How Race Becomes Biology Embodiment of Social Inequali - PDF document

HowRaceBecomesBiology:EmbodimentofSocialInequalityClarenceC.Gravlee*DepartmentofAnthropology,UniversityofFlorida,Gainesville,FL32611-7305KEYWORDSrace;genetics;humanbiologicalvariation;health;racismThecurrentdebateoverracialinequal-itiesinhealthisarguablythemostimportantvenueforadvancingbothscienti“candpublicunderstandingofrace,racism,andhumanbiologicalvariation.IntheUnitedStatesandelsewhere,therearewell-de“nedinequalitiesbetweenraciallyde“nedgroupsforarangeofbiologicaloutcomes„cardiovasculardisease,diabetes,stroke,certaincancers,lowbirthweight,pretermdeliv-ery,andothers.Amongbiomedicalresearchers,thesepatternsareoftentakenasevidenceoffundamentalgeneticdifferencesbetweenallegedraces.However,agrowingbodyofevidenceestablishestheprimacyof *Correspondenceto:ClarenceC.Gravlee,DepartmentofAnthro-pology,UniversityofFlorida,1112TurlingtonHall,POBox117305,Gainesville,FL32611-7305,USA.E-mail:cgravlee@u”.eduReceived16May2008;accepted27October2008DOI10.1002/ajpa.20983Publishedonline18February2009inWileyInterScience(www.interscience.wiley.com).2009WILEY-LISS,INC.AMERICANJOURNALOFPHYSICALANTHROPOLOGY139:47…57(2009) culturalphenomena.Second,epidemiologicalevidenceforracialinequalitiesinhealthreinforcespublicunder-standingofraceasbiology;thissharedunderstanding,inturn,shapesthequestionsresearchersaskandthewaystheyinterprettheirdata„reinforcingaracialviewofbiology.Itisaviciouscycle:Socialinequalitiesshapethebiologyofracializedgroups,andembodiedinequal-itiesperpetuatearacializedviewofhumanbiology.Inthisarticle,Iaddressbothwaysthatracebecomesbiology.Toestablishthesigni“canceoftheproblem,Ibeginwithabriefreviewoftheepidemiologicevidenceregardingracialinequalitiesinhealthandshowthattheseinequalitiesarecommonlyinterpretedasevidenceoffundamental,geneticdifferencesbetweenraces.Then,giventhepersistenceofracial…geneticdeterminism,Iarguethatitisnecessarytoclarifyandre“nethecritiqueofraceinthreeways:1)toreiteratewhyraceisinsuf“-cientfordescribinghumangeneticdiversity,2)topromoteamorecomplex,bioculturalviewofhumanbiology,and3)totakeseriouslytheclaimthatraceisaculturalconstructthatprofoundlyshapeslifechances.Drawingonsocialepi-demiologyandallied“elds,Iproposeamodelforanthro-pologicalresearchonracialinequalitiesinhealththatemphasizesthedevelopmentandintergenerationaltrans-missionofracialhealthdisparitiesacrossmultiplelevelsofanalysis.Thismodelimprovesonthestandardcritique,whichdismissedraceasbadbiologywithoutofferingaconstructiveframeworkforexplainingbiologicaldifferen-cesamongraciallyde“nedgroups.Italsoentailsashiftinhowwearticulatethecritiqueofraceasbadbiology.WHATISRACE?Debateaboutraceoftenfoundersonambiguityinthede“nitionofrace.FollowingSmedley(2007,p18),Ide“neraceasaworldview:aculturallystructured,systematicwayoflookingat,perceiving,andinterpretingreality.InNorthAmerica,acentraltenetoftheracialworldviewisthathumansarenaturallydividedintoafewbiologicalsubdivisions.Thesesubdivisions,orraces,arethoughttobediscrete,exclusive,permanent,andrelativelyhomoge-nous(KeitaandKittles,1997;Banton,1998;Smedley,2007).Theraceconceptalsoimpliesthatthesuper“cialtraitsusedtodistinguishracesre”ectmorefundamental,innatebiologicaldifferences(Smedley,2007).Thisde“ni-tionshouldnotbetakentomeanthatraceismerelyabadidea.Raceemergedfromuniquematerialcircum-stancesinEnglishNorthAmerica(Harris,1964),andracismremainsembeddedinsocial,political,andeconomicstructuresintheUnitedStates(Feagin,2006).Someresearchers(e.g.,LongandKittles,2003)distin-guishbetweenfolkandscienti“cde“nitionsofrace.Thisdistinctionmaybemisleading,becausescientistshaveplayedapivotalroleinconstructingandlegitimatingraceforcenturies(Brace,2005).Thekeyelementsoftheracialworldviewpersistedinanthropologywellintothetwentiethcentury(Caspari,2003),anditstillshapesmuchresearchonraceandhealth.RACEANDHEALTH:EPIDEMIOLOGICALEVIDENCEThereisabundantevidenceofhealthinequalitiesamongraciallyde“nedgroupsinmanysocieties(e.g.,BrockerhoffandHewett,2000;Cutteretal.,2001;PanAmericanHealthOrganization,2001;Nazrooetal.,2007;Hardingetal.,2008).Here,IfocusontheUnitedStates,whereepidemiologicaldatahasre”ectedandre-inforcedscienti“cthinkingaboutraceformorethan200years(Krieger,1987).EpidemiologicalevidenceintheUnitedStatesshowsthattherearesubstantialracialinequalitiesinmorbid-ityandmortalityacrossmultiplebiologicalsystems.Themortalitypro“leisbleakestforAfricanAmericans:In2004,theoverallage-adjusteddeathrateforblackAmer-icanswasmorethan30%higherthanitwasforwhiteAmericans;forsomeleadingcausesofdeath,thedispar-itywassubstantiallyhigher.Age-adjusteddeathratesfromdiabetes,septicemia,kidneydisease,andhyperten-sionandhypertensiverenaldiseasewereallmorethantwotimeshigheramongAfricanAmericansthanamongwhites(Mininoetal.,2007).Cardiovasculardiseaseaccountsforthelargestshareofblack…whitedifferenceinmortality(34.0%),buttherearealsosubstantialcon-tributionsfrominfections(21.1%),trauma(10.7%),dia-betes(8.5%),renaldisease(4.0%),andcancer(3.4%)(Wongetal.,2002).Similarinequalitiesexistininfantmortalityandlifeexpectancy.From1990to2004,infantmortalitydeclinedby26%(9.2to6.8per1,000livebirths)fortheUnitedStatesasawhole,butthegapbetweenblackandwhiteAmericansremainedapproximatelythesame(seeFig.1).In2004,theinfantmortalityrateamongAfricanAmericanswas2.4timestherateofothergroups,ascomparedto2.3in1990(Keppeletal.,2002;MathewsandMacDorman,2007).Black…whiteinequalitiesinlifeexpectancyatbirthnarroweddramaticallyintheearlytwentiethcentury„from17.8yearsin1903tolessthansevenin1995„butchangedrelativelylittleinthesec-ondhalfofthecentury(Fig.2).In1995,theblack…whitegapinlifeexpectancywasthesameasitwas40yearsearlier„6.9years.Onlyrecentlyhasthegapnarrowedtoitshistoriclowofjustover5years(NationalCenterforHealthStatistics,2007).Muchoftheepidemiologicalliteraturefocusesonsuchblack…whitecomparisons.Thisfocusisjusti“edongroundsofthemagnitudeandhistoricaldepthofinequalitiesbetweenblackandwhiteAmericans,butcrudeblack…whitecomparisonsarelimitedinatleastthreeways.First,theyconcealvariationinmorbidityandmortalitypro“leswithinracialcategories.Second,theyneglectthechangingracialdemographyofthe Fig.1.InfantmortalityintheUnitedStates,1995…2004,byraceandethnicity(Datasource:NationalCenterforHealthSta-tistics.2007.Health,UnitedStates,2007.Hyattsville:NationalCenterforHealthStatistics).C.C.GRAVLEEAmericanJournalofPhysicalAnthropology UnitedStates,whereAfricanAmericansarenolongerthelargestethnicminoritygroup(Smelseretal.,1999).Third,theyimplythatraceperseisanimportantcauseofhealthinequalities,ratherthanfocusingonthespe-ci“ccausalfactorsthatshaperacialinequalitiesinhealth(KaufmanandCooper,1995).Bothgeneticandsocialepidemiologistsaredevelopingnewapproachestoovercometheselimitations(GonzalezBurchardetal.,2005;Kriegeretal.,2005;Murrayetal.,2006),butmuchofthedebateisstillframedinblackandwhite.PERSISTENCEOFRACIAL…GENETICDETERMINISMInarecentreview,Dressleretal.(2005a)identi“ed“vemajormodelsthatresearchersusetoexplainracialinequalitiesinhealth.Fourmodelsemphasizeenviron-mentalfactors,including1)socioeconomicstatus,2)healthbehaviors,3)psychosocialstress,and4)socialstructureandculturalcontext.The“fthmodelassumesthatgeneticfactorscontributesubstantiallytoracialinequalitiesinhealth.Thisracial…geneticmodelcontin-uestoinformmuchbiomedicalresearchandclinicalpractice(Braun,2006;Frank,2007).Racial…geneticdeterminismpersistsinpartbecauseoftheuncriticaluseofraceinbiomedicalsciencesandpub-lichealth.Systematicreviewsinhealth-relateddisciplinesshowthatraceiswidelyused„appearingin80%ofrecentarticles„butthatitisseldomde“ned(AndersonandMoscou,1998;Drevdahletal.,2001;Comstocketal.,2004;GravleeandSweet,2008).Forexample,inthreein-dependentreviewsofliteratureingenetics(Sankaretal.2007),infantmortalityresearch(AndersonandMoscou,1998),andhealthservicesresearch(Williams,1994),notasinglearticlede“nedrace.Inlieuofexplicitde“nitions,researcherstypicallyuseraceasaproxyforsomeunspeci“edcombinationofenvi-ronmental,behavioral,andgeneticfactors(LinandKelsey,2000).Suchusagenotonlyobscuresthecausesofracialinequalitiesinhealth;italsofavorsthedefaultassumptionthatracialdifferencesaregeneticinorigin.ConsidertheimplicitracialessentialisminarecentreportfromTheAmericanJournalofSurgery:IsbreastcancerinyoungLatinasadifferentdisease?(Bif”etal.,2001).Bif”etal.beginwiththepremisethatracemayfurtherin”uencebreastcancerprognosis,andtheyseektoclarifytherelationshipbetweenrace/ethnicityanddiseaseseverity(p596).Despitethisaim,thepaperconcludessimplythatyoungLatinasmighthavemoreaggressivediseasecomparedtootheryoungwomen(p598).Bif”etal.donotsuggestwhatbiologicalprocessmightaccountforthisdifference.Theyalsodonotexplainwhattheymeanbythetermrace/ethnicity.Discussantsofthepaperpickeduponthispoint,how-ever,andtheirpublishedcommentsrevealthedefaultassumptionthatracereferstogeneticdifferences.Dr.Zanniswasstruckbyhowprimitiveweareinidentifyingwhatpatientsampleweretalkingabout(Bif”etal.,2001,p600).Hesuggestedthathowweraciallypro“leourpatientsinthesestudiesisimportant,andadded:Ithinkinthefuture,weregoingtohavetogetmoreso-phisticatedwithidentifyinggenepoolsandnotusethecolorofthepatientsskin.Likewise,Dr.Allocautioned:IthinkitsreallyimportantthatyoudefinewhatyoumeanbyLatinabecausethiscouldmeanMexican,itcouldmeanCentralAmerican,itcouldmeanPuertoRican,andIdontthinkthatyouredealingwithageneticallyidenticalgenepoolinthebestofcircumstances(Biffletal.,2001,p600).Bothcommentatorsareunquestionablyright,buttheirremarksaremostsigni“cantbecausetheydisclosetheassumptionthatrace/ethnicitymeansgenepools.Thisassumptionpervadesmuchbiomedicalresearch,althoughitusuallyfocusesonblack…whitecomparisons(Rebbecketal.,2006).Forexample,manyresearchersassumethatAfricanAmericanspoorersurvivalafteracancerdiagnosis,comparedtowhites,re”ectsfunda-mentaldifferencesinthebiologyofthehostortheat-tendantcancerorboth(Bachetal.,2002).Similarly,Pickering(2001,p50)notesthatalmostalloftheworktoexplainexcesshypertensionamongAfricanAmericanshasinvolvedtheunderlyingassumptionthatthereissomegeneticallydeterminedphysiologicaldifference.Thisassumptionismostproblematicwhenuntested.Considerarecent,widelypublicizedstudyofracialinequalitiesinpretermbirth.Thestudyclaimedtopro-videevidenceforimportantgeneticcontributorstothetimingofbirth(Kistkaetal.,2007,p131.e1)andwasfeaturedintheNewYorkTimesundertheheadline,Studypointstogeneticsindisparitiesinpretermbirths(Bakalar,2007).However,thestudyactuallypre-sentednogeneticdata.Instead,researchersinferredageneticcausefromtheresidualdifferencebetweenblackandwhitemothers,aftercontrollingforafewhealthbehaviorsandcrudelymeasuredsocioeconomicvariables.This“ndingdoesnotwarranttheconclusionthatracialinequalitiesaregeneticinorigin;genetichypothesesrequiregeneticdata.Yet,inapublishedroundtabledis-cussion,severalcommentatorsagreedthatthegeneticlinkisverystrongandthattheblack…whitegapmaybestbeexplainedbyageneticetiology(Stamilioetal.,2007,pe4,e5).REFININGTHECRITIQUEOFRACEThepersistenceofuntestedassumptionsaboutrace,genes,andhealthrequiresthatthecritiqueofracebere“nedinthreeways.First,itisimportanttoclarifywhyrecent“ndingsinpopulationgeneticsdonotrefute Fig.2.LifeexpectancyatbirthintheUnitedStates,1900…2004,byraceandethnicity(Datasource:AriasE.2006.UnitedStateslifetables,2003.NatlVitalStatRep54:1…40;NationalCenterforHealthStatistics,2007).[Color“gurecanbeviewedintheonlineissue,whichisavailableatwww.interscience.wiley.com.]HOWRACEBECOMESBIOLOGYAmericanJournalofPhysicalAnthropology theclaimthatraceisinadequatetodescribeglobalhumangeneticdiversity.Second,itiscriticaltorefocusattentiononthecomplex,environmentalin”uencesonhumanbiology.Third,itisnecessarytorevisethecon-ventionalviewofraceasaculturalconstructtostimu-latenewresearchonthesocioculturaldimensionsofraceandracism.Idiscusseachpointinturn.RaceHumangeneticvariationTheclassiccritiqueofracehasfocusedonthreeclaims.First,mosthumangeneticvariationisclinal,suchthatthereareseldomcleargeneticboundariesbetweenpopulations(Livingstone,1962;Serreandbo,2004;BarbujaniandBelle,2006).Second,mosthumangeneticvariationisnonconcordant,suchthatthetraitsweusetodistinguishracesmayhavenovalueforpredictingotheraspectsofbiology(Goodman,2000;JordeandWooding,2004).Third,humangeneticvaria-tioniswidelysharedacrossourspecies,withrelativelylittlevariationoccurringbetweenraciallyde“nedgroups(Lewontin,1972;LongandKittles,2003).Ourbasicunderstandingofthesepatternshasnotchangedin50years,despiteenormousimprovementsinourtechnicalabilitytodescribehumangeneticvariation(WeissandFullerton,2005).Yetsomeresearchersstilldefendraceasausefulframeworkfordescribinghumangeneticvariation„andforidentifyinggeneticin”uencesonracialdifferencesindisease(Rischetal.,2002;GonzalezBurchardetal.,2003;Bamshadetal.,2004).Thedefenseofracereliesontworelatedlinesofevidence:1)studiesofworldwidegeneticvariationshowthatindividualsfromthesamecontinentreliablyclustertogether(Rosenbergetal.,2002;Bamshadetal.,2003;Shriveretal.,2004;Rosenbergetal.,2005),and2)intheUnitedStates,self-identi“edrace/ethnicityisausefulproxyforgeneticdifferentiationbetweengroupsthatvaryinconti-nentalancestry(Tangetal.,2005).These“ndingshaveimportantimplicationsforgeneticepidemiology(Barnholtz-Sloanetal.,2008)andpopulationhistory(TishkoffandVerrelli,2003),buttheydonotrefutethekeyargumentsagainsttheraceconcept.First,theclaimthatrecentgeneticstudieshaverecapitulatedtheclassicalde“nitionofraces(Rischetal.,2002,p3)misrepresentsthepurposeofclusteranalysis,whichistodetectpatterninagivendataset,notdeterminetheessentialnumberofsubdivi-sionsinourspecies.AnexampleofthiserroristhecommoninterpretationofRosenbergetal.(2002)asevi-dencethathumansaredividedinto“vegeneticclusters(e.g.,Bamshadetal.,2004;MountainandRisch,2004;Leroi,2005;Tangetal.,2005).Evidencethathumanscanbedividedinto“veclustersdoesnotmeantheynaturallydivided,astheclassicalde“nitionofracewouldsuggest.Infact,thenumberofclustersnecessarytodescribeglobalgeneticvariationhasbeeninconsis-tent;somestudiesreport“ve(Rosenbergetal.,2002)andothersseven(Coranderetal.,2004;Lietal.,2008).Evenwhenthenumberofclustersisconsistent,theirboundariesandcompositionarenot[compareCoranderetal.,(2004)andLietal.,(2008)],and“nersubstruc-turesareobscured.Second,currentdefendersofracepositionthemselvesagainstastraw-manviewthatracialandethniccatego-riesarepurelysocialanddevoidofgeneticcontent(Risch,2006,p408).Thismisleadingportrayalofthecri-tiquesetsthebartoolowforproponentsofracialclassi-“cation;toresuscitaterace,alltheymustdoisshowthattheycanreliablydetectsomegeneticdifferentiationbetweenraciallyde“nedgroups,butthecritiqueofracedoesnotimplythatracialcategoriescorrespondtonogeneticdifferentiation.Onthecontrary,theargumentthatconventionalracialclassi“cationaccountsforonly5…10%ofhumangeneticvariation(Lewontin,1972;BrownandArmelagos,2001)impliesalevelofgeneticdifferentiationthatclusteringalgorithmsoughttodetect.Evidenceofgeneticclustering,then,doesnotcon-tradicttheclaimthatmosthumangeneticvariationoccurswithinratherthanbetweentraditionalracialcat-Third,recentstudiescon“rmtheclaimthatmosthumangeneticvariationisclinal.Severalresearchershaveshownthatgeneticdistanceisstronglyassociatedwithgeographicdistancebetweenpopulations(SerreandPabo,2004;Manicaetal.,2005;Handleyetal.,2007;Lietal.,2008).Theassociationisevenstrongerifonetakesinaccountprobablemigrationroutesbetweencontinentsoverhumanhistory.Forexample,Ramachan-dranetal.(2005)showthatgeographicdistancesbasedonlikelymigrationpathsexplain78%ofthevariationingeneticdistancesbetweenpopulations.OtherstudiesshowthatgeographicdistancefromEastAfricaexplains82…85%ofthegeneticdiversitywithinpopulations(Prugnolleetal.,2005;Lietal.,2008).ThispatternisconsistentwithasingleoriginofanatomicallymodernhumansinEastAfrica,followedbyserialmigrationstootherpartsoftheglobe.Recentstudiessuggestthatbothclinesandclustersarepartofthestructureofhumangeneticvariation,butclustersexplainrelativelylittletotalvariation(Handleyetal.,2007).Fourth,theclaimthatcontinentalancestrymayhelptoexplainracialdifferencesindisease(Salarietal.,2005;Risch,2006;Tangetal.,2006)posesconceptualandmethodologicalproblems:First,estimatesofgeneticancestryaregenerallybasedonnoncodingDNAwithunknownfunctionaleffectsondisease(Cooperetal.,2003).Second,manyallelesassociatedwithcommon,complexdiseasesarelikelytobeancientandsharedacrosscontinentalclusters(Keitaetal.,2004).Third,nonconcordanceimpliesthatgeneticclustersbasedonneutralmarkersmaydifferfromclustersbasedonsus-ceptibilityalleles(JordeandWooding,2004).Fourth,inraciallystrati“edsocietiesliketheUnitedStates,conti-nentalancestryislikelytobeconfoundedwithmanyenvironmentalfactors;consequently,reportedassocia-tionsbetweengeneticancestryanddiseasemaybemedi-atedthroughunmeasuredenvironmentalmechanisms(KaufmanandCooper,2008).Theseconsiderationsimplythatresearchersshouldtestspeci“chypothesesaboutthemechanismslinkingancestryanddiseaseandremaincog-nizantthatcomplexdiseaseinvolvestheinteractionofmanygeneticandenvironmentalin”uences.Tobeclear,thecritiqueofraceisneitheradenialofhumanbiodiversity,noraclaimthatgenesareirrelevanttoracialinequalitiesinhealth.Rather,thecentralargu-mentisthattheraceconceptisinadequatefordescrib-ingthecomplexstructureofhumangeneticvariation.Clearly,thereisgeographicstructuretohumangeneticvariation.ThisstructureismostconsistentwithamodelofserialfoundereffectsbeginningwithasingleAfricanoriginofourspecies.Relativelylowlevelsofgeneticdif-ferentiationacrossmajorbarrierstogene”ow(e.g.,C.C.GRAVLEEAmericanJournalofPhysicalAnthropology Himalayas,theSaharadesert)appeartoproduceminordiscontinuitiesthatcanbedetectedbyclusteringalgo-rithms(Rosenbergetal.,2005),buttoemphasizeclus-teringattheexpenseofclinalvariationandwithin-regiondiversity„thedominantsignals„istoprivilegeatypologicalviewofhumangeneticvariationwithpre-Darwinianroots(Caspari,2003).GeneticsTheargumentthatracedoesnotcorrespondtoglobalpatternsofhumangeneticvariationhascometodomi-natethecritiqueofrace.Yet,asimportantasthegeneticevidenceis,itunderstatesthecaseagainstrace.Indeed,theemphasisongeneticevidencemayunderminethecritique,becauseittacitlyacceptstheprimacyofgenesindescribingandexplaininghumanbiologicalvariation.Thus,itisimportanttoexpandthecritiqueofracebyrejectingnaš¨vereductionismandreplacingitwithamorecomplexviewofhumanbiologythatacknowledgestheinterplayoforganismsandenvironmentsoverthelifecourse.Thisgoalmayrequireashiftinthewaywearticulatethecritiqueofrace.Oftenthecritiqueiscondensedtotheideathatraceisnotbiology.Sometimes,thisideaappearsinthecontextofmoresubtleargumentsaboutthecomplexityofhumanbiology(e.g.,Goodman,2000),butmoreoftenitstandsaloneasaritualrepudiationoftheracemyth.Despiteitspopularityinscholarlycircles,thisritualhasfailedtoswaypublicunderstandingofrace.Asoneobserverputit,Clearlyformainstreampopularculture,theideathatraceisnotbiologyisstillsurprisingnews(Caminero-Santangelo,2004,p207).Thedebateoverracialinequalitiesinhealthbringsthisproblemintosharprelief.Epidemiologicevidenceshowsthat,inaverycertainsense,racebiology.Thereare,infact,well-de“neddifferencesbetweenraciallyde“nedgroupsforarangeofbiologicaloutcomes„cardi-ovasculardisease,diabetes,renalfailure,cancer,stroke,andbirthoutcomes,tonameafew.Inthefaceofthisevidence,therefrainthatraceisnotbiologyisimpotentatbest,counterproductiveatworst.Thechallengeistomovebeyondthepatassertionthatraceisnotbiologytoexplainhowracebiology.Thisshiftinemphasissuggeststhatwemayneedtodevoteasmuchattentiontorevisingourconceptionofbiologyaswedotoourconceptionofrace.Someobserv-ersmaybeuneasywithtalkofbiologicaldifferencesamongraciallyde“nedgroups.Theymayworry„withgoodcause„thatsuchtalkreinforcestheperceptionofintrinsic,geneticdifferencesbetweenallegedraces.Thiswell-foundedconcernisimportant,becauseitrevealshowdeeplyentrenchedthetwinassumptionsofreduc-tionismandgeneticdeterminismareinourunderstand-ingofrace(Caspari,2003)andbiologyingeneral(Lewontin,2000).Theideathatitispoliticallydanger-oustodiscussbiologicaldifferencesamongraciallyde“nedgroupsmakessenseonlyifwe(orouraudience)implicitlyreducebiologytogeneticsandminimizeorignorethecausalin”uenceofexternal,environmentalfactorsonhumanbiology.Thetacitcon”ationofgenesandbiologyintheconventionalcritiqueofraceunwit-tinglyperpetuatesthisformofreductionism.Recentresearchonracialinequalitiesinhealthpro-videsacounterweighttoreductionismandlendssupportforrenewedattentiontophenotypicplasticityandacom-plexviewofhumanbiologyasbiocultural.Onein”uen-tialmodelisKriegersecosocialtheoryforsocialepide-miology(Krieger,1994,2001).Tocomprehendhumansdualstatusasbiologicalorganismsandsocialbeings,Kriegerproposestheconstructofaconceptreferringtohowweliterallyincorporate,biologically,thematerialandsocialworldinwhichwelive,fromconceptiontodeath;acorollaryisthatnoaspectofourbiologycanbeunderstoodabsentknowledgeofhistoryandindividualandsocietalwaysofliving(Krieger,2005,p352).Thereisanobviousaf“nitybetweenacenturyofanthropologicalresearchonhumanbiologyinthecontextofculture.Indeed,FranzBoasmightbeseenasapioneerinthestudyofembodiment.Hisdem-onstrationthatdescendantsofimmigrantsembodiedthenewAmericanenvironment(Boas,1912)establishedplasticityasacentralconstructinhumanbiologyandturnedthetideagainstbiologicaldeterminisminanthro-pology(Gravleeetal.,2003).Yettheconstructofdoesworkthatalonedoesnot.Inparticu-lar,Kriegersmodelre”ectsanemergingconsensusthatthenextwaveofresearchneedstointegrate1)multiplelevelsofanalysiswith2)developmentalandlife-courseperspectives.TheconceptualmodelinFigure3illus-tratestheapproach,drawingonpreviousrecommenda-tionsforresearchonthesocialpatterningofhealth(e.g.,Kaplan,2004;GlassandMcAtee,2006;DiezRoux,2007;Krieger,2008).Akeyfeatureofthismodelisthatitsituatespheno-typeattheintersectionoftwoaxes.The“rst(horizontal)axisrepresentstime.Thisaxismayre”ectlife-course,developmentalprocessesatanindividuallevelorhistori-calchangeatapopulationlevel(GlassandMcAtee,2006).Thesecond(vertical)axisrepresentsthenestedhierarchyofcausalin”uencesonphenotypes,rangingfromthegenometoglobalpoliticaleconomyandecology.Thelinedepictingembodimentrepresentsthedirectandindirectin”uencesofsocioculturalcontextatmultiplescalesandlevels(Krieger,2008)ongeneexpressionandbiologicalfunctioning.Althoughthemodeldrawsoncur- Fig.3.Conceptualmodelforthestudyofmultilevelandde-velopmentalin”uencesonphenotype.HOWRACEBECOMESBIOLOGYAmericanJournalofPhysicalAnthropology rentdevelopmentsinhealth-relatedsocialsciences,themainelementsandconnectionsarealsorecognizedinanthropology(e.g.,Baker,1997;GoodmanandLeatherman,1998;KuzawaandPike,2005).Themodelappliestopopulationhealthingeneral,butagrowingbodyofevidenceestablishesitsimportanceforexplainingracialinequalitiesinhealthinparticular.First,recentresearchonthehealtheffectsofracismpointstodirectandindirecteffectsofracismacrossmul-tiplelevelsofanalysis.Atanindividuallevel,theexperi-enceofunfairtreatmentorinterpersonaldiscriminationhasawiderangeofembodiedconsequences(Krieger,1999).Researchersinseveralsocietieshavelinkedself-reportedexperiencesofdiscriminationtoelevatedbloodpressure(Steffenetal.,2003;Brondoloetal.,2008),breastcancer(Tayloretal.,2007),coronaryarterycalci-“cation(Lewisetal.,2006),bodymassindex(Geeetal.,2008),abdominaladiposity(Vinesetal.,2007),pretermbirth(Doleetal.,2004),lowbirthweight(Mustilloetal.,2004),depression(Williamsetal.,2003;Borrelletal.,2006;Kelaheretal.,2008),andotheraspectsofmentalandphysicalhealthandhealth-relatedbehaviors(Harrisetal.,2006;Borrelletal.,2007;Chaeetal.,2008;Ryanetal.,2008).Atahigherlevelofanalysis,studiesshowthatinstitu-tionalizedracismcontributestoracialdisparitiesinhealth,aboveandbeyondindividualfactors.Inparticu-lar,WilliamsandCollins(2001)arguethatracialresi-dentialsegregationisafundamentalcauseofracialinequalitiesinhealth,becauseita)constrainsopportuni-tiesforsuccessontraditionalmarkersofindividualSESsuchaseducation,occupationalstatus,orincome,andb)createspathogenicsocialcontextsthatin”uencethedis-tributionofdisease.Recentstudiesbearoutthisargu-ment.Residentialsegregationhasbeenassociatedwithoverweightandobesity(Chang,2006),lowbirthweight(Grady,2006),fetalgrowthrestriction(Belletal.,2006),cardiovasculardisease(Cooperetal.,2001),tuberculosis(Acevedo-Garcia,2000),andall-causemortality(Inagamietal.,2006).Arelatedbodyofresearchlinksavarietyofneighborhoodconditionstohealth,independentofindi-vidual-levelriskfactors(Ellenetal.,2001;Sampsonetal.,2002;DiezRoux,2003;KawachiandBerkman,2003;Zenketal.,2005;Cozieretal.,2007;Primacketal.,2007;OCampoetal.,2008).OnerecentstudyinChicago,forexample,foundthattheunadjustedoddsofhypertensionwere80%higherforAfricanAmericansthanforwhites;controllingforindividual-levelfactorsreducedthedisparityonlyslightly,butaddingneighbor-hood-levelvariablescompletelyeliminatedtheblack…whitegapinprevalenceofhypertension(Morenoffetal.,Thereisalsoevidencethatstructuresandeventsatevenhigherlevelsofanalysisreverberatetotheindivid-uallevel.Arecentstudyofbirthoutcomesbeforeandaf-terSeptember11,2001,providesadramaticexample.Lauderdale(2006)examinedbirthcerti“catedataforallCaliforniabirthsduringthe6monthsafterSeptember2001,comparedtothesameperiod1yearearlier.TheyfoundthatwomenwithArabicnames„andwithArabicnames„experienceda34%increasedinthelikelihoodofhavingalowbirthweightinfantafter9/11.Moreover,theeffectappearedtobemoderatedbyparentsstrengthofethnicidenti“cation:InfantswhoweregivenethnicallydistinctiveArabicnameshadtwicetheriskoflowbirthweightaftertheattacksofSeptem-ber2001,comparedto1yearearlier.This“ndinghintsathoweventsstructuredbyglobalpolitical…economicforcesmayhaveembodiedconsequencesthatareoftenhiddenfromview(Krieger,2008).Second,agrowingbodyofresearchaddressesthetimeaxis(seeFig.3)andsuggeststhatinequalitiesacrossmultiplelevelsofanalysishavelingeringeffectsacrossthelifecourseandevenfromonegenerationtothenext.Thisbodyofworkdrawsonlifecourseepidemiology(DaveySmith,2003;KuhandShlomo,2004)andonrecentdevelopmentsinevolutionaryanddevelopmentalbiology(West-Eberhard,2003;GluckmanandHanson,2005;JablonkaandLamb,2005).Thesynthesisofthese“eldshasthepotentialtoproduceaminorrevolutioninhowwethinkaboutracialdifferencesinbiology,becauseitidenti“esthebiological„butnotgenetic„pathwaysthroughwhichsocialdisadvantagemaybetransmittedfromonegenerationtothenext(Schell,1997;DrakeandWalker,2004;Gluckmanetal.,2007).Figure4,adaptedfromKuzawa(2008),illustratesthegeneralmodel.Thetoxiceffectsofexposuretoracisminonesownlifetimeincludeahigherriskofhypertension,diabetes,stroke,andotherconditions(Williams,1999;Geronimus,2001).Theseconditions,inturn,affectthehealthofthenextgeneration,becausetheyalterthequalityofthefetalandearlypostnatalenvironment.Theimmediateconsequenceofthisintergenerationaleffectisahigherriskofadversebirthoutcomes(Rosenbergetal.,2002;Collinsetal.,2004;Mustilloetal.,2004;andLobel,2005;Belletal.,2006;Dominguezetal.,2008),butthereisalsoalingeringeffectintoadulthood,asadultchronicdiseaseslikeheartdiseaseanddiabetescanbetracedinparttoprenatalandearlylifeconditions(Barker,2004;AdairandDahly,2005;Cruickshanketal.,2005;Pollittetal.,2005;JunienandNathanielsz,2007).Thus,thecyclebeginsagain.DavidandCollins(2007)provideanelegantexampleofhowtheselifecourseandintergenerationalprocessesunfold.They“rstcomparedbirthweightsacrossthreegroupsofwomenwhogavebirthinIllinoisduring1980…1995:U.S.-bornblackwomen,African-bornblackwomen,andU.S.-bornwhitewomen.Contrarytotheracial…geneticmodel,thedistributionofbirthweightforinfantsofAfrican-bornblackwomenwasalmostidenti-caltothatforU.S.-bornwhitewomen.Bycontrast,theentiredistributionwasshifteddownwardforU.S.-bornblackwomen(DavidandCollins,1997).Withinasinglegeneration,however,therelativeadvantageofAfrican-andCaribbean-bornwomenbegantodisappear.The“rst Fig.4.Conceptualmodelfortheemergenceandpersistenceofhealthinequalitiesoverthelifecourseandacrossgenerations[adaptedfromKuzawa(2008)].C.C.GRAVLEEAmericanJournalofPhysicalAnthropology generationofgirlsbornintheUnitedStatestomothersofAfricandescentgrewuptohavegirlsoftheirownwithlowermeanbirthweights„atrendthatshiftedthedistributiontowardthatofU.S.-bornblackwomen(Collinsetal.,2002).Thisexamplebringsusfullcircletotherootsofthecritiqueofraceinanthropology(Boas,1912).Themajorelementsofthatcritiquestillapply,butitisincreasinglyclearthatweneednewwaystoarticulatethefailuresofrace.Thecommonassertionthatraceisnotbiologymaybecorrectinspirit,butitistoocrudeandimprecisetobeeffective.Itdoesnotadequatelychallengethereductionismandgeneticdeterminismofcontemporarybiomedicalscienceorpopularculture,anditblindsustothebiologicalconsequencesofraceandracismassocio-culturalphenomena.RaceThecounterparttotheassertionthatraceisnotbiol-ogyisthemantrathatraceisaculturalconstruct.Asagrowingnumberofculturalanthropologistsrecognize,thiselementofthecritiquealsoneedstobereexamined.Thecentralproblemisthat,whenbiologicalanthropolo-gistsdeclaredraceamyth(Montagu,1997),thecon-ceptlostitsplaceinanthropology.Theriseofno-raceanthropology(Harrison1995)cametomeannotonlythattherewerenobiologicalracesofhumankindbutalsothattherewasnoofraceinanthropol-ogy.Onlyinthelastdecadehaveraceandracismre-emergedasamajorareasofresearchinculturalanthro-pology(MukhopadhyayandMoses1997;Mullings,Inadvancingthislineofresearch,Isuggestthattheconceptualizationofraceasaculturalconstructneedstobere“nedintwoways.First,itcannotbe„orappeartobe„awholesaledismissalofhumanbiologicaldiversity.InarecentinvitedcommentaryinAmericanEthnologistShaw(2007,p236)lamentsthatanthropologysviewofraceaslocallyvariableandsociallyconstructednevercapturedthepopularimaginationintheUnitedStates:Fordecades,anthropologistshavetriedtoteachtheworldthatcommonlyusedracialcategorieshavelittleornobiologicalvalidityandthatraceisasocialideausedinpracticesandinstitutionstogivepeopledifferentialaccesstoopportunitiesandresources.Morerecently,amidreportsoftheHumanGenomeProject,anthropologistshavejoinedothersintrumpetingthehomogeneityofthegeneticmakeupofpeoplearoundtheglobe(Shaw,2007,p236).Shawrightlyattributesthestayingpowerofracetodeeplyembeddedpoliticalandeconomicstructuresthatsustainracialthinkingandopposetrumpetingtheho-mogeneityofhumankind,butshedoesnotappeartoconsiderthattheremaybesomethingwrongwiththetrumpet:Partofthereasonpeoplearenotconvincedbytheclaimofhomogeneityisthatitisfalse.Weareindeedalessvariablespeciesthanareourclosestrela-tives,butgeneticvariationexists.Moreover,ascurrentdefendersofraceemphasize,variationisstructuredinsuchawaythattherearedetectablegeneticdifferencesbetweenpeoplewhoself-identifywithconventionalracialcategories(Rischetal.,2002;Tangetal.,2005).Thedenialofhumangeneticvariationis,therefore,bothfalseandstrategicallyshortsighted,becauseitopensthedoorforastraightforwardempiricaldefenseofrace.Second,theviewofraceasaculturalconstructneedstobecomeastartingpointforempiricalresearch,ratherthananendpointinthedismissalofrace.Tosaythatraceisaculturalconstructisnottosayitdoesnotexist;culturalconstructshaveanobjectiverealitydespitetheirrelianceonhumanthought(Searle,2006).Twoavenuesforresearchonracialinequalitiesinhealthfollowfromthisobservation.The“rst„ananthropology(Foster,1974)„examinestheculturalconstructionofraceinbiomedicalresearchandclinicalpractice.Thereisalreadyimportantworkinthisarea,whichshowshowhiddenassumptionsaboutraceshapetheformulationofresearchquestionsandinterpretationofdata(e.g.,Fullwiley,2007;Lee,2007;Montoya,2007;HuntandMegyesi,2008).Itwouldbevaluabletohavemoreeth-nographyofraceandracisminclinicalsettings,espe-ciallygivenevidenceforsystematicracialbiasinthedeliveryofhealthcare(BravemanandTarimo,2002;Smedleyetal.,2002;Bhopal,2007).Anotheravenueforresearch„ananthropologymedicine„istocontributetoexplainingtheoriginandpersistenceofracialinequalitiesinhealth.ChapmanandBerggren(2005)arguethatanthropologistshaveanimportantroletoplaythroughtheradicalcontextuali-zationofracialinequalitiesinhealth.Inparticular,amajorthrustofcurrentresearchinculturalanthropol-ogyistounderstandhowglobalpolitical…economicstruc-turesshapethelocalcontextofpeopleslivesandbecomeembodiedinindividualsicknessandsuffering(NguyenandPeschard,2003;Farmer,2004).IntegratingthisapproachwiththemodelinFigure3haspotentialtoelucidatethepathwaysofembodimentthroughwhichracebecomesbiology.Inaddition,culturalanthropologistscancontributetointerdisciplinaryresearchbydevelopingmeasurementstrategiesthattakeseriouslytheviewofraceasacul-turalconstruct.Myworkontherelationshipbetweenskincolorandbloodpressureillustratesthispoint(GravleeandDressler,2005;Gravleeetal.,2005).Previ-ousresearchershadshowedthat,withintheAfricanDi-aspora,peoplewithdarkerskinhadhigheraveragebloodpressuresthandidtheirlighterskinnedcounter-parts.Someresearchersinterpretedthispatternasevi-denceofaracial…geneticpredispositionforhighbloodpressure;otherssuggestedthatitmayre”ectsociocul-turalfactors.Yetpreviousstudieshadnottestedthesealternativesdirectly,becausetheycon”atedtwodimen-sionsofskincolor:thephenotypeofskinpigmentationandtheculturalsigni“canceofskincolorasacriterionofsocialclassi“cation.Thedistinctionbetweenculturalandbiologicaldimen-sionsofskincolorrequiresameasurementstrategythatincorporatestheculturalmeaningofskincolor.InPuertoRico,Iadoptedatwo-phaseapproach(cf.Dress-leretal.,2005b).I“rstconductedasystematicethno-graphicstudyoftheculturalmodelof2005).Theethnographyshedlightonlocalwaysoftalk-ingaboutskincolorandonhowshapesPuertoRicansexposuretoracismandothersocialstressors.Systematicethnographicmethods(Romneyetal.,1986)madeitpossibletotesttheassumptionthatpeoplesharedacoherentculturalmodelof.ColleaguesandIthendevelopedasurveymeasurethatexplicitlylinkedrespondentstoethnographicdataontheculturalmodeloftoestimatehowtheywouldbeperceivedHOWRACEBECOMESBIOLOGYAmericanJournalofPhysicalAnthropology byotherPuertoRicansineverydaysocialinteraction.Inasmallepidemiologicsurvey,wecomparedbloodpres-sureto,asde“nedbythelocalculturalmodel,andtoskinpigmentation,asmeasuredbyre”ectometry.Thekey“ndingwasthatbothself-ratedandculturally„butnotskinpigmentation„wereassoci-atedwithbloodpressurethroughaninteractionwithincomeandeducation(GravleeandDressler,2005;Grav-leeetal.,2005).This“ndingsuggeststhatempiricalresearchonraceisculturallyconstructedbetterpositionsustoidentifythebiologicalconsequencesofculturalconstructslikeintheUnitedStatesorinPuertoRico.CONCLUSIONRacehasplayedapivotalyettorturedroleinthehis-toryofanthropology.Inthenineteenthandearlytwenti-ethcentury,anthropologistswerecentralinlegitimatingraceasaframeworkforunderstandinghumanbiologicalvariation.Bythemid-twentiethcentury,mostanthropol-ogistsrejectedraceasbiology,andtheviewofraceasaculturalconstructcametodominatethesocialsciences.However,theanthropologicalcritiqueofracehashadonlypartialsuccess.Inparticular,currentdebateoverracialinequalitiesinhealthexposesimportantweak-nessesintheusualframingofthecritiqueandpointsthewaytowardamoreconstructiveapproachtothelinksbetweenrace,biology,andculture.Thespeci“cchallengeistoexplainhowracebecomes.Ourresponsetothischallengemustdealwithtwosensesinwhichracebecomesbiology:Systemicrac-ismbecomesembodiedinthebiologyofracializedgroupsandindividuals,andembodiedinequalitiesreinforcearacializedunderstandingofhumanbiology.Tobreakthiscycle,Iproposethattheconventionalcritiqueofraceneedstobere“nedinthreeways:1)toclarifywhyrecentgenetic“ndingsdonotwarrantareturntoracialthinking,2)topromoteamorecomplex,bioculturalviewofhumanbiology,and3)torevisetheconceptualizationofracesothatitbecomesmorethanamantra.Thesethreeclaimsinformaconceptualmodelforresearchonthemultilevelanddevelopmentalin”uencesonracialinequalitiesinhealth.Thismodelcrossesoldfaultlinesandlaysthegroundworkformoreproductivecollaborationbetweenthesocialandbiologicalsciences.Themodeldoesnotpromoteafocusonsocialandcul-turalfactorstotheexclusionofgeneticones;rather,itimpliesthattheembodimentofsocialinequalitypassesthroughbiologicalsystemsregulatedbygenes.Itdoesnotdenyhumanbiologicalvariation;rather,itclaimsthatthepatternandcausesofhumanbiologicalvaria-tionaremorecomplexthantheraceconceptallows.Itdoesnotclaimthatraceisamyth;rather,ittreatsraceasdeeplyembeddedinsocioculturalsystems.Researchonthebiologicalconsequencesofraceandracismcanhelptoreinvigoratethecritiqueofracebyofferingacon-structiveframeworkforexplainingbiologicaldifferencesbetweenraciallyde“nedgroups.ACKNOWLEDGMENTSMythanksgotoHeatherEdgarandKeithHunleyfororganizingandinvitingmetoparticipateinthesympo-siumattheUniversityofNewMexicoonwhichthisarti-cleisbased.ConnieMulliganofferedhelpfulcommentsonmyreviewofliteratureinpopulationgenetics.LITERATURECITEDAcevedo-GarciaD.2000.Residentialsegregationandtheepide-miologyofinfectiousdiseases.SocSciMed51:1143…1161.AdairL,DahlyD.2005.Developmentaldeterminantsofbloodpressureinadults.AnnuRevNutr25:407…434.AmericanJournalofPublicHealth.2005.Specialissueonrace,genetics,andhealthdisparities.AmJPublicHealth95.AmericanPsychologist.2005.Specialissueongenes,race,andpsychologyinthegenomeera.AmPsychol60.AndersonMR,MoscouS.1998.Raceandethnicityinresearchoninfantmortality.FamMed30:224…227.BachPB,SchragD,BrawleyOW,GalaznikA,YakrenS,BeggCB.2002.Survivalofblackandwhitesafteracancerdiagno-sis.JAMA287:2106…2113.BakalarN.2007.Studypointstogeneticsindisparitiesinpre-termbirths.NewYorkTimes,February27,2007,pF5.BakerPT.1997.TheRaymondPearlmemoriallecture,1996:theeternaltriangle„genes,phenotypes,andenvironment.AmJHumBiol9:93…101.BamshadMJ,OlsonSE.2003.Doesraceexist?SciAm289:78…85.BamshadMJ,WoodingS,SalisburyBA,StephensJC.2004.Deconstructingtherelationshipbetweengeneticsandrace.NatRevGenet5:598…609.BamshadMJ,WoodingS,WatkinsWS,OstlerCT,BatzerMA,JordeLB.2003.Humanpopulationgeneticstructureandin-ferenceofgroupmembership.AmJHumGenet72:578…589.BantonM.1998.Racialtheories,2nded.Cambridge:CambridgeUniversityPress.BarbujaniG,BelleEMS.2006.Genomicboundariesbetweenhumanpopulations.HumHered61:15…21.BarkerDJP.2004.Thedevelopmentaloriginsofadultdisease.JAmCollNutr23:588S…595S.Barnholtz-SloanJS,McEvoyB,ShriverMD,RebbeckTR.2008.Ancestryestimationandcorrectionforpopulationstrati“ca-tioninmolecularepidemiologicassociationstudies.CancerEpidemiolBiomarkersPrev17:471.BellJF,ZimmermanFJ,AlmgrenGR,MayerJD,HuebnerCE.2006.BirthoutcomesamongurbanAfrican-Americanwomen:amultilevelanalysisoftheroleofracialresidentialsegrega-tion.SocSciMed63:3030…3045.BhopalRS.2007.RacisminhealthandhealthcareinEurope:realityormirage?EurJPublicHealth17:238…241.Bif”WL,MyersA,FrancioseRJ,GonzalezRJ,DarnellD.2001.IsbreastcancerinyoungLatinasadifferentdisease?AmJSurg182:596…600.BoasF.1912.Changesinbodilyformofdescendantsofimmi-grants.NewYork:ColumbiaUniversityPress.BorrellLN,JacobsDRJr,WilliamsDR,PletcherMJ,HoustonTK,KiefeCI.2007.Self-reportedracialdiscriminationandsubstanceuseintheCoronaryArteryRiskDevelopmentinAdultsStudy.AmJEpidemiol166:1068…1079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