Child receives the polio vaccine in Salvador, Brazil (Joa Souza / Shutterstock, Inc.)

Race, Genetics, and Health in a Global Context

February 2, 2017

Studies of human genetic variation have long discounted the existence of biological human races. In fact, evolutionary biologists and geneticists have found that the variations in human groups are less than what is typically seen in most other mammals. Humans do not subdivide into biological races; we are all one species. However, concepts and constructs of race still permeate biomedical research, healthcare, and health policy around the world.

This often-fraught intersection of race and genetics was examined at a recent lecture led by Charmaine Royal (Associate Professor of African & African American Studies at Duke University, faculty affiliate in Duke Global Health Institute and Duke Initiative for Science and Society, and director of the Duke Center on Genomics, Race, Identity, and Difference). Presented by the Penn Program on Race, Science, and Society and sponsored by the Fels Research Policy Initiative, Royal’s presentation highlighted similarities and differences in global perceptions and applications of race by exploring how census data on race is gathered in the United States, South Africa, and Brazil. Discussion centered on ideas for advancing the discourse on race in biomedicine and best practices related to these issues.

The history of the US Census offers an interesting snapshot of how perceptions of race have changed over time. Race first appeared on the census in 1790 with only three categories:  “Slaves”, “Free White Females and Males” and “All Other Free Persons.” The categories included on the census have expanded since then and are still evolving. Even today, the Census Bureau is considering changes in the wording and categories that will appear on the 2020 census.

In South Africa, the policy of racial segregation known as apartheid was enforced through 1994. The Population Registration Act of 1950 formed the basis for racial classification during apartheid and split the population into either white, black, Indians or “coloured” (meaning mixed-race). The same categories still appear on South African census forms, with the only change being the addition of an “other” option. Research has shown parallels in perceptions of discrimination and health outcomes between black individuals in the US and South Africa. In both countries non-dominant racial groups have worse health than the dominant racial group, demonstrating a link between the way people experience discrimination and health outcomes.

As a result of the millions of Africans brought to Brazil as slaves between the 16th and 19th centuries, Brazil has one of the highest black populations of any country in the world, second only to Nigeria. The Brazilian census is driven mainly by color. The 2010 census included five categories: indigenous, yellow, white, pardo (or brown), and preto, or dark-skinned. Royal commented that a myth of “racial democracy” exists in Brazil, which suggests that the country’s diversity has led to a race-blind society. However, this post-racial narrative has caused the social and health disparities that exist between specific racial groups to be ignored. Black and brown Brazilians are less likely to receive prenatal care, more likely to die in childbirth, and have a shorter life expectancy when compared to white Brazilians. In spite of this, a 2014 study found that most Brazilians made no connection between race and health. Those who did perceive inequalities mostly believed that white Brazilians had more health problems than black or brown Brazilians. Royal suggested the ingrained perception of black people as being inherently stronger, tougher and less susceptible to pain than white people as a possible explanation for this misapprehension.

Ultimately, Royal concluded that we need to continue to have global conversations about the intersection of race and medicine. As the head of the Duke Center on Genomics, Race, Identity, and Difference, Royal’s own ongoing research seeks to better understand and address ethical, social, and biological dimensions of race in humans. Her recent study published the New England Journal of Medicine, “Will Precision Medicine Move Us beyond Race?” touches on the themes covered in this lecture.

Contact Information

Fels Institute of Government
University of Pennsylvania
3814 Walnut Street
Philadelphia, PA 19104

Phone: (215) 898-2600
Fax: (215) 746-2829

felsinstitute@sas.upenn.edu