Mixed Race Studies

United States Health Care Reform: Progress to Date and Next Steps

The Journal of the American Medical Association
Published online 2016-07-11
DOI: 10.1001/jama.2016.9797

Barack Obama, JD
President of the United States, Washington, DC

Importance The Affordable Care Act is the most important health care legislation enacted in the United States since the creation of Medicare and Medicaid in 1965. The law implemented comprehensive reforms designed to improve the accessibility, affordability, and quality of health care.

Objectives To review the factors influencing the decision to pursue health reform, summarize evidence on the effects of the law to date, recommend actions that could improve the health care system, and identify general lessons for public policy from the Affordable Care Act.

Evidence Analysis of publicly available data, data obtained from government agencies, and published research findings. The period examined extends from 1963 to early 2016.

Findings The Affordable Care Act has made significant progress toward solving long-standing challenges facing the US health care system related to access, affordability, and quality of care. Since the Affordable Care Act became law, the uninsured rate has declined by 43%, from 16.0% in 2010 to 9.1% in 2015, primarily because of the law’s reforms. Research has documented accompanying improvements in access to care (for example, an estimated reduction in the share of nonelderly adults unable to afford care of 5.5 percentage points), financial security (for example, an estimated reduction in debts sent to collection of $600-$1000 per person gaining Medicaid coverage), and health (for example, an estimated reduction in the share of nonelderly adults reporting fair or poor health of 3.4 percentage points). The law has also begun the process of transforming health care payment systems, with an estimated 30% of traditional Medicare payments now flowing through alternative payment models like bundled payments or accountable care organizations. These and related reforms have contributed to a sustained period of slow growth in per-enrollee health care spending and improvements in health care quality. Despite this progress, major opportunities to improve the health care system remain.

Conclusions and Relevance Policy makers should build on progress made by the Affordable Care Act by continuing to implement the Health Insurance Marketplaces and delivery system reform, increasing federal financial assistance for Marketplace enrollees, introducing a public plan option in areas lacking individual market competition, and taking actions to reduce prescription drug costs. Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges.

Read the entire article here.

Q&A with ‘Indian Blood’ author Andrew J. Jolivette

University of Washington Press Blog
2016-06-24

In his new book Indian Blood: HIV & Colonial Trauma in San Francisco’s Two-Spirit Community, Andrew J. Jolivette examines the correlation between mixed-race identity and HIV/AIDS among Native American gay men and transgendered people, and provides an analysis of the emerging and often contested LGBTQ “two-spirit” identification as it relates to public health and mixed-race identity.

Prior to contact with European settlers, most Native American tribes held their two-spirit members in high esteem, even considering them spiritually advanced. However, after contact—and religious conversion—attitudes changed and social and cultural support networks were ruptured. This discrimination led to a breakdown in traditional values, beliefs, and practices, which in turn pushed many two-spirit members to participate in high-risk behaviors. The result is a disproportionate number of two-spirit members who currently test positive for HIV.

Using surveys, focus groups, and community discussions to examine the experiences of HIV-positive members of San Francisco’s two-spirit community, Indian Blood provides an innovative approach to understanding how colonization continues to affect American Indian communities and opens a series of crucial dialogues in the fields of Native American studies, public health, queer studies, and critical mixed-race studies.

We spoke with Jolivette about his book, published this spring.

What inspired you to get into your field?

Andrew J. Jolivette: American Indian studies is in my blood. I felt I had a commitment and a responsibility to give back to my community and I also felt that it was important that more Native perspectives be centered and not just represented or driven by outsiders…

Read the entire interview here.

Dangerous Ideas

The Pennsylvania Gazette
2016-06-20

Melissa Jacobs

Photo by Chris Crisman C’03

PIK Professor Dorothy Roberts exposes how the myth of biologically distinct races—forged in the era of slavery—continues to poison the present, affecting attitudes and policies on everything from child welfare to medical treatment.

There’s not much humor to be found around the subjects Dorothy Roberts deals with, but the Saturday Night Live parody, “The Day Beyoncé Turned Black,” was both bitingly funny and practically tailor-made for analysis by the lawyer, scholar, and social-justice advocate who serves as the University’s 14th Penn Integrates Knowledge Professor.

Roberts referenced the sketch at the beginning of a talk titled “What’s So Dangerous About Black Women’s Sexuality?” that she gave on February 17. That was shortly after Beyoncé’s release of her music video, “Formation,” and live performance of the song at the Super Bowl halftime show—“backed up by an entourage of black women sporting Black Panther Party Afros and berets,” Roberts said, and lyrically “saluting the Black Lives Matter movement, protesting against police brutality, and celebrating black culture and black beauty, including her ‘Negro nose with Jackson Five nostrils’ and her daughter Blue Ivy’s baby hair and Afro.”

For the most part, “black people were really proud and happy that Beyoncé was as militant as she was,” Roberts added. “White America, on the other hand, reacted—at least much of it reacted—quite differently.”

Which the folks at SNL took and ran with.

Formatted like a movie trailer, “The Day Beyoncé Turned Black” skewered whites’ assumptions around cultural ownership (“Maybe this song isn’t for us.” “But usually everything is!”), arrogance in assigning racial categories (a familiar co-worker isn’t black black; but a youth outfitted in a gold Africa pendant and camouflage jacket obviously is), and fears of racial contamination (in a white mother’s mounting horror as she imagines her tween daughter has “turned black,” too, from listening to Beyoncé’s music.)

But Roberts homed in on another revealing exchange: “To me the most telling, truthful moment in this skit is two white guys cowering under a desk, when they realize that not only Beyoncé but other female celebrities who become popular with white people—like Kerry Washington, the star of ABC’s very popular Scandal—are also black. And one man says, ‘How can they be black? They’re women.’ And the other shrieks, ‘I think they might be both!’…

…“My parents had a strong sense that all human beings are equal and can live harmoniously and peacefully together,” Roberts says. “They were not so much civil rights advocates as human rights advocates. My very early childhood was deliberately focused on human equality.”

As a kindergartner, Roberts recalls, she embraced her parents’ philosophy. “I remember being proud that I had parents of different races and that was an important part of my identity. But by the time I was in seventh grade, I identified as black and was much more interested in liberation for black people than in interracial relationships,” she says. “Until extremely recently, I really diminished the fact that my parents were black and white. Most people think of me as black. I don’t identify as biracial or mixed race.”…

Read the entire article in PDF or HTML format.

Race and Medicine in America (AMST 256 – 01)

Wesleyan University, Middletown, Connecticut
Fall 2016

Megan H. Glick, Assistant Professor of American Studies

This course will trace ideas of race in American medical science and its cultural contexts, from the late 19th century to the present. We will explore how configurations of racial difference have changed over time and how medical knowledge about the body has both influenced, and helped to shape, social, political, and popular cultural forces. We will interrogate the idea of medical knowledge as a “naturalizing” discourse that produces racial classifications as essential, and biologically based.

We will treat medical sources as primary documents, imagining them as but one interpretation of the meaning of racial difference, alongside alternate sources that will include political tracts, advertisements, photographs, newspaper articles, and so on.

Key concepts explored will include slavery’s medical legacy, theories of racial hierarchy and evolution, the eugenics movement, “race-specific” medications and diseases, public health politics and movements, genetics and modern “roots” projects, immigration and new technologies of identification, and intersections of race and disability.

For more information, click here.

Will Precision Medicine Move Us beyond Race?

The New England Journal of Medicine
2016-05-26 (Volume 374, Number 21)
DOI: 10.1056/NEJMp1511294

Vence L. Bonham, J.D., Senior Advisor to the NHGRI Director on Genomics and Health Disparities
National Human Genome Research Institute, Bethesda, Maryland

Shawneequa L. Callier, J.D., Professorial Lecturer in Law
Georgetown University, Washington, D.C.

Charmaine D. Royal, Ph.D., Associate Professor of African and African American Studies and Genome Sciences
Duke University, Durham, North Carolina

Although self-identified race may correlate with geographical ancestry, it does not predict an individual patient’s genotype or drug response. Precision medicine may eventually replace the use of race in treatment decisions, but several hurdles will have to be overcome.

Read or purchase the article here.

A DNA Test Won’t Explain Elizabeth Warren’s Ancestry

Slate
2016-06-29

Matt Miller

You’re not 28 percent Finnish, either.

Our genes dictate certain things about us, but ethnicity is not derived from a single gene.

Scott Brown, the former Massachusetts senator who lost to Elizabeth Warren in the 2012 election, has decided to dredge up old accusations that may have ultimately cost him that race.

“As you know, she’s not Native American,” Brown told reporters this week. “She’s not 1/32 Cherokee.” He then called on Harvard University, where Warren was a law professor, to release records that allegedly indicate Warren benefited from affirmative action (there’s no reason to believe this is true), before suggesting that “she can take a DNA test” if she wants to prove her roots.

But here’s the thing: DNA testing cannot definitively prove whether a person is Cherokee. Or a member of any community, at least not reliably. To assume it can is to assume that there’s something inherently different in the genetic makeup of tribal members and that this thing is universal within that community. That’s not true.

Our genes dictate certain things about us—there’s a gene that programs the color of your eyes, for example. But ethnicity is not a trait derived from a single gene, because ethnicity is mostly our perception of a collection of traits, rather than a trait itself. So a genetic test that looks at our genes and comes back with an assessment of our ethnic roots isn’t honing in on a specific gene and reading what it says because there’s no such gene to read. Instead, the test is comparing snippets of our DNA to snippets of DNA of people of known origin and looking for similarities…

Read the entire article here.

Future Humans Will All Look Brazilian, Researcher Says

Business Insider
2012-09-19

Natalie Wolchover

It really happened: Six generations of inbreeding spanning the years 1800 to 1960 caused an isolated population of humans living in the hills of Kentucky to become blue-skinned.

The startlingly blue people, all descendants of a French immigrant named Martin Fugate and still living near his original settlement on the banks of Troublesome Creek when hematologists studied them in the 1960s, turned out to have a rare blood condition called methemoglobinemia. A recessive gene was pairing with itself to change the molecular composition of their blood, making it brown as opposed to red, which tinted their skin blue.

The hematologists’ attempt to trace the history of the mutant gene revealed a gnarly Fugate family tree, contorted by many an intermarriage between first cousins, aunts and nephews, and the like over the generations. Dennis Stacy, whose great-great-grandfather on both his mother’s and father’s sides was the same person – Henley Fugate – offered a simple explanation for the rampant interbreeding: In the old days in eastern Kentucky, Stacy said, “There was no roads.”…

Read the entire article here.

Beauty and the Bleach: This Issue is More than Skin Deep

Ebony
2016-06-20

Yaba Blay, Dan Blue Endowed Chair in Political Science
North Carolina Central University

Skin bleaching is a billion-dollar industry. Considering its global reach, Dr. Yaba Blay says we have to stop treating bleaching as just a matter of self-hate.

Over the past few years, social media has been abuzz with discussions of skin bleaching. In recent weeks, we’ve lamented Lil Kim’s ghostly shadow of her former self, ridiculed Ghanaian boxer Bukom Banku for denouncing his black skin, and dragged Azaelia Banks for becoming a virtual spokesmodel for Whitenicious by Dencia. While we talk amongst ourselves, a segment of a 2012 video investigating “unusual beauty trends” in Jamaica has resurfaced on Facebook. Viewed over two million times in less than one week, in that segment we see a soft-spoken blonde-haired European reporter “in the trenches” as she talks to a number of Jamaicans about their bleaching and offers requisite warnings about the dangers of the practice.

Whether from the perspectives of Black folks or from those of Whites, our communal voyeurism into skin bleaching tends to focus almost solely on the individuals who bleach their skin, and not the global institutions that make skin bleaching a viable option. And it’s a problem…

Read the entire article here.

Another Health Funder That’s Focused on Race in a Big Way

Inside Philanthropy
2016-06-16

Rob McCarthy

The racial dimension of health equity has long preoccupied top funders in the healthcare space and it’s not hard to see why. Spend five minutes looking at health data for the United States and you’ll be blown away by the scope of racial disparities in all aspects of health, including how long people live, the chronic conditions they face and whether they have health insurance.

In turn, it’s not hard to trace these inequities back to larger social and economic disparities by race, not to mention gross inequities in who has power in American society. As we report often, national health funders like RWJF and Kresge operate very much with this larger context in mind, and aren’t afraid of getting into some edgy advocacy work.

Lately, more state-level health care funders have been getting with the same program—and, in some cases, taking things even further. Just the other day, we wrote about how the Missouri Foundation for Health is making a $6 million push to address racial equity issues raised in the wake of the police shooting in Ferguson. We’ve also written about the huge investments by California funders to improve the health, and broader well-being, of that state’s Latino population.

Then there’s the Connecticut Health Foundation, which made a shift in 2013 to focus its grantmaking laser-like on the non-white residents of this New England state…

Read the entire article here.

The Myth of Race: The Troubling and Persistence of an Unscientific Idea by Robert Wald Sussman (review)

Journal of Social History
Volume 49, Number 3, Spring 2016
pages 740-741

Robert J. Cottrol, Harold Paul Green Research Professor of Law and Professor of History and Sociology
George Washington University

The Myth of Race: The Troubling and Persistence of an Unscientific Idea. By Robert Wald Sussman (Cambridge: Harvard University Press, 2014. 374 pp. $35.00).

With The Myth of Race, Robert Sussman gives us a comprehensive history of the idea of race and particularly the rise and not total fall of scientific racism Drawing on the intellectual history of his own discipline, physical anthropology, Sussman takes the reader on a journey from the role of race in the religious persecutions of the fifteenth century Spanish inquisition to an examination of the development of the eugenics movement, that movement’s link to Nazi ideology and practice, and the role of Franz Boaz and his disciples in combating scientific racism and establishing the dominance of culturally based explanations for racial and ethnic differences. The Myth of Race takes us to our uneasy present. The scientific racists of the nineteenth and early twentieth centuries have been vanquished in the minds of the scientific communities and educated public more generally, but there are still holdouts, in some places influential holdouts, asserting the validity of earlier views positing that racial differences are real, inherited and largely immutable.

The introduction provides something of a primer on race from the point of view of physical anthropology for the uninitiated. From the biological perspective, Sussman informs us, even using the term race to discuss the variations in the human species is suspect. But Sussman’s purpose is not to provide a thumbnail sketch of the biology of race, but to explore race as an intellectual construct along with a history of its uses and misuses. Race’s development as a concept was prompted by large scale European contact with new and different peoples in Africa and the Americas, a by-product of European expansion. The Church, however imperfectly, stressed the unity of humanity, the product of a single act of creation. But others, repelled by difference, or attracted by the possibility that those who were different and more vulnerable could be readily exploited, fashioned explanations to both account for differences and to insure the dominance of Europeans. Some theories accounted for difference by attributing human variation to separate creations with Africans and the indigenous populations of the Western Hemisphere being something other and something less than children of the Biblical Adam and Eve. Others were willing to stipulate to the unity of human origins, but nonetheless asserted that those strange people who were not white, not European and not Christian were the products of a degeneration that also highlighted their inferiority and the need for them to be brought under the control of their betters. Sussman is particularly strong in presenting this history and in reminding readers that moral and political philosophers like Locke and Kant more generally thought of as advocates of political liberty and just governance played a significant role in implanting notions of racial hierarchy in European thought.

But it is in his discussion of the origins and career of eugenics as a concept where Sussman makes his strongest contribution. Sussman links the origins of eugenics to concepts of scarcity and need first articulated by Malthus. These concepts when coupled with the extension of Darwinian thought beyond basic biology would provide a basis for a school of human science that reached its logical conclusions with Nazi racial science. The Myth of Race provides a chilling look at the popularity and power of the American eugenics movement. Sussman’s discussion of the influence that American eugenicist Madison Grant’s Passing of the Great Race had on Nazi racial policies is particularly instructive.

We all, to some extent, know how the story comes out, at least to date. In the inter-war years, anthropologist Franz Boaz through his meticulous research and the influence of his disciples helped defeat the scientific racists who dominated the debate before the First World War. Boaz’s research played a pivotal role in persuading educated people that culture and not biology accounted for group differences. The horrors of the Nazi holocaust played a significant role in discrediting scientific and not so scientific racism among the public at large after the Second World War…