Black Lungs: From Slavery to COVID
Essential Question: Why are Black people more susceptible to COVID and other respiratory diseases?
Standards:
Analyzing and Interpreting Data (SEP)
ETS2B - Influence of Science, Engineering & Technology on Society & the Natural World
LS1A - Structure & Function
LS1B - Growth & Development
LS1C - Organization in Organisms
ESS3C - Human Impacts on Earth Systems
Image: DIANA EJAITA
While the COVID-19 pandemic has wreaked havoc on the nation as a whole, it is becoming increasingly clear that Black Americans are paying the highest price. “While Black Americans represent only about 13% of the population in the states reporting racial/ethnic information, they account for about 34% of total Covid-19 deaths in those states.” (Johns Hopkins, Aug 2020)
Image: NPR
COVID is not unique in this regard. Racial disparities are common across respiratory (and other diseases). Black children are almost twice as likely as non-Hispanic white adults to be diagnosed with asthma and 7 times more likely to die from asthma.
But, of course, correlation is not causation. That is, being Black does not cause COVID. Or Asthma.
19th Century Spirometer
Image: Getty Images
However, that basic assertion has been continually neglected in the medical field and beyond. Studies of racial disparities in lung function date back to the 1700s. Citing the work of physicians Adair Crawford and Samuel Cartwright amongst others, President Thomas Jefferson claimed that there was a distinct “difference of structure in the pulmonary apparatus.” Cartwright, a slave owner, utilized his “findings” to justify slavery, as he claimed the manual labor was a means to “vitalize the blood” of slaves. In the 1860s, Benjamin Gould conducted a large-scale study of the lung capacity of Civil War soldiers using spirometers. The study, which remains influential today, reinforced previous studies, finding a 20% lower lung capacity in Black soldiers as compared to white soldiers. None of these studies accounted for height, weight, age, diet, medical care, living conditions, or any other confounding variables. Nevertheless, “the idea of racial difference in pulmonary function, proposed by Jefferson and further supported by Cartwright, Gould, and Hoffman, became firmly established by the early 20th century as fact. There seems to be a scientific consensus, that virtually everyone in the world has lower pulmonary function than people classified as white. Thus race has become a biologically distinct, scientifically valid category.” (Lujan, DiCarlo)
Despite their flaws, these early studies are ingrained into medical and social sciences today. A 2016 study of white medical students showed that over half held some belief that Black and white bodies were physiologically different in ways ranging from nerve endings and pain tolerance to skull size and intelligence. (1619) However, even for doctors who are wise to these myths, bias may be baked into their profession in ways beyond their control.
Modern spirometry
Image: NIH
For example, the modern spirometer, a tool used to measure lung capacity, requires physicians to input the patient’s (often perceived) race. The spirometer is “race corrected” to account for the supposed lower lung capacity of non-whites. The correction is greatest for Black patients at 10-15%, meaning a Black person’s lungs could be considered healthy even when a white patient would be considered in need of medical treatment at the same capacity. (Braun, Breathing Race into the Machine)
The issue here is not the data itself -- African Americans as a group are indisputably more affected by diseases such as asthma and COVID -- but how we interpret that data. When we see statistics showing racial disparities in medicine and we ascribe that disparity to innate differences among “biologically-defined” races, we excuse the social ills that hide behind these statistics. By “correcting” for race, we are not correcting for food deserts, unequal access to healthcare, and toxic air pollution in Black neighborhoods.
Image: Liam Downey & Brian Hawkins, “Race, Income, and Environmental Inequality in the United States,” Sociological Perspectives (Dec. 2008)
The complexity of the history and reality behind the health disparities, make it a valuable phenomenon that can guide inquiry from many curricular angles. Environmental factors such as particulate matter and other air pollutants have long been suspected to contribute to disproportionate medical outcomes. Further, iIndirect forms of environmental racism such as food deserts and access to green spaces, can also affect health outcomes as these lead to underlying conditions such as anemia and obesity. Fetal development, often nutritional, has been shown to affect susceptibility to asthma. These comorbidities can teach students about anatomy, physiology, and systems (eg. interactions of body systems). With regards to COVID and other transmissible diseases, models of population density (often higher in Black neighborhoods) and contacts (eg. on public transit, essential workers) can offer valuable insights into viral transmission and epidemiology. Engineering and computer science students can consider ways to ethically deal with skewed data, as is attempted in modern spirometers.
