I had the good fortune to hear Dr. Steve Nelson give an eloquent and impassioned talk about equity and racism yesterday, which led me to want to reprise this blog from a few years ago.
I am a racist. There, I said it.
I don’t mean an Archie Bunker-type bigot who hurls invective and spews hate. But view the world through the concept of race, the idea that characteristics are bundled together, and that knowing the color of someone’s skin can be informative about what is inside. That is the essence of racism: the idea that race is determinative, that people of different color differ in other important ways. (Some prefer to refer to this as racialism, but let’s just call a racist a racist.)
Now, I didn’t say I believe it; actually, I do not. But being honest with myself, I’d have to admit that when I encounter someone I don’t know, I reflexively begin to make assumptions about them based on their appearance. I do not consciously accept the concept of race, but my instincts are otherwise. When I see a patient in the emergency department who is black, I make assumptions about the fact that they probably live in the city of Milwaukee, and they are likely to be insured by Medicaid. I virtually always catch myself, and I work furiously not to allow that initial assumption to enter into my thinking and actions. But no matter how good I am at suppressing it, I can’t deny it came up.
I’d be willing to bet a decent amount of money that everyone reading this is also a racist. No doubt, you do your best, like me, to overcome it, and you probably don’t ever do or say anything that would be considered “racist” in the common use of that word. But it’s probably inevitable. In large part, it is a manifestation of the way our minds process information. I have written previously about heuristics – mental shortcuts our brains use to reach conclusions more efficiently. These heuristics are based on our prior experiences and on statistical facts about groups. When a child encounters a dog for the first time, she is unlikely to be fearful. If her first experience results in being bitten, she will instinctively react with caution to dogs in the future. Even those of us who have never been bitten are likely to be more leery around pit bulls, based on reports (which it turns out are probably wrong) that the breed accounts for the majority of bites.
We live in a society where, statistically, there is an association between, for example, race and poverty, or race and crime. In that sense, the heuristic isn’t wrong. It’s true that in our ED, black patients do largely live in the city of Milwaukee, and are disproportionately poor. We run into trouble in at least two ways. First is when we take a true fact about a group and apply it to an individual. Even if it’s true that more blacks in this area are more likely to not finish school, it is an affront to the inherent worth and dignity of each person to make any assumptions about an individual black person’s educational level. When we deal with a person, we cannot use mental shortcuts. But to overcome them we must acknowledge them.
It’s also a short and slippery slope from seeing an association to seeing causation. Many people are too willing to make the leap from “black people are more likely to live in poverty” (a true if unfortunate fact), to “black people are poor because they are black.” Therein lies the kind of thinking that people commonly associate with the term racism. And racism in this sense is still too prevalent in 2014.
Just six years ago, in the aftermath of President Obama’s election, we were hearing about how America had become “post-racial.” Now, it seems that race relations are in the worst shape I can remember. What went wrong?
If the first step toward a solution is admitting there is a problem, we have to accept that we are, nearly universally, racist. It takes a lot of mental effort to override our heuristics. Pretending racism is something that only overt bigots experience, it’s too easy to let down our guard. It also closes off conversation. The inherent racial thinking that we all have is pretty obvious to most members of racial minorities, but less so to those of us in the majority. Denying it invalidates their experience and prevents us from building the kind of connections that might mitigate its effects.
I’d love to think we can actually get beyond the idea that skin color has anything to do with any other inherent characteristics – we don’t tend to draw the same conclusions based on hair or eye color, after all. Not that there hasn’t been some progress. Some medical journals, for example, will not accept analyses based on race unless there is a clear biological explanation (e.g., a study involving actual skin pigmentation). Too often race is used as shorthand for socioeconomic status or educational status; such reporting simply reinforces the stereotypes and does nothing to contribute to our understanding. But race seems such an entrenched part of the way of looking at the world, it’s hard to imagine a “post-racial society” anytime soon.
In the meantime, if rational thinking is to prevail over instinct, need to accept that regardless of our best intentions, we all view the world through the lens of race. Go ahead, say it.