Exploring What Maintains the Racial Inequality Status Quo

By Dirk Hoffman

“We should understand that race is socially constructed, but the critical question becomes ‘for whom?’ and ‘for what purpose?’” he asks.

An associate professor of sociology at the University of Tennessee, Knoxville, Williams was the keynote speaker for the fourth edition of the University at Buffalo’s “Beyond the Knife” endowed lecture series established by the Department of Surgery in the Jacobs School of Medicine and Biomedical Sciences.

In opening remarks, Allison Brashear, MD, MBA, UB’s vice president for health sciences and dean of the Jacobs School, noted the lectureship was established by Steven D. Schwaitzberg, MD, SUNY Distinguished Service Professor and chair of surgery, and his colleagues, and serves as a crucial platform for engaging in essential conversations surrounding racism and health care in the U.S.

“We are deeply grateful to the Department of Surgery, particularly the social justice and health equity group led by Dr. Michael Lamb. For over three years, this dedicated group has convened biweekly to have meaningful conversations and spearhead impactful projects aimed at abolishing structural racism. Tonight’s program stands as a testament to their unwavering commitment,” she said.

Schwaitzberg said he was honored to have Williams as the guest speaker because “his expertise and passion align with the themes of our event — antiracism and health equity in our communities.”

“The Beyond the Knife lectureship has always aimed to foster meaningful discussions, inspire positive change and encourage critical thinking within the medical community, and our community as a whole,” he said. “Together, we can contribute to building a health care landscape that is truly equitable, just and reflective of the diverse communities we serve.”

Lamb, an environmental psychologist who is a research assistant professor of surgery and UB’s director of surgical education, said his first ‘mind-blown moment’ with Dr. Williams was on social media when he read a post of his that stated: “Conservatives ignore diversity to maintain whiteness. Liberals overinvest in abstract diversity to maintain whiteness.”

“This really struck a chord with me. It summed up the dilemma. It pointed unmistakably at the ever-present danger of premature self-congratulation; of spending all your energy wrestling with the wrong questions,” Lamb said.

“Dr. Williams has this kind insistence that our foe is not our fellow human beings, but rather these brutal structures in which we are all entangled. The great promise of conversation like this is it provides us with new tools to think and to act so that we don’t continue to reproduce these structures in our schools, in our workplaces, and in our homes. Love the people, fight this system.”

The title of Williams’ talk was “Structural Anti-Blackness and the Persistent Racial Inequality.”

He started by giving a brief background of his scholarly endeavors — studying couple dyads and noted much of his doctoral dissertation work focused on the ideas of stress and health.

“I then went into a postdoctoral position in minority health disparities in that I started using survey data to learn about biomarkers. And that is when my eyes began to open to how complex this thing called structural racism is.”

“Part of this work was to look at things like cortisol and alpha-amylase and how stress in one person affects their own stress response system, but how your stress can also affect your partner’s physiological stress response system,” Williams added. “Then I became an assistant professor and began really pushing the boundaries, in terms of thinking about Black families.”

Williams told the audience he was going to use terms such as “people racialized as Black” or “people racialized as white.”

“I do that on purpose to highlight race as a social construction,” he said. “When I talk about structural racism, what I am referring to is a set of ideologies and structures that not only make the idea of race possible, but they also disproportionately benefit people who are racialized as white.”

Williams noted there is a tendency for people to think that racism is an individual-level attribute whereby you have to be intentional to be racist.

But intentionality is not a necessary condition for the maintenance of white supremacy and anti-Black racism, he said.

“It is sufficient, but not necessary, especially when we think about this thing called racial disparities in health,” Williams continued. “Racial disparities in health are a social fact. We know, empirically, that on average, people who are racialized as Black compared to people who are racialized as white are more likely to suffer from cardiovascular disease.”

He noted that African Americans are more likely to die at earlier ages, there is pregnancy-related mortality across racial lines — maternal mortality and infant mortality rates that vary across racial lines.

“The debate often emerges when we start talking about why they exist and why they persist,” Williams said. “In order to understand persistent racial disparities in health or any other outcome, we first have to understand the relationship between racism and race.”

“Do you believe that race leads to racism or racism leads to race?” Williams asked. “How you answer this question speaks volumes about assumptions about racism and race.”

“What if I told you both were correct?”

Williams said the idea that race leads to racism is ultimately embedded in an essentialist perspective — the idea that race is inherently biological or culturally real.

Whereas racism leads to race highlights the social construction of race, he said.

Racial essentialism – the idea that race is biologically culturally real, racism is episodic and that inequalities are a byproduct of the disadvantaged group themselves — often gets represented that way in research and in social justice movements, Williams said.

“My work challenges the remnants of essentialism. A lot of my work is looking at what the social construction of race really means,” he said.

“Inequality was a pre-existing condition that made racial categories possible. The magnum opus of racism is racial categorization,” Williams asserted. “Racism is an ongoing feature in the U.S. It is not episodic. Policies and laws are responsible for racial inequality.”

“Until we understand this juxtaposition between racial essentialism and the social construction of race, we are going to forever talk around each other instead of talking to each other.”

“Instead of asking for what accounts for racial disparities in health, I argue we should be asking what are the mechanisms that maintains racial disparities in health,” he said. “When we answer that question we can understand its genesis, how it ends, and becomes recreated and then we can start highlighting the mechanisms, not to account for the gap in health, but what maintains it. And if we can answer the question of what maintains it, then we can find ways to end it.”

Racism as an ongoing feature of the United States adjusts itself, adapting to the changing landscapes of ideologies and structures, Williams said.

“What I care about is the making, the maintenance and the manifestation of racial stratification. Racism is composed of two components — ideological and structural,” he noted. “The ideological component is beliefs about inequality. Turns out the Colonists had to make sense of inequality because how can you preach about life, liberty and justice while you are committing genocide against the natives?”

“Stealing their land, the enslavement of Africans — you can do that by making an argument that human beings have a hierarchical order. There is a superior group and a subordinate group,” he said. “And then you create laws, policies, social practices, even discourse and language as structures to make your ideology a reality.”

Racial categories are not just a historical demographic characteristic of the population, Williams said.

“They are not just nominal variables. It is a categorical relationship of who’s on top and who’s at the bottom.”

Williams asserted that because inequality already existed, the creation of racial categories turned generic inequality into racial inequality.

“The belief about inequality gets converted into hierarchal boundaries that restricts access to some groups from valuable resources,” he said.

Williams said in his work he has moved away from calling individual people racist because he thinks it is counterproductive.

“The system was created before any of us were ever born,” he said. “Remember, racial inequality is America’s equilibrium.  So anytime there is a social movement (Civil Rights Movement, Black Lives Matter) fighting against the system, it corrects itself because it does not know how to do anything else.”

Williams also talked about how stress gets under the skin to affect health disparities — noting how our brains interpret stressors in a particular way, based on past experiences.

“Our bodies are equipped to deal with acute stress, but are not equipped to deal with chronic stress,” he said.

Williams used the analogy of being chased by a bear.

“Your fight or flight kicks in. And let’s say you get away from that bear. When the bear goes away, our physiology goes back to normal, equilibrium.”

“But let’s say you have to face a bear every damn day and there is no calming down for you. Every day, your stress response system is elevated, your cortisol levels are high,” he said. “What if that bear is racial discrimination? What if that bear is poverty? Every damn day you are dealing with some metaphorical bear and your physiology just can’t keep up. And it puts us at risk for cardiovascular disease.”

Williams said the country’s racial disparities are so prevalent and so normative, that it has created a political and racial divide.

“As we move forward, we need to think about racial inequalities as a failure of human rights, period,” he said. “It is not just differences in some outcomes. It is a violation of human rights.”

“And we have casually, as academics, made it about this disparity language, when the truth of the matter is that this country has neglected people racialized as Black.”

“Racial inequality is like saying ‘we want to increase diversity’ when we haven’t done anything to decrease the whiteness that is ever present on college campuses,” Williams added. “All you are doing is recruiting people of color to a predominantly white space in which their cortisol levels get spiked because no one is going to listen to them.”

While much work is still to be done on the subject of racial inequality, Williams remains hopeful.

“We need to understand that racism affects the health of people racialized as Black,” he said. “Fortunately, the American Medical Association has adopted a policy that recognizes that racism is a public health threat. It is a start, it’s not the end.”

Following the keynote speech, the Feb. 22 event also featured a community panel focused on the issue of race and racism.

Panelists were:

• LaVonne Ansari, PhD, chief executive officer and executive director of the Community Health Center of Buffalo, Inc.
• Chandra Redfern, chief executive officer of the Buffalo Federation of Neighborhood Centers, Inc.
• Ron Stewart, PhD, professor and chair of sociology at Buffalo State University
• The panel’s moderator was Rita Hubbard Robinson, JD, chief executive officer of Neuwater & Associates, LLC.

Stewart spoke about the power of education, noting that he grew up in abject poverty in Mobile, Alabama, and now uses his good fortune to “pay it forward.” 

He acknowledged Christopher St. Vil, PhD, an associate professor in UB’s School of Social Work, who is a former student of his who was in the audience.

Stewart noted he and St. Vil co-founded the African American Male Empowering Network, a support group for African American males attending Buffalo State, and that St. Vil, who came to Buffalo State as a student from a reform school, was the first president of the organization.

“And now he has a PhD from my alma mater, Howard University, and he is a renowned professor at UB’s School of Social Work.”

“And he is not the first African American male or female I have had that type of influence on. That is what I do,” he said. “I tell them that education can change your life.”

The panelists were introduced by Timothy M. Adams, MD, clinical assistant professor of surgery.