fierce defense of racial health equity. Proponents of social change are not immune from self-interest, except that we call for greater investment in expanding our capacity for self-advocacy (public health liberation theory) and laying the groundwork for social change. Because reproduction occurs across economic, political, academic, and social milieus, it is important for Public Health Liberation practitioners to be more broad base in knowledge and able to push for social change in racial health inequity in multiple arenas.
3) Material benefits - Capitalism forms the bedrock of American society. Racial health inequity reproduction is a consequence of the economic system. To realize health equity, we have to affect the material value of the economic production reliant on maintaining the current system. The unequal distribution of health and economic resources, including funding, are critically evaluated. These are not the forms of oppression that we defined under our constant, but rather those areas within our immediate locus of control. For example, dominant players in the public health economy extract maximal benefit from health equity and disparities public funding, often taking half of the grant funding for expenditures unrelated to direct grant activities. We are aware of cases where a university may take 70% of the total grant award, essentially the cost for the government to do business with that university. The public health research enterprise is self-aggrandizing and self-interested, as public health realism posits for all within the public health economy. However, if we want to see a shift in racial disparities, then we must affect the errant practices that do not reasonably narrow racial health inequity. Greater accountability in funding should also be tied to affecting structural determinants whether a new law, public amenities, or capacity building.
Material benefits also derive from low perception of value. Take food deserts. Even when demand for access to a grocery store is high, communities can struggle with attracting interested grocers. If we regard this as market failure, a very common occurrence, then we must involve government, which can use its powers of imminent domain to put in a grocery store or create incentives to attract a budget- or value-based grocer. Regardless of the context, it is imperative for public health in be centrally positioned within an economic mindset.
4) Constraints – Constraints are the guardrails of the system. It is what prevents racial health inequity reproduction. It can increase (good) or decrease (bad) over time. Our democratic form of government, laws, and judges are major checks on the reproduction of structural racism. However, judging by chronic and persistent racial health inequity, there are not sufficient constraints in place. It is not just what many political scientists judge to be democratic decline in the US, but the overall ability of society to make the public health economy accountable for yawning chasms in racial health equity. Constraints are shaped not only by legal and judicial action, but social norms and perceptions.