Mixed Race Studies

In First for Sitting President, Obama Publishes a Scholarly Article

Fortune
2016-07-11

Jeff John Roberts

Call him scholar-in-chief

An author named “Barack Obama, JD” published an article on Monday in a scholarly journal. No prizes for guessing the topic: It’s an assessment of the Affordable Care Act as well as policy recommendations for the next president to improve the U.S. health care system.

The article, titled “United States Health Care Reform: Progress to Date and Next Steps,” was published by the Journal of the American Medical Association.

The piece, which contains 68 footnotes to academic journals and government publications, claims to present evidence showing that the number of Americans without health insurance has dropped dramatically, and resulted in lower hospital readmission rates. Obama also used the article to recommend the introduction of a “public option” plan in parts of the U.S. and for the federal government to push down drug prices…

Read the entire article here.

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.

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A Color Problem in England

The Journal of the American Medical Association
Volume 95, Number 3 (1930-07-19)
Foreign Letters: London Letter
pages 210-211
DOI: 10.1001/jama.1930.02720030040020

From Our Regular Correspondent (1930-06-21)

There is no color line in England such as exists in America. This does not mean that the English do not appreciate differences of race. They are keen on such differences, even between European races, and often contrast the Latin races with themselves. They are by no means without race prejudices but at the same time they have a strong tendency to take a man for what he is, regardless of race or of color. His color may arouse prejudice but this may be overcome when he is known. This absence of a color line has given rise to a color problem. The great seaport of Liverpool is frequented by seamen of many races, including Chinese and many Negroes from West Africa. The cohabitation of these races with the women of the city has given rise to a half-caste population. The number of Anglo-Negroid families is about 450 and the children born of this union amount to about 1,350. On the other hand, the Anglo-Chinese children do not provide any particular problem. The Anglo-Chinese child is declared to be mentally equal if not superior to the white, and since coloring and features are far less distinctive than those of the Anglo-Negroids they are not such a handicap. Further, the family life appears to be stable, the man remaining faithful to one woman though not married to her. The Anglo-Negroid family is far different. A Liverpool association for the welfare of half-caste children has been formed. The chairman, Prof. P. M. Roxby, says that the conditions under which colored seamen from West Africa enter Liverpool are a social menace and detrimental to the best interests of blacks and whites alike.

Miss Muriel E. Fletcher has for nearly two years been occupied with an inquiry for the association into the condition of half-caste children in Liverpool, where they are more numerous than in any other port. Of the Anglo-Negroid unions she says there is little harmony between the parents; the colored man generally despises the woman with whom he consorts, while the majority of the women have little affection for the men. They regret their union but stay for the sake of the children. The mothers are generally good to the children while they are small but later resent the fact that the children cannot get work and grudge having to keep them. The children find their lives full of conflict, and all the circumstances give undue prominence to sex. These families have a low standard of life morally and economically, and there appears to be little future for the children. They attend school in the poor districts and do not show any inferiority of health or proneness to infections compared with white children. The balance of evidence is that their intelligence is below the average. Their relations with the white children are friendly but they begin to feel outcast when they leave school and this feeling develops rapidly. There is no evidence that they have any special delinquent tendencies, but all their circumstances give undue prominence to sex. Owing to their unemployment, fondness of dress and finery, and the persistence of men, it is practically impossible for them to remain chaste, even if they desire to do so. As employers are unwilling to engage colored labor, the association has tried training schemes for colored girls but with limited success. It is thought that a larger and more intensive scheme might have greater success. It has been suggested that the obvious solution of the difficulty is to replace colored firemen by white on all British ships coming to this country, but the shipowners say that white men could not work in the heat of the stokeholds on the West Coast of Africa. However, the National Union of Seamen denies this. Other suggestions are the signing on of men in Africa so that they would be obliged to take the round trip and receive no pay in this country, and greater discrimination in the issue of British passports.

Measuring Race and Ethnicity: Why and How?

The Journal of the American Medical Association
Volume 292, Number 13 (2004)
pages 1612-1614
DOI: 10.1001/jama.292.13.1612

Margaret A. Winker, MD, Deputy Editor and Online Editor
Journal of the American Medical Association

Race and enthnicity are constantly evolving concepts, deceptively easy to measure and used ubiquitously in the biomedical literature, yet slippery to pinpoint as definitive individual characteristics. A current dictionary definition of race is “a family, tribe, people, or nation belonging to the same common stock, or a class or kind of people unified by shared interests, habits, or characteristics.” For 154 years, the US government has defined race for its census takers, and for many years census takers then defined it for US residents. The terms used reflect the nation’s changing demographics and increasing recognition of human diversity. The 1850 enumerators used a form that assumed a default race of white, with a checkmark indicating nonwhites as black or mulatto, with additional indications for free or slave. Indian was added as a category in 1860. Since 1960, individuals have been able to specify their own race and ethnicity, and by 2000 the census enumerated 126 racial and ethnic categories.

Medical definitions of race have lagged behind, although thankfully the former Medical Subject Headings (MeSH) terms such as Caucasoid, Mongoloid, Negroid, and Australoid rarely appear in biomedical literature. Given that the connotations and definitions of race and ethnicity are constantly evolving, the use of the terms and concepts of race and ethnicity in the biomedical literature deserves examination…

…The use of race as a proxy for unmeasured confounders, such as cultural, social, and environmental influences, is commonplace, but race is a poor proxy for these measures. The life experience and cultural milieu of US immigrants may be completely different from those who grew up in the United States, despite being assigned to similar racial or ethnic categories. Socioeconomic status, not race, is likely the greater determinant of health and health-related qualities. Therefore, race is not a substitute for carefully assessed social and cultural characteristics.

On the other hand, race can be an important indicator of health disparities and health care delivery. An American College of Physicians position paper attests to “…ample evidence illustrating that minorities do not always receive the same quality of health care, do not have the same access to health care, are less represented in the health professions, and have poorer overall health status than nonminorities.” While race is just a departure point when evaluating such disparities, the article by Bradley et al in this issue of JAMA illustrates how race can be used along with specifically defined characteristics to begin to explore some of the reasons behind health disparities. In this retrospective, observational study of inpatients from the US-based National Registry of Myocardial Infarction, who were hospitalized during 1999 through 2002 with ST-segment elevation or myocardial infarction or left bundle-branch block and receiving acute reperfusion therapy, Bradley et al assessed time from hospital arrival to acute reperfusion therapy. As previous studies have shown, nonwhites had longer times from hospital entry to reperfusion therapy, as much as 7.3 minutes longer for blacks receiving thrombolytic therapy and 18.9 minutes longer for blacks receiving percutaneous transluminal coronary angioplasty…

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The Negro as a Health Problem

The Journal of the American Medical Association
Volume 55, Number 15 (1910-10-08)
pages 1246-1247
DOI: 10.1001/jama.1910.04330150006002

H. M. Folkes, M.D.
Biloxi, Mississippi

In the South, regardless of hair-splitting dictionary or legal definitions, it is customary to regard as negro any person who is known to have any negro blood in his veins; this despite the fact that the Supreme Court of Louisiana has lately handed down a decision restricting the term “negro” to those having a greater proportion of negro blood than would occur in an octoroon. This decision, however much it may be law, has not been the custom.

It may not be commonly known in the North that prior to the war it was the custom in the South among the better class of slave owners to give the very best care and attention to the slaves—to the house-servants as well as every other class of laborer generally. Of course, while due credit must be given to the humane motive at the bottom of this, it must be acknowledged that the economic consideration was also largely influential, as each negro, old, or young, possessed considerable cash value. Hence it was decidedly to the interest of the property owner to take care of his investment.

The natural result of this was a higher standard of physical health among negro children than has ever been attained since the emancipation, for among other unfortunate sequelæ folloing this perfectly righteous step was the handing over of the lives and care of negro progeny to their more or less fatalistic parens, who, removed from the control of intelligent direction, soon lapsed into their African condition of irresponsibility. The unfortunate creatures (as the negro race has done in all history) then reverted, in a  large measure, to aboriginal conditions.

The negro, due to his heredity and environment, is essentially a fatalist, and when moved at all it is by his emotions, and not by judgement….

…Mulattoes, octoroons and quadroons are much more susceptible to the ravages of syphilis and gonorrhea than are their more deeply tinted brethren.  Negroes of all shades are extremely susceptible to tuberculosis, and also to measles.  In my experience extending over a period of nearly twenty years, I do not recall having seen a case of scarlet fever, diphtheria, mumps or tonsillitis in black negroes, and since beginning this paper I have made inquiries of all the physicians with whom I have come in contact and have received practically the same answer as to the immunity of the pure-blooded negro from these diseases.

Mulattoes, quadroons, and octoroons are decidedly more susceptible to scarlet fever, diphtheria, mumps and tonsillitis, but with rather large experience among the different shades of negro people, I can recall at this moment but very few instances of these diseases among them.

It might not be out of place at this point to call attention to the fact that mulattoes, quadroons, and octoroons, as they are at present in the South, are mostly descendedants of their own type of people, and not the result of crossing of white and black bloods; in other words, mulatto man and woman have progeny mulattoes; quadroons present the same as themselves, as also do octoroons.  There is, however, a marked tendency toward a decrease in the number of children born to these light-colored negroes and the nearer they approach to pure white blood the fewer children they have, as a rule…

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The Morbid Proclivities and Retrogressive Tendencies in the Offspring of Mulattoes

The Journal of the American Medical Association
Volume 20, Number 1 (1893-01-07)
pages 1-2
DOI: 10.1001/jama.1893.02420280009001

W. A. Dixon, M.D.

Read in the Section of Diseases of Children, at the Forty-third Annual Meeting of the American Medical Association, held at Detroit, Mich., June 7, 1892.

Observations extending over a period of more than thirty years have thoroughly impressed the conviction upon my mind that the offspring of mulattoes are the subjects of constitutional diseases to a greater degree than are those of unmixed blood, and that when confined strictly to their own class, they scarcely reach the fourth generation in descent, by reason of disease and sterility.

I have often wondered if others have had occasion to notice this feature in mulatto life, or whether the conclusions at which I have arrived are false and unwarranted from being based upon observations confined to a local district, yet rich in examples that go far to establish the view propounded. I believe that there is not much to be found in current medical writings upon the subject. Our locality is on the border between the free and the slave States of fifty years ago and more. It…

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