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Transcript: In conversation with Dorothy E. Roberts


Paul Gilroy: Hello everybody, my name's Paul Gilroy. I am the Director of the Sarah Parker Remond Centre for the study of Racism and Racialisation at University College in London. I'm really excited, delighted, honoured to have as a guest, Professor Dorothy E. Roberts from University of Pennsylvania where she is the 14th Penn Integrates Knowledge Professor and the George A. Weiss University Professor. She holds joint appointments in the departments of Africana Studies, Sociology and in the Law school, where she is the inaugural Raymond Pace and Sadie Tanner Mossell Alexander Chair. Professor Roberts is also the founding director of the U. Penn Program on Race, Science & Society; member of the National Academy of Medicine; serves on the board of directors of the American Academy of Political and Social Science; and has been a visiting scholar widely across the world where her work is influential, notably at the Centre for Gender and Development Studies in the University of the West Indies in Trinidad. Professor Roberts's publications include many, many essays- many rich and stimulating essays, and a number of monographs: Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century (New Press, 2011); Shattered Bonds: The Color of Child Welfare (Basic Books, 2002), and Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (Pantheon, 1997). Now there's so much that I'd like to talk to you about from this amazing body of work, Dorothy. I was thinking where we could start our conversation, and considering really the impact of the Covid pandemic, not just on African Americans but notably on African Americans whose vulnerability and risk to these pathologies is notable and related in complex ways to their poverty, their social experiences, and so on. You've argued very forcefully in the past that group disparities in wellbeing have been driven by the imperatives of racial hierarchy, by racialised exploitation and by institutional racism itself. You've offered a really eloquent, rich critique of race medicine, arguing again forcefully that the best predictor of health is an individual's position in the social hierarchy. So how does Covid look to you with those interests in mind?

Dorothy E. Roberts: First, I want to say thank you so much Paul for inviting me to have this conversation with you. It's really an honour and it's so wonderful to reconnect with you. Covid is such an illustration of everything you mentioned about my work. It shows how structural racism has a profound impact on people's bodies; and the way in which because our society is organised in a racist way that privileges white people and produces all sorts of disadvantages for black people in its very structure - whether we're talking about access to health care, or the kinds of jobs people have, or their experiences of discrimination, where they live, their forms of transportation, their education - all of these ways in which US society is structured to disadvantaged black people harms our health. So it's not surprising that when you have a pandemic that is affecting people globally, it would have a more harmful and severe impact on black people and other people of colour, especially indigenous people in the United States, because of these structures that make these groups more vulnerable both to being infected but also to the disease having a more severe impact on them; and that's why we see these grossly differential rates in deaths from Covid 19. So, it's not surprising that we've seen these statistics that prove that black people in America are far more likely - in some places three, four, five times more likely - to die from Covid 19 than white people in the same locations. But this mirrors other health inequities in the United States; black women are three to four times more likely to die from pregnancy-related causes in the United States; black people have higher rates of hypertension and are more likely to die from it and from kidney disease; from asthma, black children are more likely to die from severe asthma than white children in the United States. Black babies are more likely to die in the first year, two to three times more likely to die in their first year before their first birthdays, than white children the United States. So, we would expect this and it's because, just to go into a little more detail, black workers in the United States are more likely to be in jobs that expose them to disease and less likely to be protected from it; and so they are more likely to be the hospital workers that are dealing intimately with people who are sick. They're more likely to be in jobs that are considered essential because you can't do them from a computer at home. And to get to work - they're less likely to have cars that they can drive themselves, they're more likely to be on public transportation. And they're less likely to have employers who are concerned about their health and protect them; they're more likely to work in places like big meat-packing factories, where you've got employers that don't buy the protection, and they're producing the food that we need to eat. And then they're already coming to the job though with compromised health because they're more likely to live in neighbourhoods that are predominantly black - now it's not because they're black that's the problem, it's because our society is structured so that segregated black neighbourhoods have fewer of the resources you need for good health. And I'm not just talking about access to high quality health care, although that's a big part of it; but access to high quality nutrition, to high quality education, and greater exposure to all sorts of environmental and industrial toxins that compromise health. And another big part of it, which researchers now are only starting to uncover although it should be obvious, but being exposed to police violence, for example, the high rates of incarceration. It really amazes me when you find researchers who are looking for genetic reasons for disparities in health between black people and white people, and they don't even take into account the fact that black people - men, women and children - are so much more likely to be detained and incarcerated, cycled through jails and prisons, which are extremely unhealthy places; and stressful. The stress of just being black in America has a huge impact on people's health. All of this explains why it is that we're seeing these appalling disparities and outcomes from the pandemic. What is really shocking is the way in which, despite all the evidence that what affects people's health the most is where they stand in the social hierarchy, and in the United States and globally that hierarchy is structured by wealth and race and gender, and also by disability. And so, when you see these health inequities the first thing that should come to mind is what are the structures that are producing these inequities? We know that those are the main causes of health inequities - not even the main ones, they are the only causes of health inequities. It's not natural that we find these differences in deaths and death rates, and yet as soon as we began to see the statistics showing these unsurprising yet appalling disparities, you have scientists looking for some - and I will quote, from peer-reviewed journals - "unknown genetic or other biological cause" for the racial disparities. There's an assumption there must be something naturally wrong with black people's bodies that produces their higher rates of death. This idea is so persistent in Western medicine - that races are natural divisions of human beings therefore people of different races have different diseases and experience common diseases differently, like pandemics, they're going to naturally have different rates of death because of these innate differences, and they must be there. So, we see a statistic that shows that black people are dying at three times the rate from Covid, then scientists must look for this unknown genetic cause - it's got to be there. It's absurd! It's totally absurd, and yet there were peer-reviewed articles that came out in major scientific journals, immediately published, that postulate - this is another favourite word of these scientists - postulate some unknown genetic cause. It's really amazing how this is supposed to be so scientific and the way in which these same scientists will try to discredit arguments that we should look at structural racism and racial capitalism to explain these discrepancies, and they'll say 'oh, that's political, that's ideological, that's not real science'; and yet they get published in peer-reviewed journals, pure speculation that is completely preposterous; it's the most implausible hypothesis given all we know about the impact of structural inequality on health, and yet they have the nerve to discredit people- or try to discredit people like me who say let's look at the structural reasons and let's address them. That's another point that I think the literature that came out and the media around Covid points out is the persistence of this false biological concept of race in Western science that completely distracts us from the path that would actually help to end these inequities. There's no evidence whatsoever that looking for some yet unknown genetic cause for these disparities is going to help. I really challenge the scientists looking for this- when working on my book Fatal Invention, I looked and looked and looked and looked- where are they finding any support that looking for race-based genetic differences is going to reduce health inequities. It never has. We know that what has done anything to reduce health inequities are social policies that equalize more our society, that equalize access to high quality health care, that reduce disparities in exposure to factors that we know harm people's health. So, that's another important aspect.
 
Paul: That mirrors a lot of the situation here, although I remember my years of living in the States and the Yale death plan nearly finished me off because they thought I was a negro; so I do understand some of the really appalling consequences that follow from- you called it preposterous, I think that's a great word for it, the preposterous institutionalisation of racial categories in the management of health disparities.
 
Dorothy: Yes, yes. So, let me just make one more point about it, and I'd love to talk more about that as well because it is so institutionalised. I was just tweeting a couple days ago about a lawsuit brought by NFL for the concussion where there's a settlement agreement that's dealing with all of these claims by former football players, who by the way retire in their 20s because they've been so brutalised by the sport; and they're finding many of them that they have these terrible brain injuries as a result of the concussions that they suffer playing football, and they've sued. And so there's a big settlement that's dealing with these claims, and it's been revealed that a big part of determining whether or not there is a claim at all for dementia is what is a test that looks at the cognitive capacities, or in-capacities, of the player. So the player has to prove that their brain function has been impaired by the concussions that they suffered, but that test of cognitive capacity is interpreted differently for black players; so there's a special black scale that makes it harder to qualify for a claim. Now, why should it be harder for black players- like you said institutionalised, this is embedded into the algorithms they use to determine if the players have been impaired by these concussions. And so, the black scale assumes that the black players already had impairments before they played football. So whether it's because there's an assumption that black people naturally have cognitive impairments, or that there's something about being black that impairs you prior to playing football, but add that categorically we can assume this about any black player just because of the black player's race. And it's interesting, when I've been tweeting about so-called 'race correction' in medicine- for a long time I've been tweeting about it; I've been writing about it; I have a TED Talk about it. I've been working with student groups and others to try to get rid of race correction in medicine, especially in one particularly egregious area which is glomerular filtration rate, which measures kidney function and how well the kidneys filter blood; and that in the United States - and you're right some of these corrections exist in the UK as well - but it's interesting because for some of them in the UK, if you have one white parent and one black parent you're not lumped into the black group...
 
Paul: ...you don't qualify, yeah, the one drop of blood rule...
 
Dorothy: ...whereas here in the United States, if you have one black parent and one white parent you're still grouped as black. And I just point this out to show how these are made-up categories. How is it scientific where if I get the test in the United States, I get one result, and if I happen to get it in the UK, I'm going to get a different result. I'm the same person, but whether you identify me as black or as non-black based on some made-up test, I have a different result and my diagnosis is going to be different, and treatment is going to be different. So back to the US, in the US the interpretation of this protein in the blood, which there's again a way in which the lab has an algorithm that figures out whether or not this means you're at risk of kidney failure or kidney disease, but it is literally reported differently for African Americans and non-African Americans. They divide, embedded in the test, human beings into two groups: African Americans- now, I'm not sure what if you're black but you're not African American what happens...
 
Paul: ...whether you count, yeah...
 
Dorothy: ... what they do with that I'm not sure, but the tests I've seen say 'African American' or 'non-African American'. How do you divide humanity into these two groups to begin with? But how can it be that an accurate medical diagnosis can be made based on grouping all African Americans together as if there is some biological trait we all have that distinguish us from every other human being. Now they used to say that the trait was that black people have more muscle mass and therefore that has an impact on the measurement of kidney function. And I think they've now realised that sounds absurd, and so they're kind of shying away from it; but it's still assumed that there's some innate biological feature that black people have that other human beings don't have, and that we can assume that all black people have it. It's just, again, it's preposterous. It's throughout medicine in the United States that these kinds of racial assumptions are made. They're supposed to make medicine more accurate for black people because you're taking black race into account, but what it's doing is actually disqualify black people from claims of injury and from care. SIn the case of the NFL, we're seeing these black players who are being denied damage awards for the harms that playing football has caused their brains. In the case of the eGFR, the adjustment is an upward or healthier adjustment for black people; and that means that there are cases where if the patient is deemed African American, they get this upward adjustment, so that means they may be disqualified from getting on a waiting list for a kidney transplant; whereas if they were considered any other race they would be put on the waiting list. So, they're disqualified. That is a harm. And in lung functioning, some of the measurements, the spirometer, have a button for race which adjusts for the supposed naturally lower lung capacity for black people; that means you're less likely if you're black and take this test to be seen as having a lung problem; less likely to be referred to a lung specialist. And in all of these areas we see black people have higher rates of kidney failure, they have higher rates of severe asthma. So, I would ask are these tests disqualifying black people for specialised care? Could that be part of the reason for these higher rates of disease- severe disease? So, that's an aspect of the race-based practice of medicine.
 
Paul: There are a couple of things it makes me think hearing you lay that out, because obviously I've been following your work closely for many years, so I know I follow your interests, and I'm also very fortunate having one of my old students who's been working on the concussion question for a while...
 
Dorothy: Oh, really?
 
Paul: Yeah, Lucia Trimbur.

Dorothy: Oh, great!

Paul: But anyway, the point is really it makes me want to ask you two things. First of all, you're familiar with the biomedical discourse, the clinical discourse, and the way these things are encoded and institutionalised into patterns of decision making which are racialised inappropriately and illegitimately. How is it that the concept of race functions so smoothly in linking the medical and the juridical discourses together? I'm interested in its operation as a kind of bridging concept between these two areas. Do you have a view of that?
 
Dorothy: Yeah, yeah. Well, one aspect of it is that it all boils down to this biological concept of race, which we can trace to its actual invention in order to support extermination of indigenous people, enslavement of African people, dispossession, colonialism; we can trace it. And medicine has been really important to promoting that idea because doctors are supposed to be experts on how people's bodies function, and so if they say black people's bodies function differently than Asian people's bodies, than European people's bodies, than Native American people's bodies, it seems to support that underlying biological concept. And so, doctors have been important in bridging these various ways in which then the biological concept of race operates in multiple fields, including in the law and in determining people's claims, and in very concrete ways. Doctors have testified in numerous kinds of cases to promote and seemingly confirm these biological concepts. I think this is a really important aspect of the collaboration of doctors and lawyers in promoting juridical ideas about race in the actual court rooms. We're not just talking about the way in which ideologies have meshed- I mean, they have, but they've meshed in these very concrete ways of physician testimony. You just mentioned one of your great students; we have a postdoctoral fellow at Penn Law School who's affiliated with my program on Race, Science and Society in the Center for Africana Studies, Brittany Farr, who actually got her law degree from Yale recently just a year ago; but she's been working on lots of things related to slavery and the law and contracts. And she's uncovered all of these warranties of fitness where when people purchased enslaved Africans they came with warranties that guaranteed their health; and when someone who had purchased a human being claimed that this warranty was breached because the enslaved person didn't have the health that they were promised, that the enslaver was promised, doctors came in and testified about either whether what was normal for an enslaved person, and whether or not this person who was at the subject of this legal dispute was abnormal or not for a black person. So, the doctors were really important in promoting these views. And she's found that enslaved black women were often the subjects of these lawsuits because one of the important aspects of guaranteeing the fitness of an enslaved person was whether or not an enslaved woman could bear children, because of course that was essential in the United States, especially after the end of the slave trade, to continuing the practice of slavery. And so, doctors have been influential both in continuing to confirm the innate biological differences between people of different races, and important in giving evidence- so-called scientific evidence of all of these claims that are made largely about the bodily differences of black people. I want to mention, because I've been talking so much about how doctors were influential during the slavery era, that we can trace this collaboration of doctors and white supremacists to deny claims against black people, or to support the claims of white people, throughout the centuries. And I just want to give one example that relates to my work especially in my book Killing the Black Body, that's very contemporary; and that is the role of doctors in promoting the myth of the 'crack baby'; the idea that black women who used drugs during pregnancy had experienced a biological impact, that was not said of any other women, which was that the drug deprived them of maternal instinct. So they were portrayed as these monsters who were using drugs while pregnant because they didn't care about their children, they didn't have the capacity to care about their children; and then the myth of the crack baby, that they gave birth to babies who not only were medically affected by the drug use, in ways that were not attributed to any other babies affected by drug use- their medical impairments were supposed to be greater than anything described for other babies affected by drugs; but also that it wasn't just their physical bodies but their actual social consciousness was impaired. And so, these children were predicted to become criminals and welfare dependants, and not to be able to participate in a healthy way in society because of the supposed lifelong and extreme defects that they suffered as a result of their mother’s drug use. And all of this was initially supported by doctors and medical researchers who made these completely bogus claims. The science behind it was shoddy. They would look at children who had been taken from their mothers at birth and boarded at hospitals - they were even called 'boarder babies' because so many of them were just warehoused at hospitals - and look at these children's behaviours which had been affected by structural inequities that their mothers encountered, not because of their drug use, but because of the impact of structural racism in their neighbourhoods, and then babies who had been affected by the really inhumane policies of taking them from their mothers at birth, and now blaming the mother's drug use for these outcomes without proving that the drug use caused them.
 
Paul: It puts you in the position, if you aren't careful, of appealing for better science. I mean, I know better science is needed, but I also know that the history of racism is such that having the best science on your side doesn't always make any difference to the way this institutional machinery operates. But the double standard is the racism, and that in a way takes me to where I wanted to go before we conclude, and that is to hear a little bit from you about how you're seeing the situation that's unfolded. I know it's complicated historically, and how we periodise it is an issue, but if you think about the moment of George Floyd's killing - outrageous, obscene killing - in Minneapolis; and now of course the situation which has developed in Kenosha, Wisconsin, after the shooting of Jacob Blake; a different order of violence really, because in both cases the violence isn't sort of applied forensically or technically or minimally or anything; it's excessive, it's spectacular. So, you're forced when you look at these things to try to understand the meaning of that violence. We've been talking about one kind of violence now, and it's connected to that other kind of violence. How do you see the situation in the run up to your election?

Dorothy: I think that it has made so plain that we need abolition of the entire policing apparatus in the United States. Whether we call the prison industrial complex- I think that's a good term- we need to understand that that complex is vast; that it includes law enforcement, it includes deportation, it includes prisons and jails and detention centres and juvenile detention centres. My current project is on abolishing the family policing system, what we call foster care or child welfare or child protection; those are such misnomers for what actually goes on, but the abolition movement should extend to those very brutal and violent and entangled with law enforcement structures as well. The fact that despite months of global protests against police violence and calls to defund the police, you can have police officers shoot in the back an unarmed nonviolent man who was trying to tend to his children, paralysing him - hopefully not permanently, but we don't know yet - but right now paralysing him. A man shot in the back in such a violent dehumanising way just shows you clearly that the problem isn't bad apples, the problem isn't flaws in policing that can be fixed. This is what police do; their job is to be violent. That's what their job is. That's why despite all the reform efforts that are going on- you would think that if they really were supposed to be ensuring the public safety as opposed to threatening people to protect the elite's property, if they were really about public safety, these protests would have some impact on them and they wouldn't be shooting an unarmed black man in the back seven times. So, we have to look at what are the institutional and structural factors that the police are designed to support that would cause this to happen. And then on top of it, as if it weren't enough to send that message - that they are not here to make us safer, they are here to support a white supremacist ideology and to support racial capitalism - if that wasn't clear enough, then during the protests they allow an avowed white supremacist terrorist carrying a huge AR-15- I don't know guns, so I had to look up AR-15- that is a big assault rifle! We're not talking about a little pistol that maybe they couldn't see. He had a huge assault rifle strapped to him, prominently displaying it, and he goes out and kills two protesters, and then is able to walk away marching down the street still carrying this assault rifle past police officers who do absolutely nothing. And in fact, there is video showing that earlier they had given him water and they had encouraged him; they praised what he was doing. What more evidence do you need that what abolitionists have been saying that policing in America is- we can trace it directly back to slave patrols in the United States. We can trace it directly back to the black codes and how they were intended, and did, lock up black men and women and children to exploit their labour to a point of working them literally to death; how we can then move forward and see the explosion of incarceration in the United States again supported by law enforcement; and we see this now in videos which I can't even watch anymore. It's so plain, and so, I think that there should be no doubt that the approach cannot be reform, fixing a malfunction that the police and prisons and jails and family policing and deportation and other aspects of policing in the US, and globally- my expertise is more the US but I know that these structures exist elsewhere as well; we have to focus on dismantling them and also on creating a society where we don't need them, where it's obvious and just as plain as it should be now that these are systems designed to oppress people, that we you can have a society where it would be obvious we don't need those systems because we are dealing with human needs and social conflicts in a way that does not require caging people, policing people, threatening people. One thing that, as I was watching Trump roll out this completely made-up history of the United States and its current conditions, I was thinking how dare people say that abolitionists are unrealistic. How dare they say that we are making up societies that could never exist because we have to have police and prisons, when as many of them are listening to somebody roll out a completely made-up and unrealistic history of the United States? Abolitionists are realistic. We're saying look at what conditions actually are, and face the fact that they have not worked to end violence in the United States; they have not worked to end social conflict in the United States; they have not worked to meet human needs in the United States. That's reality, and so let's be real! Let's be real and figure out something that will work, and not continue down a path of ignoring the realities of history and current conditions. So, to me, what we're witnessing in the US is a great argument in favour of abolition and building a radically different society.

Paul: Dorothy Roberts, thank you so much for making the time. I'm really, really grateful to you. I don't know what the new normal will be, but I do hope that in the new normal we'll be able to connect again and to converse and dialogue and build on our interests. I don't know when the last time was you came to London to speak, but I do hope we'll be able to get you here. And in the meantime, let's keep in touch and perhaps we can continue the conversation by other means.

Dorothy: I hope so and I hope to get back to London. If I could quickly mention, I was there last September for a gathering of activists who are addressing high rates of black maternal mortality in England and the UK. And I have to say I was so depressed by learning that your National Health Service - that many of us wish we had in the US - is not addressing the higher rates of black women dying from pregnancy-related causes in the UK. And so, I was happy to be able to work with health advocates there are on that issue. And I'm also going to be speaking to a group of social workers who are reading my book Shattered Bonds, who are concerned about the removal of black children from their homes. So, these are global issues, and I hope Paul that we are able to connect in person to continue this conversation. I really appreciate this opportunity to talk with you, albeit remotely, I hope we can do it in person soon.
 
Paul: Thank you, Dorothy.