PREFACE
The days of our years are threescore years and ten; and if by reason of strength they be fourscore years. . . .
This psalm is attributed to Moses. Moses is one of the most important prophets of Judaism, Christianity, and Islam. Religious texts say that he was born under the reign of a pharaoh who had enslaved the children of Israel sometime in the thirteenth century BCE. Archaeologists view Moses as a legendary figure, not a real person. The reality of the prophet makes no difference to the arguments I am about to make in this text. However, it is interesting to note that Moses felt that the lifespan of the people of his time (including those living under the yoke of slavery) was about seventy years and that the strongest of them made it to eighty years.
This becomes more interesting in the context of the environment in which these people labored. They subsisted on an agricultural diet, undoubtedly without any food in excess of their daily needs. The enslaved may have been driven by the lash and given little rest in subtropical temperatures. They would have been exposed to viral, bacterial, malarial, and helminth infections. Thus, while this psalm is poetic, I doubt its accuracy. We have no way to validate its claims since the archaeological finds of human remains from this region and time period are generally limited to the masters, not their slaves.
However, we do know about the lifespans of human beings under chattel slavery in the Americas and the current-day lifespans of their descendants. The mean lifespan of enslaved people varied by state but never reached seventy years. In the 1890s, African Americans were dying at rates that
prompted some scholars to propose that the “race” might be extinct by the turn of the century. Of course, this didn’t happen, and the lifespans of all Americans gradually increased over the twentieth century—but with a persistent gap between European and African Americans. The mean lifespan of African Americans exceeded seventy years by the beginning of the twentyfirst century. From 2006 to 2019, the mean life expectancy from birth ranged from seventy-two to seventy-five years for African Americans and was over seventy-eight years for European Americans.
This book examines why there has been a consistent difference in lifespan between African and European Americans and the role that our society, and the medical profession in particular, has played in perpetuating this gap. I will argue that the origin of modern medicine within the confines of false racial beliefs negatively influenced its practice and that such beliefs persist in the twenty-first century. Indeed, it might shock you to know that nineteenth-century racial thinking still plays a role in the training of physicians. These misconceptions, in combination with physicians’ implicit racial biases, inherited from a society still driven by structural racism, continue to cause harm to African Americans and other racially subordinated people.
The simple explanation for the difference in lifespan between African and European Americans is genetic differences between these groups. Western racial science began with the belief that Africans were inferior to Europeans in virtually every biological and cultural trait. This belief has been shown to be patently false, but in this book, I will not take a deep dive into topics such as the nature of human biological differentiation or the differences between biological and social conceptions of race. The reader who wishes more background on these subjects is directed to my previous works. That said, I will provide sufficient background for the reader to understand how human biological variation operates in the context of the diseases and medical procedures discussed.
Throughout this work, I shall try to consistently describe human biological ancestry using geographical terms such as African American, Asian American, and European American. Since all socially defined racial terms are imprecise, it really doesn’t matter which scheme you choose to discuss racialized groups, but it does matter that you explain to the reader which scheme you are using and why that scheme is best for the topic under discussion. When I cite material from the existing biomedical literature, I use the terms deployed by the authors of the literature in question. The terms
Black and white are often encountered in the medical literature. When you see these terms in the text, they refer to people whose primary ancestry is from Africa or Europe, respectively. The ancestry profile of Black people varies dramatically by geographic region. Africans are not one population. Structure-type genetic analysis indicates that there are at least four major population groups of Indigenous Africans (see chapters 8 and 9). The majority of Africans enslaved in the Western Hemisphere had their origins in West or Central Africa. Because of the various pattens of slavery in the West, Blacks have various amounts of African, European, and Native American ancestry. Because of the social norms of colonialism and slavery, the term white refers to people who are of primarily European ancestry. Finally, when I refer to the historical literature, I will use the terms used by the authors of those works. The terms used to describe human groups have changed over time. Some may be offensive to readers, but I think it is important to use them in their historical and cultural context to help us better understand how racism operated in the time periods discussed. Thus, the purpose of Why Black People Die Sooner is to explain why modern medicine still operates under false conceptions of race, how those false conceptions cause harm to patients, and how we can change things.