In development…
“The idea that people labeled “white” have innately higher lung capacity than other races must be considered with deep skepticism.”
Books
In the antebellum South, plantation physicians used a new medical device—the spirometer—to show that lung volume and therefore vital capacity were supposedly less in black slaves than in white citizens. At the end of the Civil War, a large study of racial difference employing the spirometer appeared to confirm the finding, which was then applied to argue that slaves were unfit for freedom. What is astonishing is that this example of racial thinking is anything but a historical relic.
In Breathing Race into the Machine, science studies scholar Lundy Braun traces the little-known history of the spirometer to reveal the social and scientific processes by which medical instruments have worked to naturalize racial and ethnic differences, from Victorian Britain to today. Routinely a factor in clinical diagnoses, preemployment physicals, and disability estimates, spirometers are often “race corrected,” typically reducing normal values for African Americans by 15 percent.
An unsettling account of the pernicious effects of racial thinking that divides people along genetic lines, Breathing Race into the Machine helps us understand how race enters into science and shapes medical research and practice.
“Race, ethnicity and ancestral categories falsely suggest genetic homogeneity within and heterogenity between groups; they ignore the genetic variability within groups, gene–environment interactions and differences due to socially mediated mechanisms.”
Redlining and Pulmonary Disease
Asthma disproportionately affects communities of color in the USA, but the underlying factors for this remain poorly understood. In this study, we assess the role of historical redlining as outlined in security maps created by the Home Owners' Loan Corporation (HOLC), the discriminatory practice of categorizing neighborhoods on the basis of perceived mortgage investment risk, on the burden of asthma in these neighborhoods.
In the 1431 census tracts assessed by this Lancet study (64 [4.5%] grade A, 241 [16.8%] grade B, 719 [50.2%] grade C, and 407 [28.4%] grade D), the proportion of the population that was non-Hispanic black and Hispanic, the percentage of the population living in poverty, and diesel exhaust particle emissions all significantly increased as security map risk grade worsened (p<0.0001). The median age-adjusted rates of emergency department visits due to asthma were 2-4 times higher in census tracts that were previously redlined (median 63.5 [IQR 34.3] visits per 10 000 residents per year [2011–13]) than in tracts at the lowest risk level (26.5 [18.4]). In adjusted models, redlined census tracts were associated with a relative risk of 1.39 (95% CI 1.21–1.57) in rates of emergency department visits due to asthma compared with that of lowest-risk census tracts.
Resources
Burney P, Hooper R. Lung function, genetics and ethnicity. Eur Respir J. 2014; 43 (2): 340‐342.
Camacho-Rivera M, Kawachi I, Bennett GG, Subramanian SV. Associations of neighborhood concentrated poverty, neighborhood racial/ethnic composition, and indoor allergen exposures: a cross-sectional analysis of Los Angeles households, 2006–2008. J Urban Health. 2014; 91: 661-676.
Flores G, Snowden-Bridon C, Torres S et al. Urban minority children with asthma: substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care. J Asthma. 2009; 46: 392-398.
Hegewald MJ, Crapo RO. Socioeconomic status and lung function. Chest. 2007; 132 (5): 1608‐1614.
Nardone A, Neophytou AM, Balmes J, Thakur N. Ambient air pollution and asthma-related outcomes in children of color of the USA: a scoping review of literature published between 2013 and 2017. Curr Allergy Asthma Rep. 2018; 18: 29.
Northridge J, Ramirez OF, Stingone JA, Claudio L. The role of housing type and housing quality in urban children with asthma. J Urban Health. 2010; 87: 211-224.
Wright RJ. Health effects of socially toxic neighborhoods: the violence and urban asthma paradigm. Clin Chest Med. 2006; 27: 413-42.