Politics of Categorization: Race and Blood
In a recent article for The New York Times, British journalist Rose George makes the case that the Red Cross needs to reassess its policy of desegregating blood based on race and ethnicity. She also argues that blood collection services need to develop initiatives to attract a more diverse pool of blood given the dearth of minority donors. George draws on the sympathetic case of a young child, Zainab, whose cancer treatment requires a rare form of blood common amongst Iranians, Pakistanis and Indians – a group that is not well represented in the donor system. While the motivations behind this appeal are laudable, I argue it reflects a deep-seated problem in how we generate medical knowledge that, in the name of producing more equitable outcomes, has had the unfortunate effect of reifying and perpetuating race as a biological fact – which it is not.
I contend that race is not an ideal way to think about blood for reasons related to robust knowledge production, scientific efficacy, and socio-cultural consequences. While George argues, correctly, that statistical regularities around blood type, and thus blood compatibility, can be found when we categorize the human population along racial lines, I maintain that this kind of racial sorting has the effect of making race appear as if it is genetic rather than a set of practices located in social structures. The question I have is that given the destructive legacy of racism, is categorizing populations using race the best way to think about blood and biology? The prevailing dilemma here has to do with whether the fictitious category of race, which, again, has no genetic basis, should be used to sort populations out of expediency, ease, or efficiency – particularly when this results in perpetuating racialization. Karen and Barbara Fields refer to this practice as Racecraft– defined as a process whereby the illusion of race is made manifest by arbitrarily identified phenotypical differences which, in turn, creates race. This is made more complicated by the fact that this historical conjuring of race has material, lived, and embodied effects including health, socio-economic, and political inequalities.
While policies aimed at addressing these disparities are desirable, with the coda that race is understood as explanatory rather than biological, they should not be relied upon in the context of biology since its effect, as scholar Troy Duster puts it, is the reinscription of race in science. Also problematic is the claim made by George about sickle-cell anaemia which she correctly characterizes as a disease present more frequently, but not exclusively, amongst populations racialized as Black. What George fails to adequately acknowledge, however, is the significance of the “but not only” exception. Briefly, the sickle-cell allele evolved as a means by which to protect individuals from malarial diseases in areas that have high concentrations of malaria carrying mosquitos and thus it an evolutionary outcome of geography and circumstance, not race. Moreover, while sickle cell carriers were predominantly present in Western Africa, which is how it made its way the to the US (via the slave trade), it is also present in Southern Europe, particularly Greece, the Arabian Peninsula, and parts of India. Similar conclusions can be made about Thalassemia, another Mendelian disease that has a wider distribution than the author suggests.
And alternatives to this kind of categorization do exist. This might include a gene-environment framework to tackle health disparities coupled with grouping methods that use genetic clustering or genotype subgroups – both of which have been established as demonstrably superior to race-based classifications. Others have suggested the use of geography or ethnicity which, while an improvement on race, is also problematic since both map onto race much too easily. This is something George herself engages in by frequently going back and forth between race, ethnicity and geography resulting in the conflation of what are very distinct phenomena. To be fair, the objective George’s piece addresses is very specific problem in a context in which race presents itself as the most ready-at-hand proxy to make her case. The problem is that this practice results in the troubling preservation of race in scientific knowledge production where it is neither useful nor justifiable in the long term.
Dr Tina Sikka is a Lecturer in Media, Culture and Heritage at the University of Newcastle, UK.