Slavery and Racial Health Inequalities: What’s the Past to Policymakers?
Writing in the Opinion Section of The New York Times, Sabrina Strings, a sociologist at UC Irvine, argues that America’s legacy of slavery is behind not only the staggering racial disparity in deaths from COVID-19 but also racial health inequalities more generally. In what is by now a familiar move, Strings contends that focusing on the “individual-level factors”—such as whether someone is obese or has asthma or diabetes—obscures the true cause of the disparity in question: the hidden-in-plain-sight workings of systemic racism.
Put differently, while it is difficult to argue with the fact that, compared with the overall population, a greater percentage of black people are obese, work in the service industry, have limited access to healthy foods, and are exposed to toxic chemicals, Strings suggests that we ought to think of these patterns as emerging not so much because of the uncoordinated choices of many independent actors as because of decades if not centuries of government action designed specifically to segregate and discriminate—e.g., in the distribution of affordable housing.
The underlying statistical facts here are not controversial. Neither is it controversial that slavery and state-sponsored discrimination existed. What is contentious is the nature of the relationship between them.
- Are certain events in the past more fundamental to the causal chain connecting the past to the present? As far as I can tell, Strings’ seems to think so, at least when it comes to slavery and current racial health inequalities. This position, however, is challenging to defend under scrutiny.
- And how much of the causal history of any given problem do we need to know in order to develop effective policy solutions to it, now? As I read her, Strings thinks that we need to know an awful lot of it—though it’s not at all clear to me just why.
To my mind, then, Strings is mistaken on both counts.
For one, there’s an issue to do with causation. It’s one thing to say that my grass is yellow because my sprinklers broke—that my sprinklers’ breaking caused my grass to turn yellow—and quite another thing to explain with any precision what exactly that means.
Am I reporting simply a regular pattern, that, empirically, when my sprinklers break my grass turns yellow in no fewer than 8 and in no more than 12 days? Or am I saying something profoundly deep about our universe, that, as a matter of metaphysical necessity, if my sprinklers break my grass turns yellow? Or is this just a high-level description, masking some more fine-grained description in mechanical or physical or psychic terms of what happens from the moment my sprinklers break to the moment I judge that my lawn has turned yellow? Or are we talking probabilistically, reporting our belief that, in 95 out of 100 simulations of our universe, when my sprinklers break the grass turns yellow? Or is the thought that, had my sprinklers not broken, my grass would not have turned yellow? Or something else completely?
While we’re at it, why not say that the drought three years ago is to be thought of as the cause of my yellow grass just as well? After all, had that summer witnessed more rain, the sprinkler head would have received less UV light and the plastic part that is now broken on the head might have made it another few years. Oh, and let’s also include the invention of plastic and the invention of metal and the development of irrigation science. All of these can be understood, in one sense or another, as causes of my yellow grass.
The thing with causality, as Hume famously made clear, is that it’s terribly hard to give an account of what it is. And if it’s hard to give an account of causality then it’s even harder to understand what it would mean for one cause to be more fundamental than any other cause, to be a so-called “true cause.”
So, is it impossible to precisify what it means to say that slavery is the “true cause” of today’s racial health inequalities? Not necessarily. But as Strings’ argument stands, it’s no more clear to me that slavery is the true cause of racial health inequalities than it is that broken sprinklers are the true cause of my grass being yellow. Both expressions make sense until you stop to think more about just what it is to be a cause and to be a true cause.
For the sake of argument, however, let’s grant that we can give an adequate account of causality. Doing so brings into focus the real problem with Strings’ argument: the suggestion that slavery is the true cause of racial health inequalities is essentially impotent, capable of little besides signaling virtue or offering an interesting history lesson.
To be clear, the problem is not that Strings has her facts wrong. The problem, rather, is that Strings chooses to focus on the wrong kinds of facts. To return to the grass and sprinkler example, it is of little help to point out that my sprinklers break frequently because, 30 years ago, the designer of this model took for his inspiration a mechanical toy car he played with as a child, inspiration which led him to create an overly complex design, one quite literally with too many moving parts. More precisely, knowing this history is of little help to my actually fixing the situation with my grass. Indeed, all I need to know is that the sprinkler breaks because of an overly complex design. (And there causality rears its confusing head again.) Armed with this information I can shop around and find a sprinkler with a more straightforward design; or, just as well, I can order a set of spare parts and learn how to fix the thing; I can even write to the company with some design suggestions.
In other words, while interesting to the historian of technology, the origin story I told above matters not at all to those of us stuck with these sprinklers and dealing with yellow grass.
The connection to slavery and racial health inequalities should be obvious. Unless we have access to a time machine, unless we can literally go back and fiddle with history and with the causal chain that connects the past to the present, what matters for knowing “why . . . black people [are] sick” is knowing where they live and how they live—not so much how they got to live in any particular location or fashion in the first place.
Put differently, if we’re noticing that black people are afflicted with disease X at a rate 5 times that for white people and that disease X is overwhelmingly likely to develop in individuals living near toxic waste dumps and that a greater percentage of blacks live near such dumps than do whites then we’ve got all we need to start working on policy. We can move the dumps, clean them up, tighten dumping regulations, increase the minimal distance they must be from housing developments, redistrict or rezone communities, work on making housing more affordable, and so on.
It might be interesting to ask, “Why are black people more likely to live near these dumps?” But that’s a question of interest only to sociologists and historians—not policymakers. Indeed, my point here is that sociologists and historians (and philosophers and literary scholars and French teachers and artists and linguists and the like) can offer policymakers relatively little. Policymakers need to know what to fix—which levers to pull or, through advance policy, to create—not the full details of how the thing became broken in the first place. History and sociology, the argument goes, aren’t so good at identifying levers in the present—and levers in the present are what policymaking is all about.
Of course, all of this is not say that scholars in the humanities have nothing whatsoever to offer. Knowing how and why poverty increased in the past and understanding how popular perceptions and conceptualizations of poverty have shifted across time, for example, can certainly clue us in to the kinds of interventions that are more and less likely to work, practically, today.
It is to say, however, that offering a history lesson to public health experts and economists trying to do something about racial health inequalities, as Strings writes of doing, is at best a failure of disciplinary humility and at worst a purely symbolic performance of moral righteousness. If it’s the inequalities we’re trying to fix, in other words, then we’d better stop with the symbolics and think about how in fact we can fix them.
