Abstract
Much of the literature on the nature and limits of using race as a scientific variable in medicine focuses primarily on United States (US) racial categories. This focus on the US is seemingly justified by ‘contextualism’ - the assumption that we must limit discussion of race and its deployment to a specific national context because “there is no transnationally valid ontology of race” (Ludwig, 2019), race does not travel across geographic or national contexts. Thus, American scholars are justified in restricting their arguments to a US ontology of race, and scholars in Brazil, the United Kingdom, India, and South Africa ought to similarly restrict their arguments (ibid.). We draw on two case studies of race-based correction in health measurement to illuminate the ways in which there are global continuities and discontinuities with the ways in which race enters into medicine. We argue that although the explanations for racial difference and their underlying racial ontologies differ across national contexts, nevertheless, a tension exists because the correction factor itself is made to travel across these contexts. This has the potential to pose unique ethical and political challenges. The first case study we draw upon is that of the history of how spirometric measurement became racialised in South Africa (SA). The spirometer is a test that doctors use to measure lung capacity for the diagnosis and treatment of respiratory disease. The spirometer is controversial because a ‘race correction’ factor is directly programmed into many commercially-available spirometers. In the US, spirometers either ‘correct’ the lung capacity of individual patients labelled ‘Black’ by 10-15%, for example, or use population-specific norms (Braun, 2015). First, 3 during Apartheid, South African researchers used American data in an effort to bolster their database of purported innate racial differences in lung function between white and Black South Africans. Second, historically, South African clinicians adopted US standards of race correction in their spirometers. Despite alternative explanations of racial difference in lung function, and a more biosocial conception of race in SA, clinicians and researchers relied on American standards of correction. The second case study we draw upon is that of Body Mass Index (BMI) thresholds. The ‘Y-Y paradox’ was proposed by two endocrinologists who juxtaposed their own (identical) BMIs with their differing levels of body fat (9.1% for the British researcher compared with 21.2% for the Indian researcher). This ‘paradox’ has been expanded on, forming the broader notion of the ‘thin-fat Indian’: a body which is thin morphologically but metabolically “obese”. This has led to changes in public health policy (notably, a lowering of the BMI threshold for clinical surveillance or intervention) both for the Indian population and for South Asian diaspora in places such as the United Kingdom (UK). Although the explanations for differing rates of metabolic illness frequently differ between India and the UK, the racial or ethnic groups that are taken to be the target of intervention differ, and, plausibly, the underlying racial ontologies differ, the lowered BMI threshold continues to be in place in these disparate settings.
