'White privilege' in American medicine

More than 27,000 Americans will likely die from a heroin or prescription painkiller overdose this year. While the victims will come from every walk of life, most of the media attention – and there has been a lot of it – has focused on what has been called the new face of heroin addiction: suburban, white, middle-class Americans. Their drug use is often depicted as surprising and puzzling, which marks a stark contrast to how addicts have been portrayed in the past. It is as if their (white) privilege makes them immune to succumbing to substance abuse.

One specific research paper got an enormous amount of attention last year: Princeton University economists Anne Case and Angus Deaton wrote in Proceedings of the National Academy of Sciences (PNAS) that "drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis" were killing less-educated, late-middle-age working class whites to such an extent that the overall mortality rate for whites was rising for the first time after decades of decline. News articles about their findings employed anxiety-laden language and headlines ("The Dying of the Whites") to suggest how alarming this trend was.

Hoping to make sense out of what appears to be two bizarre developments, Jeff Guo of The Washington Post has even suggested a possible "eerie correlation" between the climbing death rate of poor whites and Donald Trump's success in the Republican presidential primaries.

Anxiety over white mortality is not new. In fact, media reports on Case and Deaton's analysis reminded me of a book I had found some 20 years ago in the University of California, Berkeley's main library. Written in 1929 by Esperanto enthusiast James Denson Sayers, Can the White Race Survive? warned against the mixing of the races (or else American civilization would cease to exist). While researching the eugenics movement in the United States, I had come across this type of racist rhetoric before; this book stood out, however, because someone who had handled it during its 65 years or so in the library had responded to the title on its cover by penciling in a tiny "no" directly after the large question mark. So while what is now threatening white Americans – drugs, suicide, and alcohol – appears to be new, the nervousness around extinction may have a longer history.

Is this anxiety more about a loss of distinction rather than elimination?

The distinction I am referring to is white privilege – the special and often unchecked advantages that white people experience in the U.S. and much of the rest of the world, often unaware of the benefits they enjoy. While academics, social theorists, and activists have tried to bring visibility to this social operative and to inequalities that stem from it since the early 20th century, the concept gained traction in the late 1980s with Peggy McIntosh's working paper: White Privilege and Male Privilege: A Personal Account for Coming to See Correspondences Through Work in Women's Studies. To document how this privilege operates, McIntosh offered a list of "daily effects of white privilege," which included being confident that if she needs legal or medical help, her race will not work against her. During the last 30 years, her essay has helped shape the way academia discusses white privilege and its pervasiveness in society.

What does it mean for someone's race not to work against him or her when it comes to seeking healthcare?

Taking a look at the most recent research on race-based health disparities might provide some clues. The data demonstrates how racism predicated on white privilege produces predictable haves (whites) and have-nots (people of color) when it comes to medical care and health outcomes. This is why the Princeton analysis about the rising mortality rate among whites was so shocking: It presented data that countered the now commonsense narrative that the health of people of color will always be worse than that of whites.

So why are we now witnessing this reversal of fortune? Pundits have speculated on possible causes. Among them is the Chicago Tribune's Jerry Davich, who pointed to poor whites' loss of hope in an American Dream that at one time seemed attainable by all (white) Americans. For Davich, this hypothesis also explained why they – and not their nonwhite counterparts – have experienced a spike in death rates. The official commentary that accompanied the PNAS paper also weighed in by suggesting possible contributing factors, including white patients' access to opioids. Research has indeed demonstrated that physicians have been denying African American and Latino patients the powerful prescription pain relievers because they suspected that they would abuse or divert them. They made no such leap for white patients, resulting in far higher rates of addiction and overdose fatalities.

The relationship between medicine, health outcomes, and white privilege needs to be better understood, as last year's study only scratches the surface. Historically, there are plenty of examples of where medicine has taken steps to protect the health status of white Americans. For example, at the end of the 19th century, Dr. George Miller Beard invented the diagnosis neurasthenia, which medically legitimized a series of symptoms (including fatigue, depression, and mental collapse) that was debilitating many of America's (white, male) elite. Beard made the disease real by giving it a name and providing treatment. At times, medicine has been motivated by larger population concerns, as was the case with pre-World War II sterilization procedures and legislative efforts that focused primarily on white Americans who had been deemed unfit to procreate. Eugenicists who aimed to uplift the white race saw the sterilization of "degenerates" as an important step toward meeting this goal. More recently, white privilege provided the framework for early advertisements for human growth hormone (HGH) products as short white boys were central to their marketing campaigns, even though the promotions exclusively targeted practitioners. Short white boys portrayed as the perceived consumers of HGH contributed to their access to this therapy as it appeared to be intended for them.

In the United States, whiteness frames preconceived notions about what makes up a healthy individual and who has access to that status. While the spike in the white mortality rate among the working class has reminded us of the important role that socio-economic status plays in health outcomes, the type and volume of media attention given these victims of our current drug epidemic demonstrates which lives still matter most.

Aimee Medeiros is an assistant professor of the history of health sciences at the University of California, San Francisco and author of "Heightened Expectations: The Rise of the Human Growth Hormone Industry in America."

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