The Ideology, Biology, and Impact on Health
When Barack Obama was elected as the first U.S. president of African descent, the nation engaged in a complex conversation about racial identity. Genetically, as scientist Aravinda Chakravarti noted, Obama—with his white American mother and Kenyan father—could just as accurately be called "white" as "black." Yet American social convention and the historical "one-drop rule" dictated that he would be widely identified and celebrated as the first Black president 6 . This paradox lies at the heart of understanding race: it is a social construct with very real consequences, yet one that often diverges significantly from biological reality. Even as genetics has given us powerful new tools to understand human variation, the cultural meanings attached to race remain deeply embedded in our societies, institutions, and minds.
The conversation about race has never been more relevant. In medicine and public health, the COVID-19 pandemic laid bare stark racial disparities in infection rates, severe outcomes, and mortality. Yet scientists increasingly understand that these differences reflect not biological distinctions between racial groups but rather the biological impacts of social and structural inequities 2 .
A Story of Power and Justification
Race as a categorizing term for human beings first emerged in the English language in the late 16th century, initially carrying a generalized meaning similar to "type," "sort," or "kind"—as in references to a "race of saints" 3 . The contemporary concept of race as marking fundamental human differences, however, took shape primarily in the 18th century as a tool for sorting and ranking peoples in English colonies. This system positioned Europeans as "free people," Indigenous Americans as conquered populations, and Africans as enslaved labor 3 .
Colonial society faced two critical dilemmas: how to maintain control over restless poor and freed laborers who periodically threatened revolt, and how to secure a controllable workforce as cheaply as possible.
The solution emerged through the strategic division of the restless poor along lines of physical difference 3 . Colonial leaders began homogenizing all Europeans into a "white" category while instituting a system of permanent enslavement for Africans.
Race emerges in English language with generalized meaning similar to "type" or "kind" 3 .
Contemporary concept of race develops as tool for sorting and ranking peoples in English colonies 3 .
Pro-slavery forces develop ideology of Black inferiority to justify perpetual enslavement despite principles of equality 3 .
Moynihan Report attributes economic challenges in Black communities to "cultural deficiency" rather than systemic inequality 7 .
What Genetics Actually Reveals
While racial ideology imagined discrete human groups with essential characteristics, modern genetics reveals a very different picture of human variation. The human genome comprises about 3 billion base pairs of DNA, and any two people differ at approximately 1 in every 1,000 bases—amounting to about 3 million differences between any two individuals 4 . These differences, however, are distributed in patterns that defy racial categorization.
of genetic variation occurs within any given local population 4
of variation occurs between different populations 4
difference in DNA between any two individuals 4
| Level of Variation | Percentage of Total Genetic Diversity | Implication |
|---|---|---|
| Within local populations | ~85% | Two individuals from the same population can be highly genetically distinct |
| Between populations within same "race" | ~5% (part of the 15% between-population variation) | Genetic differences within racial groups exceed differences between them |
| Between continental groups | ~10% (part of the 15% between-population variation) | Traditional racial categories capture only a small fraction of human diversity |
Human populations have developed certain biological adaptations in response to local environmental conditions, but these adaptations are specific to particular environmental pressures—not comprehensive superiority or inferiority.
Lighter skin allows for more efficient vitamin D production in regions with less sunlight, while darker skin provides protection against intense UV radiation near the equator 8 .
The original human condition was lactose intolerance after weaning. However, in populations with long histories of dairy farming, a genetic mutation allowing lactose digestion into adulthood spread through natural selection 8 .
The sickle cell allele, when inherited from both parents, causes sickle cell anemia. However, inheriting just one copy confers resistance to malaria, explaining its high frequency in malaria-prone regions 8 .
| Genetic Trait | Environmental Pressure | Population Distribution | Protective Benefit |
|---|---|---|---|
| Sickle cell trait | Malaria | High frequency in malaria-endemic regions of Africa, Mediterranean, South Asia | Resistance to malaria for heterozygotes |
| Lactose tolerance | Dairy farming | Northern Europeans, West African pastoralists, some Middle Eastern groups | Ability to digest milk into adulthood as additional nutrition source |
| Light skin pigmentation | Low UV radiation | Northern latitudes | Enhanced vitamin D production in limited sunlight |
| High lung capacity | High altitude | Tibetan, Andean, Ethiopian highland populations | Enhanced oxygen uptake in thin mountain air |
The complex relationship between race, biology, and health has created significant challenges for medical and public health research. While health disparities along racial lines are very real, the interpretation of these disparities often mistakenly attributes them to innate biological differences rather than social and structural factors.
Substantial data reveals stark health disparities along racial and ethnic lines in the United States:
As of 2022, American Indian/Alaska Native (67.9 years) and Black (72.8 years) people had significantly shorter life expectancies compared to White people (77.5 years) 9 .
Black (10.9 per 1,000) and AIAN (9.1 per 1,000) infants were at least twice as likely to die as White infants (4.5 per 1,000) 9 .
Black, Hispanic, and AIAN people face higher rates of diabetes, hypertension, and obesity 9 .
Among adults with mental illness, Hispanic (40%), Black (38%), and Asian (36%) adults were less likely than White adults (56%) to receive mental health services 9 .
Traditional medical research often treated race as a biological variable, implicitly attributing health disparities to genetic differences. Contemporary research, however, increasingly recognizes that structural racism, not biological difference, drives most racial health disparities 2 .
The concept of social determinants of health acknowledges that conditions in which people live, work, and play—shaped by the distribution of money, power, and resources—profoundly affect health outcomes 2 .
Best Practices and New Approaches
The growing recognition that race is a social construct with biological consequences—rather than a biological reality itself—has prompted calls for more thoughtful approaches to using race in medical and public health research.
Researchers should not assume race is relevant to their hypotheses without scientific justification 5 .
Researchers should not use White populations as the default reference group or present non-White groups as "deviations" from the norm 5 .
Research should examine how race intersects with other social identities like gender, socioeconomic status, and immigration status 5 .
When using race as a variable, researchers should clearly state their rationale and acknowledge the limitations of race as a measure 5 .
When studying racial disparities, researchers should include direct measures of structural racism and discrimination rather than using race as a proxy for these experiences 5 .
| Concept | Definition | Research Application |
|---|---|---|
| Structural racism | Macro-level systems, social forces, institutions, ideologies, and processes that interact to generate and reinforce inequities among racial and ethnic groups | Measures: residential segregation, discriminatory policies, institutional practices |
| Implicit bias | Unconscious attitudes, positive or negative, toward a person, group, or idea that affect understanding, actions, and decisions | Measures: Implicit Association Test (IAT), analysis of differential treatment in healthcare settings |
| Polymorphism | Natural variation in a DNA sequence that occurs in at least 1% of a population | Used to study population histories and relationships; examples include ABO blood groups |
| Clinal variation | Gradual change in a trait or allele frequency across geographic space | Demonstrates continuity of human variation and challenges discrete racial boundaries |
| Epigenetics | Study of changes in gene expression caused by mechanisms other than changes in DNA sequence | Measures biological embedding of social adversity, including racism-related stress |
The emergency department provides a compelling natural laboratory for observing how race impacts health and healthcare delivery. Research reveals that even with similar clinical presentations:
The science is clear: race is not a biological reality with discrete boundaries, but a social construct with real biological consequences. Human genetic variation does not align with traditional racial categories, and the health disparities we observe along racial lines primarily reflect the biological impacts of social and structural inequities rather than innate genetic differences.
"We are presenting these data by 'race.' We are using 'race' here as a proxy for racism. While 'race' is socially constructed and has no genetic basis, racism has real biological, physiological, political and economic consequences" 5 .
The path forward requires researchers, clinicians, and public health professionals to directly confront and measure the structural and systemic factors that generate health disparities—moving beyond using race as a crude proxy for unmeasured social factors. It demands that we acknowledge the historical legacy of racial ideology in science while developing more precise and nuanced approaches to understanding human variation and health disparities.
In the final analysis, making sense of race requires us to hold two truths simultaneously: race may not be biologically real, but racism certainly is—and its effects on health and human wellbeing are profound and measurable. Recognizing this complex reality represents our best hope for achieving genuine health equity.