This dialogue question is straight forward: Why do you think so much money and attention go towards genetic research rather than towards improving social conditions? Similarly, why do you think so much money goes toward medical care and treatment rather than prevention? What points from what you have read and viewed help inform your response?
One of the things I’ve noticed in the materials in this course as well as other courses and my own personal life is just how readily we miss the forest for the trees. The alluring study of the leaves of the tree in front of us, or the details of its bark, or even the intricacies of the root network below – this type of study is important and certainly interesting. What we miss, though, are the lessons we would learn if we zoomed out and studied how the trees come together to make a forest. I, personally, have fallen victim to the idea that if I can just understand every detail of the tree at a micro level, I should be able to deduce how a group of trees interact at a macro level.
The forest is more than the sum of its trees, however. It is influenced by a number of other factors in multi-dimensional levels. I’m using this analogy to refer to the study of genetics in healthcare research. I come from a microbiology/genetics background – I find studying living things at the micro level to be quite rewarding. I also believe that genetic study is simpler than the study of the higher-level social determinants of health. If the root cause of a health disparity is determined to be a genetic difference between, say, two races, researchers can close the book on their studies. They can pat themselves on the back and say “We figured it out, it’s all because of genetics, nothing more to do here boys, let’s pack it up!” They are excused from the responsibility of solving health inequities because genes are considered immutable and as such, health disparities are inevitable.
This is problematic in at least two ways. First, self-reported race is widely considered a poor indicator of genetic ancestry. Not all individuals who identify with the black race will have African ancestry, and similarly, most white people have no lineage at all from the Caucasus Mountains to be considered ‘Caucasian’ by ancestry. Additionally, the dynamics of human genetics themselves are more complicated than what’s implied with ‘genetic cause’ discussions of health disparities. We as individuals express certain genes in certain ways as a result of the experiences of our grandparents. This concept is referred to as epigenetics, and it’s truly fascinating. Differences in nurturing instincts of new mothers are associated with the experiences of stress and famine three generations higher. Great-grandma’s trauma influenced circulating cortisol levels, which subsequently changed her genetic expression. She then passed those changed genes down to her offspring.
What this means is that disparities between races are symptoms of the larger condition that caused them – racism. This applies even down to observable genetic differences. When health researchers stop after finding those differences, they miss the point. The genes aren’t the cause of differing health outcomes, social conditions are. Those social conditions are harder to resolve in comparison to simple genetic counseling, however. Blaming genes for poor health outcomes is the same as blaming the victim. It’s simplistic and it’s lazy, but it looks like the problem is solved.
I believe that these concepts apply in the context of treatment vs. prevention of health problems as well. Health conditions will continue to occur within a community if their root causes aren’t addressed. It’s simpler, however, to treat the symptoms of a health condition in an individual, as well as the symptoms of a condition such as racism in a community. We can place the blame on the shoulders of the victim, then pat ourselves on the back for solving the problem. The problem isn’t solved, though, and we caused additional harm to the victim by making them responsible for the inequities that afflict them. We unburden ourselves of responsibility, as a community, with this focus on personal responsibility. We protect our own egos of being faultless as the expense of the health and well-being of our fellow humans.
Going back to the original forest analogy, I realize that it’s impossible for me to understand the afflictions of the forest as a whole if I focus entirely on understanding the details of the trees. I fail to notice higher dimensional aspects of the health of the forest, such as climate change. In order to see the forest and the trees, I must stretch my capabilities. While difficult, it is ultimately rewarding. Similarly, we must stretch our understanding of health by considering the higher-level social determinants that are the true root causes of health inequities.