Talk:Issues in Interdisciplinarity 2020-21/Truth in Definitions of Race and Implications in Black Maternal Care

=‘Truth of Race in Clinical Decision Making in Black Maternal Care’=

Strand = Truth

Truth in the definition - lacking biological evidence to corroborate and potentially influenced by social conceptions of race which further skews them

Power in implications - Black women suffering higher rates of maternal and infant mortality, receiving lower doses of pain relief, adverse health outcomes etc

Case studies: Accounts from women who received maternal care from the NHS, articles on health outcomes for POC, NHS reports/data

Disciplines:


 * Sociology
 * Biology - Genetics
 * Medicine
 * Anthropology
 * Media
 * Linguistics?
 * Law
 * Computer Science
 * Statistics

11er467va

A few links to check
Also here are the links to all the articles/journal articles I know of:


 * https://onlinelibrary.wiley.com/doi/abs/10.1002/ajpa.24162

Biological anthropology's critical engagement with genomics, evolution, race/racism, and ourselves: Opportunities and challenges to making a difference in the academy and the world onlinelibrary.wiley.com
 * Biological anthropology's critical engagement with genomics, evolution, race/racism, and ourselves: Opportunities and challenges to making a difference in the academy and the world - Fuentes - - American Journal of Physical Anthropology - Wiley Online Library


 * Gravlee (2009) American Journal of Physical Anthropology 139:1:47-57

The important ones if we go the clinical decision making route:

 * https://experts.umn.edu/en/publications/physician-knowledge-of-human-genetic-variation-beliefs-about-race


 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/?fbclid=IwAR2WzUJeme9IKACR2asxcA8vcv60xj4VpBzs4tbNczW77cmlDV3ZTHoqyrY


 * https://www.bmj.com/content/368/bmj.m442

Newspaper:

 * https://www.hsph.harvard.edu/magazine/magazine_article/america-is-failing-its-black-mothers/ -> this is an article outlining the black maternity care issues within the USA with a lot of usefull figures and examples which we can potentially use in e.g. the introduction to introducce the problem.--Kuramae (discuss • contribs) 11:56, 4 December 2020 (UTC)

--> definition of race is being question and implemented. Uclqmtr (discuss • contribs) 20:55, 1 December 2020 (UTC)
 * https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32076-6/fulltext


 * https://www.theguardian.com/lifeandstyle/2020/oct/02/something-has-to-be-done-tackling-the-uks-black-maternal-health-problem

Tinuke Awe and Clotilde Rebecca Abe, the founders of Fivexmore, a campaign group set up to improve Black maternal health. Photograph: Christian Sinibaldi/The Guardian www.theguardian.com
 * 'Something has to be done': tackling the UK's Black maternal health problem | Life and style | The Guardian

- This article underlines a tension between medicine/Biology and Sociology/law: encounter of huge inequalities in pregnancy management despite the fact that several studies have proven that there are no biological causes.

- Question of each practitioner opinion. (definition should not be opinionated ? ) Uclqmtr (discuss • contribs) 20:47, 1 December 2020 (UTC)


 * https://www.telegraph.co.uk/news/2020/11/08/black-maternal-healthcare-high-priority-kamala-harris/


 * https://www.bbc.co.uk/news/uk-england-47115305

Petitions:

 * https://petition.parliament.uk/petitions/301079

11er467va (discuss • contribs) 08:23, 8 December 2020 (UTC)

Some further links for Medicine and Sociology discipline sections sort of thing:

 * https://www.nature.com/articles/s41432-019-0062-1


 * https://onlinelibrary.wiley.com/doi/full/10.1111/acem.13214


 * https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993983/ -> this is the most comprehensive and has links to other relevant studies


 * https://www.bmj.com/content/368/bmj.m363 ---> this links to what someone suggested about computer science/statistics algorithms etc!!


 * https://www.bmj.com/content/361/bmj.k2748 -> this is about the NHS specifically - not sure if we can get access though


 * https://eachother.org.uk/black-maternal-health-5-issues-facing-black-mothers/ -> a general overview of the issues in black maternal care, might be useful for some inspirations.


 * https://www.nationalpartnership.org/our-work/resources/health-care/maternity/black-womens-maternal-health-issue-brief.pdf --> Policy making but gives a good recap on the statistics and causes of inequality. Uclqmtr (discuss • contribs) 12:32, 4 December 2020 (UTC)

First draft
Public policy making is substantially influenced by a set of statistics, supposed to mirror the reality of the world. (1) However, in the field of Policy making to address the disparities in Women’s Maternal Health Care, the question of race definition and its limit has an impact on the objectivity of these numbers.

1.	The definition of race in statistics

Indeed, in statistics, the race of an individual is classified either by self-identification, mostly used because it is considered to be a more consistent measure, or by others perception. In this last case, phenotypic characteristics are used to produce studies on genetical influences without any proven relation between those two facts. Furthermore, in a world that is more and more diverse, where people find their origins in several ethnicities and races, creating race-based statistics is increasingly difficult and decreasingly relevant. 	Evolution through time as every truth: steel needs changing hence the importance of policies 	Normative truth? question of point of view? But if biology says that race does not impact then what the point?

2.	From raced-based to race-conscious medicine

A new movement has evolved recently, arguing for an evolution from raced-based to race-conscious medicine.

-	Race based medicine: “the system by which research characterizing race as an essential, biological variable, translates into clinical practice, leading to inequitable care.”

-	“introduce race-conscious medicine as an alternative approach that emphasizes racism, rather than race, as a key determinant of illness and health, encouraging providers to focus only on the most relevant data to mitigate health inequities.” Problem of structural racism in medicine.

Conclusion: Statistics influences policy making which influences not only the actual health care situation of black women but also the definition of race in medicine itself. Maybe a solution would be to replace the use of race to create statistics by culture as is has been proven that environment and habit has more impact on health than genetics and race specially as it is measured right now. To achieve this, statistician would need to work hand in hand with social anthropologist to achieve a new classifying system which successes in reflecting reality.

Uclqmtr (discuss • contribs) 20:15, 7 December 2020 (UTC)

Second draft
Public policy making is substantially influenced by a set of statistics, supposed to mirror the reality of the world. However, making policies aiming to address the disparities in Women’s Maternal Health Care, involves defining race, and its limitations in producing unbiased numbers.

Indeed, in statistics, the race of an individual is classified either by self-identification or by others’ perception. The first method is more frequently used as it is considered to be a more consistent measure. Nevertheless, it is also quite common for a person’s race to be defined by an outside eye whose judgment is only build upon phenotypic characteristics. These assertions are disputable as they imply that apparent physical differences justify a racial difference in genetic heritage, a relationship which, as seen earlier, has never been scientifically demonstrated.

Furthermore, in a world of growing diversity due to a rising number of births from mixed unions, creating race-based statistics seems increasingly difficult and decreasingly relevant.

Ergo statistics shape policy making affecting not only the actual health care situation of black women but also the definition of race in medicine itself.

A potential solution is to substitute the notion of race while establishing statistics by a cultural partitioning. In truth, culture-related habits and environment has more impact on health than genetics and race specially as it is measured now. A collaboration between statisticians and social anthropologists is hence required to achieve a new classifying system that produces a better reflection of reality. Uclqmtr (discuss • contribs) 13:04, 8 December 2020 (UTC)

Kuramae
Added my draft on the aspect of sociology to the main page, please feel free to have a look at it. The last section in the second paragraph is based on my own thoughts, please let me know if you have any suggestions there. I will fix the references later. --Kuramae (discuss • contribs) 23:03, 4 December 2020 (UTC)

I decided not to add this section in the second paragraph for now: At the first glance it seems obvious that access to health care is dependent on financial, socioeconomical or geographical circumstances of the individual. 1 In countries such as the US, where health care is not considered a right of the citizen, these access inequalities are amplified. However, after taking societal status, education and income into account, black women still face significant difficulties during maternal period compared to women of other races, thus there must be other underlying reasons. Findings in sociology shed lights on personal biases on race, which have potentially huge contributions towards inequalities in maternal care. source: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/12/racial-and-ethnic-disparities-in-obstetrics-and-gynecology -> this paragraph can be added or used somewhere else if needed--Kuramae (discuss • contribs) 23:03, 4 December 2020 (UTC)

11er467va
VERY VERY PRELIMINARY DRAFT

How and if ‘races’ should be categorised has been contested in biological anthropology since the discipline’s conception, and arguably a conversation which founded the discipline. At a time of significant racial inequality and discrimination, notions of race at this time were founded on prejudice and depicted black communities as being more ‘primitive’ on the basis of morphology. In the decades since, anthropology and other disciplines have moved entirely away from the notion that morphology is a reflection of any other significant biological or genetic differences, instead, approaches to understanding race have involved ancestry, and social definitions including self-identification. This has in part been in response to the acknowledgement that morphological features exist on a continuum, and thus forming discrete categories would be arbitrary, and the more recent evidence which highlights genetic variability in humans and the likelihood of mixed heritages in all individuals.

Problematically, whilst the definitions of race remain ambiguous, it leaves practitioners with no rigid idea of what should inform their clinical decision-making. This affects patient outcomes two-fold, there is both a risk of overgeneralising and misinformedly extrapolating data on health from white people to black people, and treating black patients differently based on unfounded conceptions of racial differences which are both reinforced by and at times a product of, racial prejudice and discrimination. The focus of this chapter will be the latter, summarising how practitioners’ clinical decision making in the case of black healthcare in the US and the UK is influenced by both ill-informed and ill-conceived notions of racial differences, ultimately resulting in adverse health outcomes for black people.

11er467va (discuss • contribs) 17:19, 4 December 2020 (UTC)

SECOND DRAFT

As a discipline concerned with the synergy between biology and culture, biological anthropology has often been looked upon to inform wider definitions of race. Problematically, with the discipline’s origins firmly rooted in Western euro-american scholarship, early conceptions of race within the discipline were marked by racial discrimination, prejudice and exclusion - the repercussions of which are still visible today. Emphasis on morphological features resulted in the labelling of black individuals as ‘primitive’ or ‘savage’ - essentially conceived of as less developed. In the decades since, with Darwin being a key figure in dissolving such a view, biological anthropology moved away from evolutionist and morphological definitions of race and has instead focused on ancestry or genetics to inform their notions of race. This variability in approaches to understanding ‘race’ however, has meant that definitions of race are unstable and localised - a major issue when such definitions are used to inform medical interventions and healthcare.

Recent research investigating genetic research has stressed the need to reevaluate biological conceptions of race which, as they note is, ‘’- so disputed and so mired in confusion‘’. Perhaps more significant still, studies into such a ‘biological basis’ for race have remained inconclusive at best and disproven such a notion at worst. As such, contemporary understandings of race have declared it to be a social construct used to arbitrarily categorise groups based on physical characteristics - much like its very earliest conceptions. This understanding places it firmly in the social world rather than the natural, alongside ‘ethnicity’ which is used to refer to groups diverse in their ‘’racial, national, tribal, religious, linguistic, or cultural origin or background.” Still, due to the higher prevalence of certain conditions in some groups, racial categories have been maintained in the healthcare system and are often used to inform treatment or diagnoses.

(revised)

As a discipline concerned with the synergy between biology and culture, biological anthropology has often been looked upon to inform wider definitions of race. Problematically, with the discipline’s origins firmly rooted in Western euro-american scholarship, early conceptions of race within the discipline were marked by racial discrimination, prejudice and exclusion - the repercussions of which are still visible today. Emphasis on morphological features resulted in the labelling of black individuals as ‘primitive’ or ‘savage’ - essentially conceived of as less developed. In the decades since, with Darwin being a key figure in dissolving such a view, biological anthropology moved away from evolutionist and morphological definitions of race and has instead focused on ancestry or genetics to inform their notions of race. This variability in approaches to understanding ‘race’ however, has meant that definitions of race are unstable and localised - a major issue when such definitions are used to inform medical interventions and healthcare.

Recent research investigating genetic research has stressed the need to reevaluate biological conceptions of race which, as they note is, ‘’- so disputed and so mired in confusion‘’. Perhaps more significant still, studies into such a ‘biological basis’ for race have remained inconclusive at best and disproven such a notion at worst. As such, contemporary understandings of race have declared it to be a social construct used to arbitrarily categorise groups based on physical characteristics - much like its very earliest conceptions. This understanding places it firmly in the social world rather than the natural, alongside ‘ethnicity’ which is used to refer to groups diverse in their ‘’racial, national, tribal, religious, linguistic, or cultural origin or background.” In such a way it can be seen how not only the environment in which the scholarship was founded influenced understandings of ‘race’, but how it led to the very conception of the black and white dualism which has since been regarded as a natural distinction upon which biological research should be based. Still, due to the higher prevalence of certain conditions in some groups, racial categories have been maintained in the healthcare system and are often used to inform treatment or diagnoses.

(revised again)

As a discipline concerned with the synergy between biology and culture, biological anthropology has often been looked upon to inform wider definitions of race. Problematically, with the discipline’s origins firmly rooted in Western euro-american scholarship, early conceptions of race within the discipline were marked by racial discrimination, prejudice and exclusion - the repercussions of which are still visible today. Emphasis on morphological features resulted in the labelling of black individuals as ‘primitive’ or ‘savage’ - essentially conceived of as less developed. In the decades since, with Darwin being a key figure in dissolving such a view, biological anthropology moved away from evolutionist and morphological definitions of race and has instead focused on ancestry or genetics to inform their notions of race. This variability in approaches to understanding ‘race’ however, has meant that definitions of race are unstable and localised - a major issue when such definitions are used to inform medical interventions and healthcare.

Recent research investigating genetic research has stressed the need to reevaluate biological conceptions of race which, as they note is, ‘’- so disputed and so mired in confusion‘’. Perhaps more significant still, studies into such a ‘biological basis’ for race have remained inconclusive at best and disproven such a notion at worst. As such, contemporary understandings of race have declared it to be a social construct used to arbitrarily categorise groups based on physical characteristics - much like its very earliest conceptions. This understanding places it firmly in the social world rather than the natural, alongside ‘ethnicity’ which is used to refer to groups diverse in their ‘’racial, national, tribal, religious, linguistic, or cultural origin or background.” In such a way it can be seen how not only the environment in which the scholarship was founded influenced understandings of ‘race’, but how it led to the very conception of the black and white dualism which has since been regarded as a natural distinction upon which biological research should be based. Still, due to the higher prevalence of certain conditions in some groups, racial categories have been maintained in the healthcare system and are often used to inform treatment or diagnoses.

Whilst the definitions of race remain ambiguous therefore, practitioners are left with no rigid idea of what should inform their clinical decision-making. This can affect patient outcomes two-fold, there is both a risk of overgeneralising and misinformedly extrapolating data on health from people with european ancestry people to people with african ancestry (where biological variation may be found), and treating black patients differently based on unfounded conceptions of racial differences which are both reinforced by and at times a product of, racial prejudice and discrimination.

References (awaiting conversion to wiki-references)

1. Yudell M, Roberts D, DeSalle R, Tishkoff S. Taking race out of human genetics. Science. 2016;351(6273):564-565.

2. Fuentes A. Biological anthropology's critical engagement with genomics, evolution, race/racism, and ourselves: Opportunities and challenges to making a difference in the academy and the world. American Journal of Physical Anthropology. 2020;.

3. Wagner JK, Yu JH, Ifekwunigwe JO, Harrell TM, Bamshad MJ, Royal CD. Anthropologists' views on race, ancestry, and genetics. American Journal of Physical Anthropology. 2017 Feb;162(2):318-27.

4. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences. 2016 Apr 19;113(16):4296-301.

11er467va (discuss • contribs) 11:55, 5 December 2020 (UTC)

BASc to the future
Race is an often unquestioned term in standard operating procedure. However, it is not always applied universally, and certainly not to great effect. Even the smallest phenotypic variations are often considered “racial differences”, and the difference between genotype and phenotype often go unnoticed [4].

In the case of pregnancy, some complications in black patients have sound biological basis. This is true in the case of Sickle Cell Disease (SCD). Figures from the CDC suggest that it occurs among 1 in every 365 black or African-American births, significantly than the figure of 1 in 16,300 for Hispanic-Americans [6]. This has been explained by the tracing of the origin of the Sickle Cell Trait to countries in which malaria is or was prevalent, as the carrier state has a protective effect against this disease. As such, most SCD patients have a common African ancestry.

But there are many complications that, although statistically apparent, can not be explained solely through inherited traits. An example would be the fact that black people, on average, have higher blood pressure than other groups. Even though scientists speculate that it might have its roots in genetics, it is also easily attributed to environmental factors including smoking, salt intake and stress [5]. Generalising these trends is very complex, as we are both unsure of where they originate, and that environmental factors might vary drastically within the classically considered “races”. Using strictly biology will not be satisfactory in evaluating the effect of these.

Contrary to measurable statistics, there are many aspects in treatment that rely much more on perceived truths. The subjectivity of pain establishment in patients is seen most clearly in the US protocol, for instance in the question “on a scale of 0 to 10 with 0 as no pain and 10 as the worst pain possible, how would you rate your pain?”[1]. This assessment relies heavily on the trust between the healthcare provider and the patient. Although it has been standardised, study has shown that people assume a priori that black patients feel less pain than white patients [2]. That would naturally cause for undertreatment.This assumption is similar to the racial bias of the 'strong black women narrative' in sociology. (no need to change your text, I just wrote it to showcase the link between these two disciplines)

The intrinsic difference in the way truth is seen between objective gathering of statistics and research in genes, and the more subjective treatment methods for pain relief, may very well cause tension within biology.

Perhaps a new classification would be in order. At this point in time, doctors tend to stick to the familiar, classical “races”. These are often based on phenotypical differences, while ignoring similarities in genotypical makeup. Furthermore, the focus in healthcare should shift away from considering racial classification as causal, but rather as a risk indicator [3].

''I corrected some spelling mistakes. Otherwise I think this section is very precisely written you indicated the issues of truth in biology as well as their approach to it.''--Kuramae (discuss • contribs) 11:10, 6 December 2020 (UTC)

Cut down version
Race is an often unquestioned term in standard operating procedure. However, it is not always applied universally, and certainly not to great effect. Even the smallest phenotypic variations are often considered “racial differences”, and the difference between genotype and phenotype often go unnoticed [4].

In the case of pregnancy, some complications in black patients have sound biological basis. In the case of Sickle Cell Disease (SCD), CDC figures suggest that it occurs among 1 per 365 African-American births, significantly higher than any other “race” [6]. Tracing the origin of the Sickle Cell Trait points to countries in which malaria is or was prevalent, as the carrier state has a protective effect against this disease. As such, most SCD patients have a common African ancestry.

Unfortunately, genetics can not account for all complications in pregnancy. High blood pressure is more common in black patients than others. Although scientists speculate that it might have its roots in genetics, it is also easily attributed to environmental factors including smoking and stress [5]. Understanding the interplay between sociology, anthropology and biology will be necessary in research into such complications.

On the other hand, there are many aspects in treatment that rely much more on perceived truths. This is most clear in pain establishment, where patients must rank their pain from 0-10 [1]. This assessment relies heavily on the trust between the healthcare provider and the patient. Study has shown that people assume a priori that black patients feel less pain than white patients,[2] very similar to the ‘strong black woman’ narrative in sociology.

The intrinsic difference between subjective and experimental methods may very well cause tension within biology.

[1] https://journals.sagepub.com/doi/pdf/10.1111/j.1748-720X.2001.tb00039.x

[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0048546

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681827/

[4] https://read.dukeupress.edu/jhppl/article/11/1/97/27977/The-Biological-Concept-of-Race-and-Its-Application

[5] https://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes#1

[6] https://www.cdc.gov/ncbddd/sicklecell/data.html

https://www.cdc.gov/ncbddd/sicklecell/data.html

https://journals.sagepub.com/doi/10.1177/0002764215613401

Completely revised version
In general, biomedicine rejects the concept of race applied to humans. Within biological taxonomy, where race is considered no more than an informal rank, races are “thought to be discrete, exclusive, permanent, and relatively homogenous”. And while that might have been true when races were first classified, a large amount of mixing has taken place since.

The greatest issue with research lies not in the definition of race, but the lack thereof. Articles using the term “race” rarely give a definition, and it is often used as a term for environmental, behavioural and genetic factors. That ambiguity favours the prevalent thought that “race” means “gene pools”, thus excluding the sociological and anthropological factors that lie at the very foundation of race.

One widely publicised study connected higher rates of preterm birth in black patients to genetics, but gave no genetic data. Articles like these, in which racial inequalities are attributed to gene pools solely through exclusion of social factors, obscure truth and could misinform practitioners.

Using race as a blanket term for both environmental and genetic factors in itself has issues. Sickle Cell Disease causes many complications in pregnancy, and can reliably be traced back to malaria-prevalent countries. High-blood pressure in black patients, which can cause pre-eclampsia, on the other hand, is largely attributed to environmental factors. Both of these complications are considered in research as classifiable by race, but relate to distinct ancestral (genetical) and environmental (sociological) aspects. Clarifying these differences is necessary if we are to reduce the ambiguity of "race", and so its impact on health outcomes.

BASc to the future (discuss • contribs)

Sociology
I have just finalised my bit on sociology. Suggestions for improvements / corrections are very welcomed. It is now at 237 words which leaves us a bit space for other parts. Thank you for the great collaboration so far everyone. --Kuramae (discuss • contribs) 12:03, 9 December 2020 (UTC)

Good morning, I read through your part, I think it is very good for the short amount of words we had to cover such a large topic. I just did a few minor grammar edits.

Uclqmtr (discuss • contribs) 11:53, 11 December 2020 (UTC)

I revised and offered suggestions using Google Docs Kuramae, of course any edits made are at your discretion! I've attached a copy of the link to the docs! https://docs.google.com/document/d/1HFkdGLIy2X9pV8Dhrse64_DfddiNLwscQQXJu8CH2EY/edit?usp=sharing

Biology
Added a new draft version that hopefully fits in better with the rest of the chapter. Will be uploading it to the main page shortly, after I've finished it off. BASc to the future (discuss • contribs) 12:24, 12 December 2020 (UTC)

Thanks for the comments during our zoom call, which have since been implemented into the section. BASc to the future (discuss • contribs) 10:59, 13 December 2020 (UTC)

Statistics
Good morning everyone, Thank you for the productive zoom session we have had last night. Following on what we discussed I am going to adapt my draft on policy making to make sure that the major disciplines involved in Health care are well tackled. I will be writing a part about statistics and mention its relation with policy making (About 150 words) and add the article about race-based medicine/Race-conscious medicine as a possible solution to the issue we are treating in the conclusion. Please feel free to give me your feedbacks.

Uclqmtr (discuss • contribs) 10:56, 8 December 2020 (UTC)

I have added my part on statistics in the book. I still need to insert a few references and it is probably too long so if there is anything that you believe to be unnecessary please let me know. Thank you for your help and i am free if you need anything. Uclqmtr (discuss • contribs) 13:02, 8 December 2020 (UTC)

Just read through your contribution. It is very onto the point. I made a few edits: first of all changed the title to statistics as policy making is perhaps not a discipline in itself(?). I also switched the position of the first two paragraphs, I think this gives it more of a flow: you introduced the definition of race in statistics and then show how this can be applied or influence policy making. I also corrected some grammar mistakes, rephrased sentences to save words. In case there is space: I think the link to maternal care could be shown more strongly, just as a personal opinion. Please have a look at it and let me know if you disagree with something. --Kuramae (discuss • contribs) 12:35, 9 December 2020 (UTC)

Thank you so much for your feedback. I am thinking about calling this part statistics in policy making, but I worry this might disturb the structure of the chapter. Any opinion ? Furthermore while I do agree that switching the two paragraphs gives more impact to the piece, I feel like it might mess up a bit the logic of the part but I'll try to work on that. Thank you again.

Uclqmtr (discuss • contribs) 18:29, 10 December 2020 (UTC)

I've gone over your citations and matched them with the Vancouver style of other citations. Good work overall and good sources. BASc to the future (discuss • contribs) 12:24, 12 December 2020 (UTC)

General comments
I've gone over all sections and ironed out inconsistencies in references and their in-text location. I have chosen to place the sources after the sentences, as that is the style generally used in other Wikipedia articles. If there are any comments regarding that please leave them below. BASc to the future (discuss • contribs) 12:24, 12 December 2020 (UTC)

We've discussed issues in phrasing during our latest zoom call, and changes to reduce the word count. These have since been implemented on our main page. The zoom calls have been a great place to discuss comments and additions to the various sections. BASc to the future (discuss • contribs) 10:59, 13 December 2020 (UTC)

I've submitted this version through turnitin, and it did not detect any significant plagiarism. BASc to the future (discuss • contribs) 12:25, 13 December 2020 (UTC)

01.12.2020
FOUR SECTIONS:


 * 1) Importance of social definitions of race for legislation, Equality Act (hate crimes/discrimination etc), diversity and inclusivity at work/school (HR). How social-biological definitions contrast because of the disciplines behind them


 * 2) Biological definitions of race - tensions within biology and which are currently applied to medicine -> How conceptions of race influence clinical outcomes and decision making - link between scholarly/academic biology and practiced medicine - focus on Black maternal care (I would suggest to integrate this part as a result of the tension in biology on clinical decision making, OR medicine as a new paragraph as a discipline)


 * 3) Truth of race in law and how this affects clinical decision making / maternity care


 * 4) 3rd discipline?


 * 5) Conclusion: Are there tensions identifiable in the above described disciplines? Possible solutions + Use of race in medicine more generally, why it is necessary (can be a predictor of certain conditions)? How to communicate a more 'truthful' notion of race to clinical practitioners in the NHS and integrate it into the study of medicine more widely -> there might be studies available that have already looked into potential solutions that we could use

11er467va (discuss • contribs) 08:21, 8 December 2020 (UTC)

I added some thoughts from my side mainly in the 'sections' part, additionally, I think the title 'Truth of Race and its Implications on Clinical Decision Making / Black Maternal Care' would be more suitable, as we wouldn't want to make sure not just to focus on biology but different disciplines in order to identify potential tensions within these. --Kuramae (discuss • contribs) 18:49, 1 December 2020 (UTC)

03.12.2020
BASc to the future's little suggestion corner

I'm working with a paper for the biology part and came across a part that might be interesting for the sociological piece: "Additional study of the influence of English language proficiency on pain treatment should be pursued to understand how patient-physician communication influences the assessment of pain." BASc to the future (discuss • contribs) 11:17, 3 December 2020 (UTC) Source: https://journals.sagepub.com/doi/pdf/10.1111/j.1748-720X.2001.tb00039.x

Another one I came across that gives a general overview of the problem: https://www.raconteur.net/healthcare/fertility/racial-disparities-antenatal-care/

Interesting summarising work: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681827/

04.12.2020
- As Truth is a notion that varies through time, This wikichapter will focus on the issue of racism in health care and race definition in the present but in order to make sense of the progresses in social policies, I will extend the time period we focus on. This will also allow us to perceive the evolution of thought regarding race and its definition.

- And I have tried to reorganize the discussion page to make it clearer, I hope you don't mind.

Uclqmtr (discuss • contribs) 10:17, 4 December 2020 (UTC)

I created the framework for the our Wikibooks page and added my draft to the section. Please feel free to comment and edit. I also shared some thoughts on the 'Draft' section on this discussion page. Thank you everyone for your efforts so far.--Kuramae (discuss • contribs) 23:05, 4 December 2020 (UTC)

05.12.2020
Interesting: "In 2015, an informal survey of all four years at Warren Alpert Medical School of Brown University (n = 180) showed that 76% of students felt that the medical school curriculum as a whole did not adequately prepare them to address race and racialized health disparities in concrete ways as physicians" https://journals.lww.com/academicmedicine/Fulltext/2016/07000/Race_Matters__Examining_and_Rethinking_Race.14.aspx BASc to the future (discuss • contribs) 15:58, 5 December 2020 (UTC)

Just read through both drafts, very well written in my opinion. The only thing we will need to do is perhaps to shrink them down due to the word limit. --Kuramae (discuss • contribs) 11:19, 6 December 2020 (UTC)

07.12.2020
Cystic fibrosis is comparable to SCD as an inherited, progressive, life-threatening disease associated with decreased quality of life and shortened life span, but it primarily affects White Americans. Cystic fibrosis affects one third fewer Americans than SCD but receives 7 to 11 times the research funding per patient, which results in disparate rates of development of medications: currently, the Food and Drug Administration has approved 4 medications for SCD and 15 for cystic fibrosis

source: https://www.nejm.org/doi/full/10.1056/NEJMp2022125

BASc to the future (discuss • contribs) 20:29, 7 December 2020 (UTC)

10.12.2020
Here's the link to the google doc where people can see suggestions!

https://docs.google.com/document/d/1HFkdGLIy2X9pV8Dhrse64_DfddiNLwscQQXJu8CH2EY/edit?usp=sharing

11er467va (discuss • contribs) 14:30, 10 December 2020 (UTC)
 * Thank you very much. I just applied some changes you suggested in my paragraph. However, I decided to keep the last sentence as I think shows a good relation of how sociology can impact policy making, which is an interdisciplinary and worth to be included.--Kuramae (discuss • contribs) 19:04, 11 December 2020 (UTC)

Thank you very much for your edits! I will make the changes you suggested! I saw that you put a whole part of your work in red, is it because you are thinking of deleting them ? Uclqmtr (discuss • contribs) 18:36, 10 December 2020 (UTC)

Following the mail exchanges with our seminar leader. I believe we should change the title to TRUTH IN DEFINITIONS OF RACE AND IMPLICATION IN HEALTH CARE and then specify in the intro that we will be using the example of Black maternal care to reinforce our arguments. Do you all agree ?

Uclqmtr (discuss • contribs) 18:41, 10 December 2020 (UTC)


 * I agree with your title suggestion --Kuramae (discuss • contribs) 11:11, 11 December 2020 (UTC)

11.12.2020
After some thoughts I do still think that our chapter is not yet specific enough and we do need to base our findings on a case study. I would suggest introducing the case study in a few sentences in the introduction, maybe one about a women / group of women who suffered from inequalities in maternal care. Then just add a short link of our findings in our sections to this study. I added this link before: https://www.hsph.harvard.edu/magazine/magazine_article/america-is-failing-its-black-mothers/ It is an article which I think we could base our studies on. Please let me know what you think.--Kuramae (discuss • contribs) 19:28, 11 December 2020 (UTC)

Introduction
Good morning, Here is a proposition of modification for the Introduction, Please tell me what to think of it. It might be a bit too long.

The issue of black maternal healthcare provides a microcosm in which the wider concept of race can be examined. The truth behind a biological basis of race has been challenged since the concept’s inception, and yet racial categorizations are still used to inform medical practice and interventions. To define is to reach a consensus that attributes a meaning to a word, so that each word stands for a truth that allows people to communicate. By exploring how misguided definitions of race adversely affect health outcomes for black patients in the US an UK, this chapter directly highlights the problems caused by different conceptions of truth. The case of care provided to black women during pregnancy will serve as an example to support our arguments with a concrete application to reality. Uclqmtr (discuss • contribs) 14:54, 12 December 2020 (UTC)

I think this revision of the introduction is brilliant - explicitly explaining the link between the truth and 'definition' will really help the reader understand the point we are making! We could perhaps change 'stands for' to 'reflect' to save on words and reduce 'the case of' to just 'Care provided to...'. Otherwise I think it's really well expanded from what we wrote during the meeting. 11er467va (discuss • contribs) 14:49, 12 December 2020 (UTC)

''The case of care provided to black women during pregnancy will serve as an example to support our arguments with a concrete application to reality. ->By telling the stories of two black women, a research based article of Harvard University highlighted racial disparities in health care outcomes, such as 30% higher pregnancy related death rate which black people suffer under (https://www.hsph.harvard.edu/magazine/magazine_article/america-is-failing-its-black-mothers/). This will serve as an example to support our arguments with a concrete application to reality. The potential causations of the racial gap in health care outcomes is traced back by a multitude of disciplines.''

Uclqmtr (discuss • contribs) 12:14, 12 December 2020 (UTC)
 * Thank you for your suggestion. It is very thoughtful and more precisely tailored towards our chapter. I added a specific example (in Italic) using my suggested article above to strenghten our arguments in the chapter. Please let me know what you think of this. --Kuramae (discuss • contribs) 13:31, 12 December 2020 (UTC)

Thank you for adding this! I think whilst it would be beneficial to add a specific example like this one, I don't think we have the words to allow for it. Also, with the bio-med section's two examples of health conditions which directly affect pregnancy and your examples of research in which it has been found that Black women are treated poorly during pregnancy (the careless one and the postpartum care one), I think we've given plenty of evidence for the wider case study of 'black maternal care'. But I do see your point and if we had more words I think it would have been great to include something like that you've written. 11er467va (discuss • contribs) 14:49, 12 December 2020 (UTC)

Thank you for checking this out so quickly. While I agree that your addition will allow the reader to how a more concrete approach to the issue we want to tackle, I am worried about the word count! Hope it fits ! Uclqmtr (discuss • contribs) 13:56, 12 December 2020 (UTC) Same for conclusion:

Conclusion
Ultimately, healthcare institutions believe they are following positivist truths based on robust scientific evidence about race in their practice, when in fact their medical interventions are informed by notions of race which are constructed by the society in which they live. The failure to consider the social and environmental factors involved in health outcomes for black patients reinforces the assumption of a biological basis for race. It becomes obvious therefore that only an interdisciplinary approach combining anthropology, biology, social policy, statistics and sociology, among others, can reveal the truth about race and its implications in healthcare. A proposal to shift from a race-based to a race-conscious has been made in order to fight structural racism which results in major inequalities. Uclqmtr (discuss • contribs) 12:32, 12 December 2020 (UTC)
 * Very good, the last sentence is definitely needed and straight to the whole point of this discussion. --Kuramae (discuss • contribs) 13:34, 12 December 2020 (UTC)

This was my very minor revision of the conclusion I did previously - but I agree the last sentence is really nice to highlight a potential solution.

Ultimately, healthcare institutions may believe they are following positivist truths about race founded in biology in their practice, when in fact their medical interventions are informed by notions of race which are constructed by the society in which they live. With the failure to consider the social and environmental factors involved in health outcomes for black patients further reinforcing the assumption of a biological basis for race. It becomes obvious therefore that only an interdisciplinary approach combining anthropology, biology and sociology among others, can reveal the truth about race and its implications in healthcare.

11er467va (discuss • contribs) 15:01, 12 December 2020 (UTC)

Wonderful changes ! thank you for this enlightening contribution. Uclqmtr (discuss • contribs) 15:10, 12 December 2020 (UTC)

I had a look over your section that you sent me Basc to the future, the revisions you've made have really stressed the relevance of interdisciplinarity in this case and honed in on the issue with truth in regard to race in bio-med - really good and not at all 'lost' anymore I think. I've made a few semantic/grammatical notes which you may or may not want to listen to, but content wise its very direct and explicit and great! I know you've probably already got the link from last time but here it is again! https://docs.google.com/document/d/1HFkdGLIy2X9pV8Dhrse64_DfddiNLwscQQXJu8CH2EY/edit?usp=sharing

11er467va (discuss • contribs) 14:56, 12 December 2020 (UTC)

I'm slightly concerned that we don't explicitly mention positivism prior to the conclusion, although it is implied in the biomedicine section. I would therefore suggest perhaps one of the following edits:
 * Articles like these, in which racial inequalities are attributed to gene pools through eliminating social factors, falsely pose as positivist truth and misinform practitioners. (bold to replace "obscure")
 * Change title of section to "Misguided positivism in Biomedicine"

BASc to the future (discuss • contribs) 11:18, 13 December 2020 (UTC)
 * Well spotted Basc to the future. Just wanted to mention that positivist truth is also shortly mentioned in the sociology section so we are save, but it is great to have it highlighted once more elsemore to really emphasise the role it plays. Otherwise I agree with this article being the final draft. --Kuramae (discuss • contribs) 17:32, 13 December 2020 (UTC)

20.11.20 - zoom n°1
11er467va created the Wikipedia chapter prior to the meeting.

We’ve started off with two ideas: 11er467va proposed we work with “definitions of race”, Uclqmtr proposed working with “memory”

11er467va mentions that race theory shows tensions between biology and sociology. Aspects that could be discussed are how data might be manipulated, and how it is used by different parties. Uclqmtr chimes in that the most suitable issue strand for this subject would be Truth.

Uclqmtr suggested that there might be more sources on race theory, which ensures that less of the chapter is left to own interpretation/original thought.

A meeting at the beginning of every week is suggested, to discuss progress and new ideas. 11er467va supports this and mentions that she doesn’t feel ready to start writing right after the first session.

Uclqmtr is unsure what the tasks should be. How are we dividing the writing? BASC to the future suggests not to write 4 individual sections, but rather three. That way, 		more words can be used to go more in-depth. He suggests 11er467va, as native English speaker, to go over the grammar/spelling in the chapter.

11er467va & Uclqmtr both suggest that we use a mind map to visualise our ideas, which is supported by BASC to the future and Lydia

11er467va, linking back to the discussion on race theory, mentions that certain sicknesses are more likely to occur in certain ethnical groups. She also mentions that she’d heard of a study that suggested that the scientific evidence for race was unfounded.

Uclqmtr, elaborates on some points of het “memory” idea: How does the brain react to events, how does it choose what information is valuable to retain? How do politics have an effect of what you want to remember How the internet has influenced our memory

BASC to the future brings up that algorithms might provide a hard-science insight into the “internet” aspect.

BASC to the future suggests looking at problems that have a more clearly defined hard-sciences background. An example being plastic pollution, which has economic and chemistry parts, and perhaps even sociological?

11er467va/Uclqmtr both discuss how rich companies ship off their trash to poorer countries.

After that, Helene joins the call and shares her insight. She believes the mentioned ideas are too general, and should be reduced. The memory idea could be reduced to a study of brain science, or how we recollect certain political events The race issue could be linked to recent BLM events, like the statue in Bristol being toppled. Kuramae mentions race in the second world war.

The discussion then goed back to the race issue. It is mentioned that we have conceptions of race but no real definition of it, whereas laws suggest that there might be one.

We have conceptions of what race entails but we have no real definition.

Uclqmtr wonders if Darwinism could be incorporated into the chapter, he discusses species from a natural sciences perspective.

11er467va builds on the race issue by mentioning a study about care discrepancy between black and white people. According to study, unfounded biological definitions of race were used, which influenced decision making.

BASc to the future (discuss • contribs) 11:17, 3 December 2020 (UTC)

01.12.2020 - zoom n°2
Article should include:
 * Conscious decision to focus and be precise on two disciplines: medicine and biological anthropology. And link other disciplines critically such as law, sociology, statistics, social policy.
 * Intro: definition of race in the black maternity health care.


 * biological definition of race
 * biological anthropology: classification
 * Why is the definition of race used in medicine
 * social policy implications and evolution/law.
 * statistics ? creation of medical rapport or algorithm that categorize people
 * sociology: bias by practitioner : black studies ? cultural studies?

Uclqmtr (discuss • contribs) 21:03, 1 December 2020 (UTC)

04.12.2020 - zoom n°3
Meeting 3 on zoom - 04/12/2020 15.30

Summary


 * Revision of our drafts so far; we decided to move the conceptions of truth to the conclusion and apply them more specifically to race in healthcare
 * we needed to explicitly explain how our strand - truth - is relevant and in fact the subject matter of the chapter
 * A member will include statistics and potentially computer science to identify racial disparities
 * The entire objective of the chapter is to stress that both the ambiguity around biological distinctions between ‘races’ AND practitioners’ implicit biases/systemic racism are responsible for adverse health outcomes for black patients in the US and UK
 * Endeavouring to finish drafts by Mon 7th Dec - our next meeting is scheduled for 8pm that day
 * Final version finished by 10th Dec as to help with other deadlines
 * Biology section could potentially use more examples
 * Bio-anthro to include distinction between ethnicity and race - mention of social construction
 * A member of group will now cover statistics + computer science almost exclusively

11er467va (discuss • contribs) 17:12, 4 December 2020 (UTC)

Many thanks for my group members who wrote down their discussion content of the call which I wasn't able to attend. I now tried to take out only the main points of the discussion and put them into the summary so it is more precise. Please feel free to change it if something is wrong.--Kuramae (discuss • contribs) 11:28, 6 December 2020 (UTC)

07.12.2020
--Kuramae (discuss • contribs) 14:48, 8 December 2020 (UTC) Common work on the intro:
 * Discussed introduction and conclusion
 * Intro to be a few sentences introducing topics
 * Conclusion to discuss positivism and constructivism
 * We then revised a peer’s contribution, decided to omit some of it and reintroduced a paragraph they had written
 * Mentioned all of us need to cut ours down to word count - agreed to do this post-meeting
 * Read through another peer’s rough draft - offered thoughts and suggestions, mention of including literature on funding that was found
 * Worked together on introduction and conclusion: short introduction to the issue; conclusion should stress the need of interdisciplinary thinking and outline the links between the disciplines once again, but paragraphs in the main part should introduce the links more in depth.
 * We decided to shorten the paragraph on statistics but emphasise other subjects more to go in depth
 * We have to decide on whether we should use black maternal care or general health care
 * Final points to be done until next time: pictures, finish all drafts & proof read, shorten paragraphs to around 250 words each
 * Goal: finish the chapter by Friday with a final meeting

The issue of black maternal healthcare provides a microcosm in which the wider concept of race can be examined. The truth behind a biological basis of race has been challenged since the concept’s inception, and yet racial categorizations are still used to inform medical practice and interventions. This chapter explores how misguided definitions of race adversely affect health outcomes for patients in the US an UK.

Conclusion:

Ultimately, healthcare institutions believe they are following positivist truths based on robust scientific evidence about race in their practice, when in fact their medical interventions are informed by notions of race which are constructed by the society in which they live. The failure to consider the social and environmental factors involved in health outcomes for black patients reinforces the assumption of a biological basis for race. It becomes obvious therefore that only an interdisciplinary approach combining anthropology, biology, social policy, statistics and sociology, among others, can reveal the truth about race and its implications in healthcare.

Uclqmtr (discuss • contribs) 21:20, 7 December 2020 (UTC)

11.12.2020
Hopefully final zoom
 * rethinking of the Biology/Medicine part
 * votes on several subjects: title, switching paragraphs ect
 * re-structuration of a few parts
 * Make sure that we involved the notion of truth in the chapter.

Uclqmtr (discuss • contribs) 12:11, 11 December 2020 (UTC)

12.12.2020
During this zoom call (1400-1630) the following subjects were discussed:
 * Title was changed to "Truth in Definitions of Race and Implications on Black Maternal Care"
 * The completely rewritten biomedicine draft was approved and added into the chapter
 * Minor phrasing errors throughout the chapter were adjusted
 * All pieces placed together in the Wikibooks and cut to appropriate size to fit word count
 * New additions to conclusion and introduction were approved and implemented

BASc to the future (discuss • contribs) 10:50, 13 December 2020 (UTC)

13.12.2020
Final meeting (not on Zoom):


 * Final revision of the entire text - minor revisions added or lost
 * Added more images to the chapter
 * Agreed to submit
 * Converted to pdf and submitted!

11er467va (discuss • contribs) 08:51, 14 December 2020 (UTC)