Running head: UNFORESEEN CONSEQUENCES: RACISM

Unforeseen Consequences: Racism

Lisa Mboup
ENG - 2089
April 23, 2015
Professor Oberlin

UNFORESEEN CONSEQUENCES: RACISM

Unforeseen Consequences: Racism

Poor health outcomes for African-Americans cannot be blamed on one cause. The
outcomes are the end result of multiple issues converging to diminish the health of AfricanAmericans. The racist and oppressive actions of the majority population were taken to further a
goal of hegemony and economic enrichment, not to create conditions where early death is the
result. The early death of the population from which the foundation of American wealth and
world domination was created is counter-intuitive to the economic interests of the group.
Keeping the population in control is a rational goal, killing the population is an irrational goal;
therefore the early death of formerly free, and presently underpaid labor is irrational.
Throughout this paper the preventable illness, Type II Diabetes, will be used to illustrate
the consequences of racism.
Perceptions of the Disparity
The health reports on the nightly news about the disparities between African-Americans
and other groups, while accurate, are often lacking in information regarding the root causes; the
inference is often that the problem is genetic or a bad lifestyle choice. As an example, look at the
depiction of Type II Diabetes in the African-American population. Type II Diabetes has been a
long-standing health threat to the African-American population but the problem has always been
discussed in terms of modifiable risk factors and lifestyle choices on the part of AfricanAmericans. The discussion of the food desert problem did not take place until recently, the
higher costs of healthy foods was not mentioned as a factor, and the impact of dietary habits
ingrained in the population that can be traced back to slavery was never mentioned. The clear

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implication was always, something is wrong with them, the population is bringing it upon
themselves, and the high-risk behavior is the reason.
The reality is that the disparity has roots in many areas that are non-modifiable risks.
Major factors that contribute to the health disparities include perceptions of the AfricanAmerican patients, doctor patient relationships built on mistrust, food choices, food deserts, high
poverty rates and limited exercise.
Mistrust
The mistrust factor is a major hurdle. The poor have a higher rate of mistrust of large
institutions than the general population as a part of the historic role the institutions have played
in disrupting the lives of the poor (Payne, 2003). African-Americans have a higher rate of
mistrust of large institutions as a result of historic and systemic racism (Payne, 2003 & Dingley,
2004). African-Americans in general have a higher rate of poverty than other groups (Census,
2010). That combination means that there is a significant population of poor African-Americans
who have no trust in the large institutions of society; justice, legal, education, political and
medical (Payne, 2003 & Dingley, 2004, & Katz, Kegeles, Kressin, Green, James, Wang, and
Claudio, 2008). The mistrust is not the irrational reaction to a series of misperceptions; the
mistrust is the rational reaction to a series of historical incidents.
The Tuskegee Experiments are one of the major historical incidents that resulted in
modern mistrust towards the medical profession (Katz et al, 2008). The Tuskegee Experiments
was a government funded medical research project that took place in Tuskegee, Alabama under
the direction of an African-American physician and an African-American nurse (Katz et al,
2008). A group of men, infected with syphilis, was given placebo medical treatments to see the

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long-term effect of syphilis on the human body (Katz et al, 2008). The irony of course is that
society at this time did not see African-Americans legally, or socially, as humans, and yet the
experiment to see what would happen to people was conducted. The long-term medical effects
from syphilis were not unfamiliar to the medical community; psychosis, blindness and sterility
were all well known in the literature from historical cases of untreated syphilis during a time
when there was no penicillin to treat the problem (Katz et al, 2008 & Ignatavicius & Workman,
2011). The men were allowed to think their syphilis was being treated while the researchers took
careful notes on their deterioration (Kata et al, 2008). The medical professionals did not follow
their Hippocratic Oath, instead they watched the men suffer, go insane, live in pain, lose their
sight, become sterile, developed disfigured genitalia, and have open sores leaving them
susceptible to infection, while a treatment costing less than $5 was intentionally withheld from
the population (Katz et al, 2008).
This was not an isolated incident, just one of the most well-known. Other incidents
include the University of Cincinnati radiation experiments on the poor, the New York University
low-oxygen provision to poor infants, the New York homeless study, the Columbia prisoner
experiments and the Henrietta Lacks stem cell line incidents (Katz et al, 2008 & Brinkley, 1999).
The cumulative effect of these stories results in a population that refuses to heed medical advice
that the diet eaten is not healthy, or that smoking is bad for you, or that high sodium intake leads
to strokes. The population is not ignorant for refusing to believe the medical community; the
population is logical for recognizing that there is no reason to trust the medical community.
The most surprising thing about the Tuskegee Experiments is not that they occurred, or
that medical professionals ignored their Hippocratic Oath, or that African-American medical
professionals were enlisted to run the program. The surprising thing about the Tuskegee

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Experiment is that IT ENDED IN 1972 (Katz et al, 2008). This was not a remnant of Slavery.
This was not an antebellum program. This was not a Jim Crow era incident. This was taking
place while Dr. King was marching, while Kennedy was President, while African-Americans
were protesting Vietnam, while Caucasians were smoking at Woodstock, and at a time when the
African-American middle class was coming into existence. Again, using Type II Diabetes as an
example, are African-Americans who just 40 years ago were allowed to die from a treatable
disease are supposed to trust the medical community that everything to help them is being done
by physicians? What has the medical community done to earn a return to a trusting relationship?
The UC radiation experiments took place during and after Tuskegee. The experiements
involved poor African-Americans exposed to radiation to see the effect on the body (McCarthy,
1994). No consent was requested from the patients, no charges were filed against the physicians,
no accreditation threats to the college, in fact the only punishment to the University was in the
form of civil lawsuits filed decades later after all the perpetrators were deceased (McCarthy,
1994). There is nothing in this incident that helps to restore a sense of trust between the medical
community and the African-American population.
The Henrietta Lacks stem cell case was only resolved in 2013 (Parry, 2013). Also known
as the HeLa cell line, the case involved an African-American woman who is considered the key
to solving cancer (Parry, 2013). The HeLa cells were recognized more than 60 years ago as
having value to cancer research, no one told Henrietta Lacks. The cells were taken, grown,
distributed, sold, and published repeatedly from 1960 until 2011 without a single dime, a single
signature on a consent form, or a single phone call to the family (Parry, 2013). Now the family
has a new agreement with the National Cancer Research Institute so that permission from the
family is sought for any new distributions or publications, but no compensation agreement and

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no reparations for old injustices (Parry, 2013). There is nothing in this case to provide a basis
from which trust for the medical community can be restored.
Other examples can be listed, but the point is clear; the trust between the medical
community and the African-American community was broken less than one generation ago and
nothing has been done to repair the damage.
The justice system has a historic role in maintaining the status quo between the rich and
poor, the African-American and majority population, and in general maintaining the status quo.
The education system and the financial system have both required federal intervention to reform
practices and improve disparities (Payne, 2003).
The African-American community is disparaged for not following medical advice. The
perception among the medical professionals is that the community does not care about health and
that this is a modifiable risk factor. The argument can be made that not following the advice of a
group of professionals with a documented history of misleading, stealing, harming, and failing to
provide treatment to the very population that their oaths swore to uphold is not only a smart
choice, but also the only choice that can be reasonably made. Therefore, the risk is not
modifiable on the part of the patient; the risk is modifiable on the part of the American medical
community.
Food Choices
Food choices are credited as a modifiable risk. High fat products, processed foods, high
fructose corn syrup products, high sodium, snack items and processed meats are all discussed as
negative dietary habits of the low-income African-American community. The problem is that

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there are not always food choices being made by the population, the choice is made before the
food is sent to the store.
Studies of urban communities nationwide have found a phenomenon referred to in the
literature as Food Deserts. A food desert is defined as a section of the urban landscape where
there is no point-of-sale for fresh fruits and vegetables (Center for Closing the Health Gap,
2015). The most infamous food desert reported nationally was about the city of Detroit. Within
the city limits, there was a 10-year span where no major grocery chain had a store (Harrison,
2009). Kroger, Walmart, Thriftway and Aldi had all closed locations in the area (Harrison,
2009). The city was not the result of a natural disaster, or war-torn Fallujah, this is a major
American city with professional sports franchises and the headquarters of a multinational car
company, but no grocery store.
The Food Desert problem is especially harmful to the poor. The often lack transportation.
Not having a car makes grocery trips expensive because the person must pay for a ride. Needing
a ride to the store, and having that ride cost, limits the number of trips per month. During the
limited trips the purchases made with be of non-perishable items. Even if perishable items are
purchased there can only be a limited quantity that may last a week or so, but the majority of
African-American women in poverty shop once-per-month according to a study in the magazine
Appetite (Disantis, 2014). The reasons for only shopping once-per-month are a combination of
transportation issues, financial issues, and employment scheduling (Disantis, 2014). The food
choices designed to last 30 days in storage are processed foods, canned foods, frozen foods, and
snack foods.

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The financial considerations for poor women also lead to processed foods. A 2-liter
bottle of a generic soft drink is under $1.00 (Disantis, 2014). Smaller quantities of orange juice
or milk is over $2.00 (Disantis, 2014). A 600-calorie package of Ramen noodles is $0.29 and to
get 600-calories from apples would cost over $2 since each is only 85-calories (Disantis, 2014).
The Ramen noodles can last for years, the apple has a life of about 8 days. The poor shopper has
to limit the percentage of the budget spent on food, and the options considered unhealthy are less
expensive. The financial circumstances leave the poor shopper with limited choices.
The places to shop are limited, the food products offered are limited, the food options that
are within financial reach are limited, and the African-American shopper is derided as making
bad choices? Where was the choice? The shopper cannot choose among stores, or among
products. The choice comes from the societal structure that makes it possible for grocery chains
to obtain licensing, tax breaks, and incentives to open stores in the suburbs and not the urban
core.
Poverty
In raw numbers, African-Americans are not the majority of poor people, but by
percentage they have the largest group in poverty (U.S. Census, 2010). Thirty-eight percent of
the children living in poverty in the United States are African-American; that is the largest group
by over four percent (U.S. Census, 2010). Ruby Paynes wrote a book called A Framework for
Understanding Poverty. In the book Dr. Payne helps the reader view society through the lens
of several different socioeconomic groups. While examining the societal views of the poor Dr.
Paynes research revealed a massive distrust of large institutions and of any institution that
depends on paperwork. In her analysis she posits that the middle class values the paper trail of a

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life: credit reports, medical records, police records, and transcripts. For the impoverished groups
personal relationships are what matters and are the method for judging others; whether or not a
friend will loan you money is more important than if the bank will loan you money. Without
using this particular vocabulary the records kept by the dominant culture are used as a
hegemonic practice towards the subordinate culture. The notes taken, behavior reports from
school, job evaluations, police documents were all created as a means to brandish the individual
with a scarlet letter that holds them back from full entrance into the dominant culture. Now in
the computer age no record ever dies and the mark put upon a person at a young age follows
them forever preventing entrance to the middle class permanently. The mistrust of large
institutions starts early and extends to the medical field. Even something as seemingly
transparent as the kidney transplants, necessary after long-term Type II Diabetes are subject to
racial disparities.
According to Dr. Susan L. Furth racial disparities exist in access to the renal transplant
list even in pediatric cases, the study attributes the disparities to multiple variables including bias
in identification, and presentation to a nephrologist (Furth, 2000). As an African-American
reading that research conclusion the immediate implication is that the general practitioners and
pediatricians are not treating the children properly and not referring them to the nephrologist.
The possible actual causes that come to mind could be that poorly trained doctors end up at the
clinics serving the poor, or that the doctors dont care out of racism, or a lack of insurance
leading to fewer referrals. Whatever the reason for the disparity, to the African-American patient
on the waiting list the first cause that comes to mind is racism.
The current transplant system perpetuates the perceptions of racism by having an
extremely complicated process that takes hundreds of pages and is so full of medical jargon that

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the nonprofessional would have significant trouble reading the document (UNOS, 2012). As an
African-American the part of the system that feels shady in my mind is the regional aspect of the
allocation system. There are 11 regions of the United States and they are not balanced racially.
African-Americans comprise 12% of the United States population (US Census, 2010). In region
8 for example the following states are included: Colorado, Iowa, Kansas, Missouri, Nebraska,
and Wyoming. The average population of African-Americans in those states is less than 3% (US
Census, 2010). An organ that is procured in that region is unlikely to ever be placed with an
African-American donor and the African-American residents of that region have almost no
chance of procuring an African-American kidney. In an age of jets that can cross the country in
less than 8 hours and the ability to keep a kidney more than 24 hours why are there regions?
Someones needs are served by those regions and it is safe to assume given US history that the
regions were not set up to benefit African-Americans.
The impact of poverty on the community is that a larger percentage of the population
lives within food deserts. The Type II Diabetes problem among African-Americans is
exacerbated by poverty by limiting the shopping options and access to fresh products.
Limited Exercise
The exercise habits of African-Americans in poverty are limited by poverty. The poor
cannot afford the price of a gym membership, the free exercise options like walking and
bicycling are challenged by the low-income, high-crime, communities of the poor (Gyan, 2004).
If the community is unsafe the residents cannot go for a peaceful walk. Additionally the trends
of city created walking paths and bicycle trails is not a phenomenon that has located options in

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the impoverished communities, but is instead has led to trails from the business districts to the
inner suburbs and high-income communities (Gyan, 2004).
African-Americans make up a high percentage of blue-collar jobs, service industry jobs
and labor-intensive jobs (Census, 2010). The positions already require the burning of significant
calories to complete the workday. Exercising for many people after the workday is completed is
not feasible given the physical requirements and the need to save energy for the next day. The
rest of the population, lacking free options, and indoor equipment, are no getting proper exercise.
Cumulative Risk Factors
The risk of a poor diet, and limited exercise, is a bad combination leading to Type II
Diabetes (Ignatavicius, 2011). The African-American population has a genetic predisposition to
certain diseases that is documented in multiple medical journals and textbooks (Bihm, 2006 &
Churpek et. al, 2015 & Ignatavicius and Workman, 2013). The frequency of medical visits, diet,
exercise habits, and access to healthy food options are all influenced by race (Associated Press,
2000, DiSantis, 2014, Jancin, 2013 and Gyan, 2004). The exacerbating factor of racism is
documented by multiple studies and interacts with health in multiple ways (Gee and Ford, 2011).
Racism incites the same fight or flight reaction as danger, but the body can often do neither;
because of the circumstances lived and because of legal implications (as the news has recently
reported in police interactions fight you get arrested, flight you get arrested) (Gee and Ford,
2011). The release of unneeded adrenaline and cortisol for running or fighting exposes the
kidneys, pancreas, liver, and kidneys to the higher levels and over time health is damaged (Gee
and Ford, 2011 and Ignatavicius & Workman, 2011). Over time, the damage from stress and the
damage from Type II Diabetes on the kidneys are indistinguishable since both damage the

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nephrons (Ignatavicius & Workman, 2011). The determination of which caused the damage, and
in what percentage to attribute damage, is not possible for the physician to determine in the
presence of both problems (Gee & Ford, 2011 and Ignatavicius & Workman, 2011).
Conclusion
The combination of all the issues proves that the determination of Type II Diabetes as a
modifiable disease risk is not correct for all populations. For the population of poverty stricken
African-Americans, especially women, the diagnosis of Type II Diabetes is not a modifiable risk.
Calling the process inevitable may take the argument too far; but when the risks are not
modifiable what is the correct designation?
Intended Consequence
The intended outcome of the system is hegemony. The process of hegemony is the
development of practices and policies to keep the dominant culture in the power position, and the
subordinate culture in the powerless position.
In Paolo Freires, Pedagogy of the Oppressed, the techniques used to maintain
hegemony are discussed. One of the more powerful techniques of the dominant culture is to
provide the subordinate culture with activities, organizations, and information that simulate
power to keep them busy and distracted from organizing into actual power activities (Freire,
1986). The example of this used in schools is the student council, in cities the community
council, and for many large organizations the sub-committees of a board. In each of those cases
the only power held by the group is that delegated by the larger body. The student council can
pass resolutions regarding a limited set of issues and a faculty advisor or the principal often
ratifies all their decisions. The student paper is under the same control. Rather than act as an

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independent watchdog similar to the role of real newspapers, the school newspaper functions as a
propaganda arm under the direction, editorially and financially, of the school.
African-Americans have been treated the same way. The NAACP, the Urban League, the
National Action Network and other bodies formed with the purpose of racial justice, each find
themselves over-time applying for federal grants, collecting corporate contributions, and
operating as a subcommittee of the real power structure. The financial dependence upon outside
sources also makes the organization beholden to the dictates of those organizations. In
Cincinnati, the NAACP branch was the recipient of anti-drug funds from the local prosecutor, the
organization did not endorse any candidates in the next prosecutors race after the funds were
issued.
When the leaders accept hegemony, the followers are left unable to develop a plan to
fight the hegemony. The money, planning, brainpower, resources, and energy are all consumed
with the channels set up by the dominant culture. The members of the subordinate culture that
break-off from the channels can be noted as possible threats to the hegemony.
The medical problems that result from racism were not a part of the planning. The
problems are the unintended confluence of the conditions. The pockets of poverty were part of
the plan to keep the poor from mixing with the rich in schools. The lack of investment in lowincome communities, including investment in grocery stores, is the plan, the food deserts that
resulted were not the plan. The purchasing of processed foods was not the plan, but the cost
disparity resulting from a lack of competition has pushed the customers to the lower priced
foods. The mistrust from long-term medical abuse was not the plan. The people in charge
would, according to the precepts of Freire, prefer that the population remain compliant and

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engaged (Freire, 1986). The fact that the population rebels, in even the small way of ignoring
medical advice, is the kind of dissent that the dominant culture does not allow.
Carter G. Woodson, author of The Miseducation of the Negro, put forward the same
concept in his work, but using different terminology than Paolo Freire. Carter states that if a
person has been indoctrinated to only use the backdoor of a house, the person will create a back
door when none is present rather than break their indoctrination and walk through the front door
(Woodson, 2012). The African-American population in this country was brainwashed for a long
time, no matter how badly the population was treated there were many in the population still
dedicated to full assimilation.
Now, he mistrust has fully come home to roost. After decades of African-Americans
ignoring medical advice, the high cost of treating Type II Diabetes has motivated the government
to step up efforts to regain trust. The Affordable Care Act specifically targets the disorder. The
dominant culture wishes to repair the rift with the subordinate culture, to regain full control.
The loss of trust was never the goal, the presence of mistrust is an unintended
consequence that has caused financial hardship and more importantly a loss of control.
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