The racial politics of health

The U.S. FDA recently approved Bidil, a drug used to treat heart failure among African Americans. This is the first time a drug has been approved by the FDA for use in a specific racial/ethnic population.

Why just African Americans? Research conducted over the past decade or so has demonstrated that people of African descent might have a particular biological/genetic predisposition towards heart disease and cardiovascular problems. Drugs such as Bidil are aimed at addressing the problems arising from such a disposition.

I have mixed feelings about the production of drugs that target ethnic groups who have supposed genetic predispositions towards health problems such as CVD. On the one hand, if it is indeed the case that such ethnically-based genetic predispositions exist, then drugs to address them can be very good things. There are numerous examples of genetic-based disorders that are more common in some ethnic populations than in others, such as Sickle Cell Anemia (African Americans), inherited breast cancer (Ashkenazi Jewish women), and possibly diabetes (people of Hispanic and Mexican descent).

On the other hand, such genetic research and drug production for many of these supposed ethnic-based disorders are fraught with all kinds of scientific, social and political problems. First, the very idea that certain racial populations are at genetic risk for CVD and diabetes is controversial. Not all health care researchers agree with this position. In addition, even if a racially-based genetic predisposition exists for disease such as CVD and diabetes, having the gene itself does not guarantee that one will get the disease. After all, a predisposition is just that. To get the disease, other environmental factors have to be at play as well. In case of CVD and diabetes, these other factors include dietary habits, exercise patterns, weight, smoking and drinking habits, emotional and psychological stress, etc. And as epidemiological research has shown, African Americans and Hispanics are more likely to suffer from overweight and obesity, poor dietary habits, stress, etc. than their white counterparts.

When viewed from this environmental angle, then, the problem of CVD and diabetes among African Americans and Hispanics is not so much a genetic problem as much as it is a social, political, cultural, and economic problem. Individuals from these populations suffer disproportionately from poverty, job loss, racism, lack of access to healthy food, crime ridden neighborhoods, and other socioeconomic problems--problems that can facilitate poor eating habits, lack of exercise, smoking, obesity, high stress, inadequate medical care, etc. From a public health perspective, then, the way to address CVD and diabetes in these population is to take a structural approach and work to improve the lives of these disadvantaged communities.

When I hear about drugs being produced to treat complex and multifaceted, racially-based health problems such as CVD, I worry that this pharmaceutical approach will overshadow the public health approach by medicalizing health problems that are also--and perhaps even more so--social, political and economic problems. Emphasizing the genetic factors at will just enable our racist and classist society to flourish. And given that we live in an age where genetics and biotechnology are the new big sciences, and researchers are looking for genetics links to all kinds of disorders and personality traits, the possibility that genetic understandings of disease will overshadow social, political and economic causes of disease is very real and in my opinion, ethically problematic.