Infectious Fear

Saturday, March 9, 2019

Through much of American history, African American intellectualism was pushed out of the medical system even as it produced new medical and scientific knowledge.

As a result, the health practices they developed were often “formulated outside the technologized and institutionalized system that is medicine,” according to Dr. Samuel Kelton Roberts Jr., a historian and author of Infectious Fear: Politics, Disease, and the Health Effects of Segregation.

On February 26, Roberts discussed his findings with students from several UCSF schools as part of the UCSF Faces Race Campaign, which seeks to discuss the effects of white supremacy and the history of race in America.

Roberts’s book traces the history of early public health efforts in this nation through the lens of tuberculosis and geography, giving special focus to how African American populations as well as other populations of color have struggled to break into a health system that tends to first respond to the issues of the majority white population.

Acknowledging that he trained at an Princeton, an institution that has a public health department but no medical school, he referred to himself not as a historian of medicine but as one of health.

While drawing from this history of American health practices, Roberts found himself fascinated by the HIV/AIDS epidemic. He wondered when the last time a disease so informed by race, politics, and stigma had arisen, and he found the answer in tuberculosis. Just as HIV was first conceptualized as a disease of risk and then understood as a disease of structural poverty, so too was TB.

Those considered outgroups through history carried the burden of disease, and cures were developed only once the majority groups began to suffer.

TB was a great research subject because it provided Roberts with the opportunity to explore how capitalism and race intersect to influence healthcare.

“Labor history and politics elaborate themselves as contradictions, in which race emerges as a very convenient way to resolve it,” Roberts said.

In other words, inequalities in housing, access to resources, and geography produce health outcome inequalities that are then justified along racial lines.

Inequalities led to higher rates of people of color or those in poverty suffering from diseases like TB or HIV, but the American system decided the etiology must be the race of those suffering rather than their conditions of life.

Corinne Conn, a first year medical student, asked Roberts about specific moments in American history where a more equitable outcome for African American health could have been made.

Roberts called this the “Terminator question.” How would you change something in the past to make your present better?

He said one of the biggest post-WWII Terminator events has been the establishment of mass incarceration.

Given that so many are imprisoned for economic reasons, he’s dubious that race can explain the existence of mass incarceration.

Instead of doing “real investigation into the question of mass incarceration,” he said, “we have done the hard work of convincing the U.S. population that this exorbitant rise in incarceration is because people deserve it.”

The opioid epidemic is the newest Terminator question and area where race, capitalism, and health intersect. Roberts has shifted his research to the postwar heroin epidemic and how changes in policy and racial politics since the mid-1960s have affected our current situation.