London, July 4, 2020
In spring 2020, when so many people all over the world first became transfixed by the dangers of the novel coronavirus that causes COVID-19, there was a strong narrative that we were “all in this together” as we were implored to “flatten the curve.” This message was pervasive in the United States, where I am from, and in the United Kingdom, where I live—filling my newsfeed of both mainstream media and social media. And yet, with each passing week, the racially and ethnically unequal pattern of who was most likely to be sickened and killed by COVID-19 became increasingly visible. If the looming curve looked mathematical and indiscriminate, that obscured the very different lived experiences that structure epidemiological risk.
As spring turned to summer, high-profile incidents of deadly violence against Black people sparked an awakening from COVID’s numbing numbers: the vigilante killing of jogger Ahmaud Arbery, the police killing of Breonna Taylor in her own home, and especially the police murder of George Floyd caught on video footage that has been widely shared. These murders and the righteous protests that they have sparked remind us that, in our racist societies, unequal vulnerability is not new.
These crises of COVID-19 and of police brutality can call our attention to the factors that contribute to health inequality, such as systems of health care and of policing, in a context of segregated neighborhoods and unequal urban infrastructures. They also point toward the depth of the societal transformation that would be required for Black Lives to be treated as if they truly Matter.
The deaths from COVID-19 and the recent police and vigilante murders are acute instances of chronic health and social inequalities. And the sources of these inequalities far exceed the institutions of health care and policing, extending to the broader social, political, and economic structures that shape unequal lived experiences.
During this disrupted period, as the news cycle and social media cycle both churn relentlessly, it can feel hard to keep up. Going against the rush to take time for considered analysis is not the default setting of social media engagement. The speed of the onslaught of information on social media is part of its design. Consider: Facebook’s original corporate motto was “move fast and break things,” and this kind of recklessness has been a pervasive mind-set among tech companies. Yet, as Black feminist analyst of science and technology Ruha Benjamin points out, that approach has included a disregard for breaking people.1 Benjamin insists that technology design and use—including social media—should instead “move slower and protect people,”2 and I would add that the same is true for the way that we engage with media images and stories more broadly. If we take the time to sit with these events, take them in, and both unpack their specificities and attend to how they are part of broader structures, they can become concrete entry points into understanding the wide-ranging ways in which racism operates.
It is in this spirit—simultaneously urgent and slow—that I sit down to complete this book.
Sickening: Anti-Black Racism and Health Disparities in the United States explores a series of distinct, evocative events to illuminate wide-ranging aspects of racial health disparities in the contemporary United States. I start at a time before the widespread use of social media, in the immediate wake of the attacks of September 11, 2001, and consider a sequence of particular events that have taken place over the twenty years that followed. The topics that I explore here are ones that I have been thinking about over the course of these two decades—through my doctoral studies in Science, Technology, and Society that I began in September 2001, through writing a dissertation about race and heart disease, and through more than a decade of teaching undergraduates about the intersections of biomedicine and culture and of science, technology, and race. Science, technology, and medicine both shape and are shaped by society and culture, and the racism that is pervasive both in health care settings and in broader society has consequences on both society and health. Each of the cases that I recount is sickening in at least two ways: provoking outrage and disgust and revealing multifaceted ways in which living in a racist society makes people sick.
The chapters take on diverse, familiar spheres of recognized urgency: terrorism, natural disaster, mass incarceration, police brutality, environmental justice, and reproductive justice. Each chapter is grounded in close attention to a concrete event that provides a distinctive window into those larger phenomena: the deaths of two Black postal workers in the 2001 anthrax attacks; the spike in chronic disease after Hurricane Katrina in 2005; the Scott sisters’ case of 2010, in which double life sentences were suspended on condition of kidney donation; the preferential protection of General Motors machines rather than people at a key moment in the Flint water crisis in 2014; a teenage girl subjected to excessive force by a police officer at a 2015 suburban pool party; the life-threatening experience of childbirth for tennis star Serena Williams in 2017. Sickening shows that exceptional events can reveal the fundamental racialization of citizenship and health in the United States.
Each of the cases engages with health in different ways. Sometimes I write directly about medical care contexts, in which denial of care causes direct bodily harm and even death. But I also consider broader public spheres, not narrowly medical, as spaces that foster or inhibit bodily flourishing. Here, considering the World Health Organization definition of health is instructive: “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”3 Health is a capacious category, inextricable from the entire social world.
The six cases that I explore are a small portion of the egregious occurrences of the first two decades of the twenty-first-century United States. Although these cases are by no means comprehensive, there is a logic to their selection. Each offers opportunities to explore particular themes, and, taken together, they provide a more robust look into how racism harms health and well-being. Many additional topics could be covered, for example, anti-Black racism has structured the HIV/AIDS epidemic in the United States,4 a vital public health issue that deserves sustained attention but does not find it here. I hope that readers will be informed by the six examples that are analyzed in this book as they grapple with other events—whether past events or events yet to come.
Attending to such wide-ranging examples foregrounds the multifaceted ways in which living in a structurally unequal society impacts the health and citizenship of racialized populations, especially African Americans. Racial disparities in medicine and health do not have a single cause but are the result of wide-ranging and interconnected elements of living in a racist society. In addition to the major themes of each of the particular chapters, Sickening draws attention throughout to structures that mediate health inequalities, ranging from encounters with health care providers to encounters with governmental authorities, in contexts of unequal infrastructures.
On one level, this book is a resource that I have wanted for use in my own undergraduate classroom. I strive to lay out the case studies and define key terms as I go, so that the chapters can be accessible to students with little background knowledge of the events and theories being discussed. Also, I have chosen topics and analytical frames with the goal of giving students a foundation in understanding key topics in racism and health. At the same time, no matter what level of background readers bring with them, I hope that this book is an opening to further engagement. To that end, I often identify and quote many scholars from diverse fields in the main text, rather than relegating that material exclusively to the footnotes, to characterize and invite readers into ongoing academic conversations of potential interest: there is much more worth reading. At the end of the book, I provide a set of analytical strategies that can be used as an assignment in an undergraduate classroom.
On another level, the book is also an interdisciplinary text that seeks to draw together and contribute to plural fields of scholarship, and I hope that graduate students and my colleagues in the social sciences and humanities will find its analysis rich enough to provide new insight. Readers who are unfamiliar with the scholarly debates might skim some sections within the chapters that attend to theoretical matters without worrying too much about the nuances, or they might become curious about them and follow the footnotes to explore them in more depth.
My focus is on the United States in particular, rather than taking a more global view, because attending to the specific national context is vital for understanding the historical and social constitution of racial inequality. At the same time, I strive to provide enough context and explanation that readers in many countries will find the accounts accessible and will be able to both appreciate the specificities and make transnational connections of their own.5
The selection of the twenty-first century is intentional, even as it will become clear that much longer histories matter tremendously. Many books about racism in medicine and health focus either on centuries-long histories starting with colonialism and slavery6 or on famous twentieth-century cases that happened long before today’s college students, and indeed many Americans, were even born, such as the Tuskegee Syphilis Study and the creation of the HeLa cell line from the cells of Henrietta Lacks.7 As important as this history and these cases are, I have found in my teaching that reliance on them as the starting point for conversation can create an impression that the drivers of racial inequality in health are located in the past. This mode of narration sets up racism as a residual legacy of the past and, in so doing, elides the agency and responsibility of present-day actors and structures. By focusing specifically on twenty-first-century events, and following relevant historical threads without assuming either progress or stasis, this volume illuminates the ways in which these inequalities are constantly re-created in the present.
I start my account with an event that happened in 2001: the deaths of two Black postal workers in the anthrax attacks. The anthrax attacks have largely faded from public memory, in part because they happened just weeks after the large-scale terrorist attacks of September 11, 2001, and yet they are a useful starting point for this book. The September 11 attacks were more than just a large-scale tragic loss of life: they were truly extraordinary, the attacks themselves a spectacle. As I will discuss in the first chapter, the impact of those attacks was unusually democratic, in that people from all walks of life died as the planes crashed and the buildings collapsed. In the mass mourning of that time, there was a widespread media narrative that Americans, denizens of the most powerful country on earth, were now newly vulnerable. This obscured a more fundamental truth: that many Americans were never safe, and vulnerability has always been highly structured by race, gender, and class. After September 11, as before, Americans have never really been “all in this together,” and attending to the deaths of the postal workers that occurred the following month helps to make that clear. The events that I analyze in this book are less spectacular than those of September 11, and the unequal impact that they have is far more ordinary. Although there is an element of spectacle in the events that I recount—they are, after all, events that garnered considerable attention—the unequal exposure to risk and the unjust denial of care are also profoundly routine. They are emblematic of the “slow violence” that often goes unnoticed but is fundamental to how bodily well-being becomes unequal.8
Another motivation for this starting point is worth highlighting. I specifically avoid starting my account where many other accounts of race and biomedicine in the twenty-first century begin—with an invocation of a ceremony on the White House lawn in 2000, at which President Bill Clinton announced that with the completion of the Human Genome Project, “one of the great truths to emerge from this triumphant expedition inside the human genome is that in genetic terms, all human beings, regardless of race, are more than 99.9 percent the same.”9 That is because, if we want to understand race and biomedicine today, the Human Genome Project is a poor jumping-off point. First, it implies that genetics is somehow fundamental to medicine and health, whereas genetics actually plays a relatively small role in medical care broadly, and a vanishingly small role in contributing to disparities in health outcomes.10 Second, it puts the focus on the ontology of race—what race is—rather than foregrounding the far more important question of the impact of racism.11
From the book’s subtitle, readers will notice that my focus is less on race and more on racism. Because of this focus on racism as a social practice, I am not particularly interested in the problem of how racial categories are defined. Whereas many accounts of racism in science and technology studies focus on the ambiguity of race, I am more interested in its durability: the resilience of race as a concept in the face of constant critique and the amenability of racial disparities to provide not only an explanation of difference but a ground from which to demand change.12 The enduring philosophical question of “who counts as Black?” is not one that is salient in any of the cases that I examine. On one level, this is because self-identified race has a very high correlation with socially defined race, especially for Americans who are white or Black. Even more fundamentally, when it comes to our health, how others define our race can have a greater impact on our health than how we define ourselves.13
The ways that race shapes experiences of health and medicine have far more to do with how others perceive us in snap judgments than with how we perceive ourselves in all our complexity. Racism operates in such a way that what matters most is whether authorities, ranging from physicians and police to teachers and mortgage officers, consider someone to be Black, not whether that Blackness might in some way be partial or contestable. This point is informed by historian Barbara Fields, who, writing about a 1999 case in which a Guinean immigrant named Amadou Diallo was shot by New York City police officers forty-one times in his own entryway while holding up his wallet, states,
Diallo probably defined himself as a member of his nation or tribe or lineage, rather than as “black.” But, under the American system, it was the officers’ definition of him, not his definition of himself, that held the balance between life and death.14
Racial identities are not essences, then, but products of social processes. In keeping with the convention in much antiracist scholarship, I capitalize the term Black to highlight that it is a proper noun—a historically constituted social group rather than a physical description—and use the terms African American and Black interchangeably.15 I am less interested in precisely naming and demarcating the categories than in attending to the unequal structuring of bodily experiences in a racist society.16 In the United States, increasing interest in gene frequencies, on one hand, and self-reported identity, on the other, has not displaced the reliance on a very particular commonsense visual convention in determining who counts as Black. As historian Evelynn Hammonds argues, “in the US race has always been dependent on the visual,” and ideas about the mixing of what are conceived of as pure types does not displace this racial typology but reinforces it.17 Any troubling of the categories does not undermine the impact of racism.
Racism impacts health in many ways. One helpful delineation comes from influential physician and epidemiologist Camara Jones, who outlines three “levels of racism”:18
Like Jones, I am most interested in the level of institutionalized racism, which is evident in differential exposures to harms (such as pollution) and differential access to assistance (such as medical care). Personally mediated racism is also often relevant, as enacted by people in positions of authority, ranging from police to health care providers. Internalized racism is largely beyond my scope, although there are occasional glimpses of it in quotes from key actors in the stories, and readers might reflect on how these events might produce such effects. All of these levels of racism contribute to health disparities, which is to say, the unequal burden of illness and unequal risk of death among different groups in society.
In broadly similar ways, many public health scholars have already characterized some of the same larger structural forces that my account seeks to illustrate. For example, Zinzi Bailey and colleagues describe “pathways between racism and health” in the medical journal The Lancet, including “economic injustice and social deprivation,” “environmental and occupational health inequities,” “psychosocial trauma,” “inadequate healthcare,” and several more elements.19 The more intimate scale of the stories that I describe is meant to complement rather than replace this important work. The case study approach can help to bridge the conceptual gap between the important macrocosmic and quantitative research of epidemiologists and the microcosmic level of individual lives.
Although the topic of “racism and health disparities” should and could encompass attention to the structural issues and experiences of many groups of people in the United States, this book focuses on the effects of anti-Black racism on Black people in particular. Anti-Black racism plays a particularly pervasive role in the United States, and the cases in this book reveal diverse aspects of this singular topic. This is not to deny the impact of racism on other groups. Notably, racism fundamentally structures experiences of Native Americans, and of migrants from Latin America and their descendants, who are racialized in contested ways. Ideas about the inevitability of Indigenous illness have been foundational to notions of America as a settler colony,20 and attending to the ways that those ideas are constantly renewed in the present demands a book of its own. The racialization of migrants from Latin America is intertwined with anti-Indigenous racism, while also emerging from particular borderland histories and xenophobic exacerbations in the present.21 Indeed, poor and working-class white people’s health is also negatively impacted by racism, because many white Americans would rather equal benefits be denied to others than support policies that would improve health and health care access for all.22 Attention to the experiences of all these groups is an urgent and growing scholarship in its own right.
Some readers might question the focal framing of racism—surely some of the events described are fundamentally related to socioeconomic class inequality? Indeed, class matters a great deal, as will become clear in the chapters. Yet race cannot simply be displaced to class. In the United States, race and class are inextricably linked, and a desire to treat them as isolated variables is a desire to replace lived experience in the United States with an abstraction.23 Experiences of race and class—as well as gender, sexuality, ability, and other stratifications of power—are not additive but intersectional.24 Moreover, diverse phenomena ranging from segregated neighborhoods to disproportionately negative encounters with police and medical providers contribute to what public health scholar Nancy Krieger has characterized as the “accumulated insults” of living in a structurally racist society—facing repeated experiences with discrimination that takes forms that are indirect, direct (focused at individual-level discrimination), and population level (such as segregation).25 No one individual’s intersecting experiences can be completely separated from the individual’s experiences as a member of a group. There might be places and times in which class identity fundamentally supersedes racial identity, but in the United States, fidelity to lived experience of inequalities demands a central focus on racism.
Although the term biopolitics can be jargony—and certainly a great deal of scholarly ink has been spilled on its elaboration—it remains a useful idea. It is most associated with the late twentieth-century French theorist Michel Foucault. His discussion of the emergence of “biopower” in the modern age is instructive: “one might say that the ancient right to take life or let live was replaced by a power to foster life or disallow it to the point of death.”26 Foucault is highlighting a key contemporary aspect of the matter of the management of life: modern institutional power is not located so much in killing, as it was for premodern rulers, as it is in the differential between fostering (some) life and letting (others) die. Surveillance becomes a more pervasive mode of control than overt violence. The differential fostering of life operates in a way that is generally not spectacular but completely ordinary and routine.
There is a rich scholarship in the Foucauldian biopolitical tradition that attends to race, racism, and health. Sociologist Janet Shim’s approach is perhaps most resonant with my own: she argues that race (and gender and class) should be reconceptualized as “social relations of power that are located not just in the biological bodies of individuals but in the social spaces between them, producing and stratifying the distribution of health and illness.”27 A larger share of this literature attends to the stakes of biomedical innovations, and this can sometimes be rather removed from the question of making live and letting die—focusing instead on the novel subjectivities produced as individuals come to understand themselves as biological subjects and seek to understand their history and optimize their health in the context of market-driven biomedicine.28 These processes can become relevant for making live and letting die, for example, when biomedical ideas obscure rather than illuminate structural inequality. As sociologist Anthony Ryan Hatch argues in his analysis of the metabolic syndrome, this can be “the kind of biopolitics that simultaneously manufactures health problems and their remedies, deploys race as a way of concealing inequality,” and constructs biomedical ideas precisely “to sever the relationship between body and society.”29 Moreover, some of the technology-oriented scholarship in the Foucauldian tradition provides insight into the question of differentially fostering life, especially of race-based pharmaceuticals and medical hot-spotting.30 Even when these technologies promise to repair health disparities, they often instead increase surveillance of racialized populations without actually benefiting them. Sociocultural theorist Nadine Ehlers and geographer Shiloh Krupar provide a lucid introduction to Foucauldian biopower as they lay out their evocative concept of “deadly life-making,” in which, in a racist society, the operations of forms of “making live” increase disparities and can even kill.31
The biopolitical sphere as we find it in this book is generally in the domain of ordinary life and routine medicine rather than novel sensibilities or genomic innovations. Distinctions between those whose lives are fostered and those whose lives are disregarded are constantly remade. For example, the differential availability of routine pharmaceuticals for acute and chronic diseases will be explored in the chapter on the deaths of the postal workers in the anthrax attacks and in the chapter on the increase in deaths from heart disease and diabetes after Hurricane Katrina. The differential exposure to harms, including carceral and environmental harms, will be explored in the chapters on the Scott sisters’ case and the Flint water crisis, respectively. Various forms of surveillance remain central—now including state and medical surveillance as well as social media. One of the things that the biopolitical approach helps to highlight is that citizenship is about more than participation in electoral processes, and people’s bodies as well as their political identities are at stake. Several chapters will touch on the plural senses of “biological citizenship” that emerge.
There is also a more fundamental notion of citizenship that inspires me, largely distinct from the Foucauldian tradition, that I want to bring to bear on this biopolitics. It comes from African American studies, notably political scientist Melissa Harris-Perry:
If you ask most people what they think of when they hear the word politics, they are likely to give a definition that includes voters, parties, elections, public policy, and processes of contestation and representation. But formal participation in government is only one part of a more encompassing effort to be recognized within the nation. The struggle for recognition is the nexus of human identity and national identity, where much of the most important political work occurs.32
Contestation over citizenship in plural forms—some directly related to health and well-being, some indirectly related—emerges as a key theme of this book.
On one level, this theme of “citizenship” is a way to engage with who counts as an American citizen. There is a relatively narrow technical sense in which this matters: who is entitled and able to make demands on the U.S. government for services and care. There is also a broader, more representational sense in which it matters: who is discursively characterized as an authentic American and who is characterized as diversely outside the American public—as criminal, interloper, refugee in the aftermath of Hurricane Katrina—or as dependent in the carceral context of the Scott sisters, or as somehow less than fully human in the combination of hypervisibility and dehumanization of Serena Williams. In addition, I will engage with plural theoretical ideas of citizenship, ranging from “biological citizenship” to “corporate personhood.” Sometimes citizenship struggles play out at an individual level: an individual person demanding rights and/or recognition. More often, however, citizenship struggles are mobilized by and for groups that, to at least some extent, precede any particular recognition demand. Consider Black Lives Matter: although that movement frames Blackness in somewhat different ways from the way that previous movements such as the civil rights movement have, it is building on that already existing political identity and making a recognition claim. Claiming to matter is claiming citizenship.33
My own training is in the interdisciplinary field of science, technology, and society (STS)—also called science and technology studies—and I am particularly attentive to a few key preoccupations of that interdisciplinary field. The first overlaps with a key Foucauldian idea: knowledge and power are inseparable. Epistemological concerns—that is, questions about how we come to know things—are inextricable from power. Although STS canonically tracks how scientific truth claims are made in laboratories,34 this core insight is also relevant to understanding the wider world. The way that the credibility of truth claims is influenced by the social location of the speaker is illustrated many times over in this book when Black patients’ complaints are not believed or taken seriously by their health care providers. As a second example, my attention is centrally on how the social and material inequalities that I track work in practice.35 There is an emergent quality to structural racism and health inequalities that are not outside the social sphere in which they operate but constitute it. The third example is interest in both matter and meaning. The material and semiotic aspects of the events that I describe—their ability to shape both our bodies and our understanding—are inseparable, and both aspects are important.
Most scholarship in STS that focuses on the present is social scientific, employing qualitative research methods, such as interviews and participant observation, but this book is predominantly humanistic. This is not unique, and feminists who engage STS have been visionary in this kind of disciplinary boundary crossing—notably the foundational feminist STS theorist Donna Haraway36 and a rich and growing body of Black feminist technoscience scholarship.37 Feminists writing in sports studies have also articulated a resonant approach.38 Although I hope to be in conversation with scholarship in the qualitative social sciences, especially anthropology and sociology, I take an interdisciplinary interpretive cultural studies approach: performing close readings of public events.39 As Moya Bailey and Whitney Peoples have argued in their important call for a Black feminist health science studies, “media and health are co-constitutive,” and media representations are an appropriate object for feminist technoscience analysis.40
Sickening attends closely to journalistic and academic accounts of each case to retell the stories of the specific events while putting them into a broader frame. If the stories were taken out of historical and social context and presumed to be able to operate analytically on their own, they would not provide persuasive analytical tools—the cases might be dismissed as anomalies. Putting the events into historical and contemporary social context helps to show the ways in which they reveal medicine as usual.
The stories that I have chosen are already publicly available and widely disseminated as cultural narratives. Thus I have purposely forgone interviews as a method. New interviews would not necessarily be more robust in terms of epistemic validity than the publicly available accounts and would have the potential of adding to the harm. Although I have certainly found interviewing to be useful in many projects, I am leery of performing my own interviews as a basis on which to ground stories of suffering. Asking people to retell their stories to me might authenticate my standing as a researcher, but it does not necessarily serve them. Feminist science and technology studies scholar Nassim Parvin’s argument with regard to digital archiving projects is also relevant here: in our contemporary era, we are surrounded with such stories, which are all too often turned into commodities.41 This is not to diminish the value of qualitative social science research, including into suffering, but to suggest that interviews might best be reserved for illuminating perspectives that are not already available as public narratives.42 In my cases, I will leave the investigative journalism to the journalists and draw on already existing accounts to write a more interpretive account of my own.
My perspective is informed not only by my disciplinary training but also by my situatedness and experiences as an activist and an educator. Although I moved to London in 2018, I was born in the United States and lived there almost all my life. I was raised in rural northern Michigan, and I moved to cities on the East Coast and in the South for education and work: a couple of years each in Baltimore and Houston, a decade each in Boston and Atlanta. I spent ten years on the faculty at Georgia Tech, teaching such classes as Biomedicine and Culture and Science, Technology, and Race, and engaging with undergraduate students has been formative for my thinking. My hope is that this book provides useful teaching material for undergraduate students in the United States and beyond. Experiences beyond the academy have also been formative. I am a white lesbian who has been involved in activism for decades—especially feminist, queer, antiracist, and antiwar—and many of my commitments are rooted both in feminist and antiracist scholarship and in intersectional activism. Thus I have learned not only from my academic training but also from deep and long-standing engagement with students and with social justice advocates. My point of view is shaped by and accountable to distinct but overlapping academic and activist communities.
The chapters are written in such a way that they can be read individually, though reading them in combination is likely to be a richer experience. Reading multiple cases provides an opportunity to engage crosscutting themes across diverse examples and to explore the ways that structures that mediate health inequalities interlock and combine. The most accessible chapters are chapter 1 and chapter 6. The middle chapters are a bit more challenging because they delve into complicated concepts: biopolitics (chapter 2), biological citizenship (chapter 3), more than human politics (chapter 4), and race as technology (chapter 5).
Chapter 1 examines the case of two Black postal workers, Thomas Morris and Joseph Curseen, who died of inhalation anthrax on October 21, 2001. These postal workers’ deaths took place in a defining moment in U.S. history, making the case a fitting one with which to open this book focused on racism and health in the twenty-first century. The chapter is anchored especially by the transcript of a telephone call to the emergency number 911 that one of the postal workers made hours before he died, recounting his unsuccessful pursuit of treatment for what he had rightly suspected was anthrax. Returning to this event provides a fresh perspective into the continuities and discontinuities at the dawn of the twenty-first century. Although the postal workers’ deaths were extraordinary, their experiences provide a valuable focal point for thinking about political and medical systems that routinely fail to provide adequate care to African Americans. In this chapter, I focus on three intertwined elements: the justifiable suspicion among African Americans that neither the state nor the medical system prioritizes their care; the reluctance to recognize Black suffering among officials, physicians, and mainstream media; and how this event—which happened so soon after September 11, 2001—already revealed as a lie the then-powerful narrative that in the post–September 11 world, Americans were “all in this together.”
In chapter 2, I discuss the unnatural disaster of chronic disease after Hurricane Katrina. Hurricane Katrina hit southeast Louisiana in late August 2005. The levees that protected New Orleans failed; 80 percent of the city was flooded—mostly residential areas—and thousands died. In the initial days after the storm, public health experts worried about the spread of infectious disease. However, chronic diseases, such as cardiovascular disease and diabetes, emerged as the far greater threat. In this chapter, I attend to the ways in which lack of access to care contributed to increased chronic disease, focusing especially on one particular, tangible element: pharmaceuticals. I track the travels of pharmaceuticals in the aftermath of Hurricane Katrina to explore three key ways in which the response to the emergency exacerbated the preexisting vulnerability of the population, especially with regard to health: at emergency shelters, in drug donation programs, and in ongoing care. Each of these disrupted pharmaceutical flows provides an opportunity to see ways that those most acutely impacted by Hurricane Katrina were framed as outside of the “mainstream American public,” in intertwining ways. Disrupted pharmaceutical flows at emergency shelters exemplify the ways in which Katrina victims were impacted by discourses and practices associated with criminality; disrupted pharmaceutical flows in drug donation programs do the same with regard to subjects of global health charity; disrupted pharmaceutical flows in ongoing care illuminate their marginalization. Being outside ordinary pharmaceutical flows and being outside the “American public” occur through mutually reinforcing processes. The chapter concludes with discussion of biopolitics, as elaborated in Foucault’s important lecture “Society Must Be Defended,” to argue that being ideologically defined as outside of society has material consequences for racist distributions of mortality.
Chapter 3 explores the impact of mass incarceration through attention to the case of the Scott sisters. In December 2010, the governor of Mississippi suspended the dual life sentences of two African American sisters who had been imprisoned for sixteen years on an extraordinary condition: that Gladys Scott donate a kidney to her ailing sister Jamie Scott. The Scott sisters’ case is a highly unusual one, yet it is a revealing site for inquiry into U.S. biopolitics more broadly. Close attention to the conditional release and its context demands a broader frame than traditional bioethics. This chapter draws on the Scott sisters’ case as a site for interrogating the U.S. context of racialized mass incarceration. Tensions between racialized exclusions, the promise of consumerist freedom, and their lack of expectations of the state are foundational to a distinctly American biological citizenship. By putting the Scott sisters’ case into conversation with broader arguments about incarceration as a site of racialization and anthropological literatures of organ transplantation and of biological citizenship in diverse geographical sites, this chapter seeks to articulate some of the racialized contours of biopolitics in the United States.
In the fourth chapter, I attend to one small element of the Flint water crisis: the swift provision of clean water to the General Motors engine plant even as the people of Flint were abandoned for years. In April 2014, the city of Flint, Michigan, began drawing on a new source of water as part of fiscal austerity measures. Almost immediately, Flint’s human residents complained about the look and smell of the new water, but these complaints were dismissed and ignored by city managers for years. Representatives of the most prominent nonhuman corporate resident of Flint—General Motors (GM)—complained about the water quickly, too, because the new water supply was corroding the machinery at their Flint engine plant. But only GM was able to change water sources before the damage to the pipes became permanent. The chapter follows such disparate nonhuman objects as fiscal bonds, machines, and pipes to track the intertwined flows of capital, labor, and water. In this chapter, I argue that the differential protection of the nonhuman material integrity of GM’s machines over the nonhuman material integrity of the water pipes and the human bodily integrity of the people of Flint provides a window into racialized biopolitics. The protection of finance and machines over infrastructure and people illustrates the devaluation of groups of humans considered to be surplus in the service of the interests of capital. It also demonstrates the extent to which ideas of emergency, citizenship, and bodily integrity are politically contingent. This small event within the broader Flint water crisis illustrates a fundamental element of racial disparities in health in the United States: differential protection of nonhuman financial capital and racialized human life.
Chapter 5 analyzes an infamous instance of police brutality at a pool party. In June 2015, fifteen-year-old Dajerria Becton was among the African American teenagers at a pool party in the Dallas suburb of McKinney, Texas, who were violently suppressed by the police. The incident was captured on cell phone videos that were widely disseminated, which included a powerful image of the small bikini-clad girl’s bodily vulnerability under the knee of a police officer. Close attention to the McKinney case reveals ways in which racism and antiracism are renewed and refigured in the twenty-first century. In this chapter, I articulate and put into relation the plural technologies of race (and gender) that came together in this encounter and its aftermath: suburban communities and swimming pools, bikinis and police uniforms, cell phone cameras and social media. This chapter explores the spatial and social relations specific to a homeowners association–managed community pool and puts that into relationship with the role of the police in enforcing segregation. The chapter also foregrounds the role of social media in distributing focal images for righteous anger, while arguing for the value of deeper engagement with the incidents and their contexts to more fully explicate what they reveal about unjust social structures. It engages the literature of “race as technology” and the “liberatory imagination” to explore how artists and activists are mobilizing images as part of advocacy for justice.
In chapter 6, I explore tennis star Serena Williams’s life-threatening experience when giving birth to her daughter in September 2017 as a window into reproductive injustice. That someone with so much wealth, power, and expertise faced such challenges receiving the care that she needed exposes the inadequacy of frequently invoked explanations for high maternal mortality among Black women, such as poverty or failure to seek prenatal care. The chapter then puts Williams’s account of her experience into the context of two intersecting elements: links between her birth experience and those of far too many Black women, and representations of her body over the course of her career to illuminate the ways in which Black women’s bodies are simultaneously hypersurveilled and inadequately cared for. Williams is not an uncomplicated figure in this landscape, but when she mobilizes her social media platform to call attention to racially stratified access to safe births and to demand change, she contributes to reproductive justice advocacy.
The book’s conclusion explores some of the ways that the cases analyzed in this book provide insight into the twinned events of summer 2020: the crisis of COVID-19 and the resurgence of Black Lives Matter. It draws together what has been learned by looking across domains—workplaces, communities, institutions, leisure spaces, infrastructures—underscoring the value of considering wholes and parts. It also provides a set of analytical strategies on which readers can draw to form analyses of other events, presented in a way that can be modified for use in wide-ranging classroom contexts: an iterative four-step template for analysis that I call the sickening assignment. Finally, it encourages readers to combine analysis and additional action.