BIOLOGICAL DETERMINISM AND THE “NEGRO PROBLEM”

Biological determinism—the assertion that behavioral norms of and biological differences between human groups, namely “races,” are a consequence of inherited inborn distinctions—coupled with an ideology of racial inferiority, permeated scientific thought and inquiry and influenced the practice of medicine during the nineteenth and early twentieth centuries (Byrd and Clayton, Reference Byrd and Clayton2000). These ideas were used to promote and justify racial and social hierarchies as well as to explain the “Negro” problem, and leading physicians and scientists subscribed to these notions “proved” by spurious studies. For example, craniometry correlated skull measurements with brain size, intelligence, and personality traits (Byrd and Clayton, Reference Byrd and Clayton2000). Influenced by the evidence from the craniometric research, physician-scientist Samuel Cartwright used these findings to guide medical practice and support the premise that Blacks should be managed and treated differently from Whites.

Eugenics, the study of improving the population by controlling hereditary qualities (e.g., race) through reproduction and migration, further promulgated biological-deterministic theories and ideologies of racial dominance in health by espousing the biological superiority of Whites over other groups. Frederick L. Hoffman, one of the most prominent figures of the eugenics movement, authored Race Traits and Tendencies of the American Negro (Reference Hoffman1896). Hoffman examined a host of vital (i.e., birth, morbidity, and mortality) and social (e.g., employment and educational conditions) data to investigate the living conditions of Blacks. He observed higher death rates among the “colored race” in comparison to “whites” and surmised that the differences were attributable to “an inferior vital capacity” as opposed to “conditions of life,” which would inevitably lead to the extinction of the “colored” race (Hoffman,Reference Hoffman1896, pp. 310–312). Hoffman's interpretation added to the dominant thought collective which essentially deemed “negroes” as unhealthy, immoral, and a “hindrance to the economic progress of the white race” (p. 329).

Among the earliest and most poignant rebuttals to Hoffman's work (Roberts Reference Roberts2009), were those by Kelly Miller (Reference Miller1897) and Du Bois (Reference Du Bois1896), who highlighted various fundamental flaws. Both critiques discerned egregious errors in Hoffman's sources and challenged the accuracy of the census and anthropological data used. For example, the mortality data Hoffman selected was based primarily on large cities, where Blacks represented only 12% of the population. Du Bois further compared the death rates of individuals in European countries with American Blacks to expose the fallacy of the racial extinction argument; he demonstrated that Whites residing in Germany, Naples, and Budapest had higher age-adjusted death rates than American Blacks. Du Bois ended the review stating that Hoffman's conclusions were of “doubtful value, on account of the character of the material, the extent of the field, and the unscientific use of the statistical method” (Du Bois Reference Du Bois1896, p. 130).

CONCEPTUAL AND METHODOLOGIC SIGNIFICANCE

Du Bois's training in empirical sociology at the University of Berlin had a tremendous impact on the methods used in The Philadelphia Negro (Reference Du Bois1899). Berlin was well-known for its pioneering economic and sociological methods that utilized objective, empirical, and scientific principles to solve social problems (Lewis Reference Lewis1993). Strongly influenced by this praxis, Du Bois applied these methods to mitigate racial inequality. The Philadelphia Negro and The Health and Physique of the Negro American (Reference Du Bois1906) provided empirical data debunking dominant notions of racial inferiority and showed remarkable prescience in laying the foundations of current racial/ethnic health-disparities research.

The Philadelphia Negro (Reference Du Bois1899) was among the first major empirical works in American sociology. Modeled after Charles Booth's (1889–Reference Booth1891) ground-breaking Life and Labour of the People in London that examined the causes of poverty and class relations, The Philadelphia Negro was the first social-science study sampling Blacks and employing variegated yet complementary qualitative, semiquantitative, and quantitative research methods. Conducted between August 1896 and December 1897, the general scope of the study entailed the description, analysis, and interpretation of the life and conditions of Blacks. More specifically, the study investigated education and illiteracy, occupational status, social organizations, churches, businesses, housing, crime, suffrage issues, and health.

Du Bois was intimately involved with the collection of data, canvassing the neighborhood to conduct fieldwork, including extensive interviews with 2500 households. Information about individuals (e.g., occupation, educational level attained) and family structure was collected. Du Bois created a street schedule—a questionnaire for amassing information on the physical characteristics of neighborhoods—that allowed him to collect data on the “character of houses” and “cleanliness of streets” (Reference Du Bois1899, p. 408). He also enumerated the types of churches, businesses, stores, and organizations located throughout each neighborhood. Moreover, maps were used to depict the geographic distribution of individuals by race and economic status. Additionally, census data were used to empirically document the distribution of health status.

In Chapter Ten of The Philadelphia Negro, Du Bois sought to understand the death rate of Negroes in Philadelphia and provide a more accurate interpretation of the data—investigating whether higher mortality among Blacks reflected living conditions different from those of Whites. He compared all-cause and cause-specific (e.g., “consumption” [tuberculosis]) death rates between Blacks and Whites by gender, age, neighborhood of residence, and foreign-born status from 1884–1890. Du Bois demonstrated neighborhood variability where, in general, the death rates of Blacks were higher than those of Whites. For example, in Ward Six, Black mortality was 49.77 deaths per 1000 in comparison to 24.30 deaths per 1000 among Whites. Du Bois stated that the wards where Blacks had higher mortality “contain the worst slum districts and most unsanitary dwellings of the city” (Reference Du Bois1899, p. 154). Also, there were a few neighborhoods where the death rates of Blacks and Whites were similar. This point was illustrated in the fourteenth ward, where Blacks and Whites had comparable death rates—20.08 and 20.18 per 1000, respectively. Du Bois attributed this finding to his observation that the “best Negro families” resided in these areas (Reference Du Bois1899, p. 155). The statistics and comparisons made by Du Bois provided evidence exhibiting the primacy of living conditions and the role of socioeconomic status as factors contributing to higher death rates.

Moreover, Du Bois noted that the influence of negative racial attitudes on health outcomes was not limited to Blacks. For example, regarding consumption, the leading cause of death at that time, he stated that “negroes are not the first people who have been claimed as its peculiar victims; the Irish were once thought to be doomed by that disease—but that was when Irishmen were unpopular” (Du Bois Reference Du Bois1899, p. 160). This statement reflects Du Bois's awareness of the differential susceptibility of various racial groups to disease. During the time when the concept of race and Whiteness was evolving, Du Bois recognized that consumption was strongly influenced by the magnitude of racial discrimination.

From a conceptual standpoint, Du Bois articulated alternative theories and mechanisms to explain Black health risk. Du Bois envisaged a broad framework of the environment—encompassing the social, physical, economic, and political circumstance of Blacks—which ultimately contributed to the poorer health outcomes observed. Although Du Bois acknowledged other factors, namely, “poor heredity,” “ignoran[ce] of laws of health,” and “neglect to take proper medical advice” as possible causes of the differential mortality patterns, he emphasized the role of social conditions (Reference Du Bois1899, pp. 160–163).

Du Bois (Reference Du Bois1906) further crystallized the conceptualization of social conditions as a cause of poor health status among Blacks in “The Health and Physique of the Negro American” which was published together with the Eleventh Atlanta University Conference Proceedings in a volume which he edited. These annual proceedings were a series of reports of the conditions of “Negro” life and fostered the linkage between research and social action, where topics such as economic organization (1899) and education (1900) were exhaustively investigated. The 1906 conference focused on health, physical conditions, and mortality.

Using data compiled from a multitude of sources, including the U.S. Census as well as reports from hospitals and physicians, a comprehensive view of health was documented. The monograph begins with an astute discussion of the historical origins and evolution of racial classifications and their relationship to the social conditions of Blacks. Moreover, Du Bois had refined—and structured more forcefully—the social condition argument. According to Du Bois, the relationship between “race” and mortality was confounded by social and economic conditions. Du Bois furnished stratified data showing that “if the population were divided as to social and economic conditions the matter of race would be almost entirely eliminated” (Reference Du Bois1906, p. 89). This point was elegantly illustrated when he demonstrated that consumption mortality for poor Whites residing in New York and Chicago was higher than that of Blacks residing in other sections of the respective cities.

DU BOIS'S LEGACY: ADVANCING RACIAL/ETHNIC HEALTH-INEQUALITY RESEARCH

The methods and conceptual principles that have emerged from the two seminal works have had profound implications for social science research. More importantly, this pioneering endeavor offers valuable lessons for shaping current public health research and creating policy that seeks to understand and eliminate racial/ethnic inequalities. Specifically, Du Bois's work pointed to the need for: (1) improved data collection and methodological sophistication of data by race, (2) a cautious interpretation of studies documenting racial differences, (3) the utilization of a multidisciplinary research approach, and (4) the translation of research into interventions and policies.

Du Bois was deeply concerned about the publication and availability of “reliable statistics” on Black health and well-being. He developed an ambitious program of inquiry for the Atlanta University conferences, where he envisioned conducting detailed studies of African Americans over a hundred-year period in ten-year cycles. The desired objectives included accumulating “valid and accurate data,” “sharpening tools of investigation,” and “perfecting methods” (Du Bois Reference Du Bois2000, p. 64). Unfortunately, the implementation of this scientific enterprise lasted only thirteen years. Yet many of the challenges Du Bois sought to address remain relevant today. For example, the reliability of estimates based on large national health data sets may be limited by the small sample size of select racial groups (e.g., Asians, Native Americans, and Pacific Islanders) and specific ethnic subgroups within each of the official racial categories. The National Health Interview Survey, which provides national estimates instrumental to tracking health status and setting national health objectives, is not able to generate reliable estimates for within-group variation among Hispanics. The lack of sufficient data may inhibit the accurate documentation and estimation of health disparities.

Du Bois was a vociferous advocate for the use and development of rigorous methods to illuminate the causes of the “Negro problem,” specifically as it related to the disproportionate burden of morbidity and mortality experience of Blacks. In The Philadelphia Negro, he stated that the death rates must be compared “with that of the communities in which they live and thus roughly measure the social differences between these neighboring groups” (Reference Du Bois1899, p. 148). Du Bois crudely characterized neighborhood environment by using color-coded maps to indicate the economic class structure of Black households. Contemporary researchers show greater detail, and pinpoint the locations of the social, physical, and economic resources of neighborhoods. Spatial and analytical techniques such as geographic information systems (GIS) and multilevel modeling have enabled researchers to make significant progress in understanding the ramifications of neighborhoods on health, despite the very real challenges related to measuring, conceptualizing, and analyzing the relationship between them (Diez-Roux Reference Diez-Roux2007; Oakes Reference Oakes2004). For example, GIS has been used to document spatial disparities in access to health care facilities and cancer diagnoses (Dai Reference Dai2010).

The creation of “disciplines” and dogmas to advance arguments of racial inferiority was embedded in the social milieu of the nineteenth and early twentieth century. Du Bois, among many, challenged racial stratification theories and his work cautioned against the interpretation of data that facilitated the reification and perpetuation of dominant ideological paradigms around race, especially as it pertained to health. Although, contemporary debates regarding the sources of racial/ethnic health disparities have evolved, the underlying tenor has remained unchanged where genetic versus social causes continue to be at the core (Braun Reference Braun2002; Burchard et al., Reference Burchard, Ziv, Coyle, Gomez, Tang, Karter, Mountain, Perez-Stable, Sheppard and Risch2003; Duster Reference Duster2005; Krieger Reference Krieger2005; Risch et al., Reference Risch, Burchard, Ziv and Tang2002), despite the falsification of race as a biological concept. The conceptualization of race, and by extension racial/ethnic health differences, has the capacity to shape the design and conduct of studies, the interpretation of research findings, the training of health practitioners as well as biomedical and public health researchers, and policies and interventions (Braun Reference Braun2002). Thus, Du Bois's legacy is of particular import, because the methodological advancement and sophistication of genetic studies have retooled the debate. Recent papers seek to understand how distinctive social and physical environments are embodied through biological and physiological processes across the life course and ultimately contribute to racial/ethnic health disparities (Krieger Reference Krieger2004). Epigenetics is the study of mechanisms that modify gene expression in the absence of changes to the nucleotide base sequences of genes. Epigenetic frameworks have been developed to illustrate how the social environment can produce epigenetic changes and contribute to racial disparities in cardiovascular health (Kuzawa and Sweet, Reference Kuzawa and Sweet2009).

Du Bois's texts inherently challenge contemporary researchers to utilize integrative approaches to tackle health disparities. He examined racial inequality across various aspects of life and demonstrated that health was at the nexus of other inequalities. It is possible that employing multidisciplinary research and policy approaches will further elucidate the etiology of health inequalities. This is significant since non-health-related policies may exacerbate health inequalities. For example, the health impact assessment (HIA) may be considered an example of a multidisciplinary research and policy tool to promote healthy and equitable development across communities. HIA procedures, methods, and tools can be used to assess the potential health impact of a proposed policy, program, or project (Kemm et al., Reference Kemm, Parry and Palmer2004). Wier and colleagues (Reference Wier, Sciammas, Seto, Bhatia and Rivard2009) demonstrated the utility of HIA to assess the effects of transportation planning decisions on traffic-related exposures and health conditions of nearby residents. Multidisciplinary partnerships between government agencies and various community coalitions in the San Francisco Bay Area have made significant progress towards establishing guidelines for conducting HIAs and reducing health inequalities (Corburn Reference Corburn2009).

Du Bois's legacy reminds us that public health has an underlying philosophy of social justice (Kreiger and Birn, Reference Kreiger and Birn1998). Du Bois wanted valid science to be the catalyst for improved living conditions and “to serve as the basis of further study, and of practical reform” (Du Bois Reference Du Bois1899, p. 4). This commitment to translating research into practical interventions and policy is exhibited in the adoption of several resolutions at the conclusion of the Eleventh Atlanta Conference, including one recommending “the formation of local health leagues among colored people for the dissemination of better knowledge of sanitation and preventive medicine”(Du Bois Reference Du Bois1906, p. 110). Although it is not required that every researcher become an activist, it is critical that research be used in a practical manner.