Hello and welcome to fat gab. This is the podcast where the International Journal of feminist approaches to bioethics brought to you by fab Network. My name is Katherine McKay and today I'm joined by Keisha ray to discuss quiches plenary presentation from the recent fab Congress entitled black bioethics and the future of health equity. Hi, Keisha.
Hi, thanks for having me.
Thanks so much for joining me today. So I wonder if you could give our listeners just the kind of quick overview of what your plenary about black bioethics in the future of health equity was about? Sure.
So I think, in general, I really wanted people to think about this question in the same ways that I've been thinking about this question and offer up some of my opinions and some of my answers, but then also make it recognizable that this is an ongoing sort of contemplation for me. So the question that I posed at the beginning of the presentation was, What can Black Americans health tell us about what a more equitable access to health should look like? And then also, what is the role of bioethics in that? What do we have to do to answer this question and to be a part of the solution to be a part of this question? And so I set forth there to sort of think about the status of black Americans health as it is now to look at the inequities and the racial disparities that exist and health and access to health care for black Americans. But then take a step back and think okay, now, what does that mean for health equity? What does that mean for how we teach how we research how we just conduct ourselves as bioethicists? And what would it mean for how we should be thinking about health equity for other other social groups that do not have equitable access to health?
So it sounds like there's kind of these, these two angles, there's the sort of like, what's happening with black Americans health? And what does that show us? And then there's this other side, it's clearly connected, but it's like, what's happening in the discipline of bioethics?
Right. And so in my quest for thinking about where bioethics can make the most impact, and how we can make sure that we stay relevant, and that we stay as a group that thinks about the most vulnerable people, one way to do that, especially in the times now, when expertise is always questioned. There's lots of political happenings around what it means to be an expert. I think we are even questioning that ourselves. What does it mean to be an expert? So I proposed this idea of thinking about the most vulnerable populations, and particularly thinking about black people and their health. And the way that it relates to the work that we do in bioethics from a black bioethics perspective, which is, which is really this practice is this ethos is a way of thinking about how our work, contribute or dismantles anti black racism. And so for me, this sort of two pronged approach of thinking about what is the status of black Americans health? What does it mean to have an equitable access to health care and to help and then to think about bioethicists and how we can contribute and how we can be advocates for equitable health?
So what are some of the what are some of the things that are revealed in that work so far?
Right. And so I think lately, we're seeing a lot of institutions. And we're seeing a lot of bioethicists, saying bioethics has to do better about black Americans, we have to do better about them, we have to do better about including them in our work, whether that be empirical bioethics, whether that be just thinking about how I work can impact them as a marginalized group. And so for me, one thing that comes out of this is that we may have to do bioethics slightly different, it doesn't mean that we have to abandon what we like about it, or what we love. What drew us to bioethics? What made us pick that over some other kind of discipline, you know, in grad school, or whatever, it doesn't mean that we have to sort of start all over. But it does mean that maybe we can move a little bit differently, right, I like to use that that kind of phrasing is that we might have to just move a little bit differently. It may mean inviting different kinds of people to be invited speakers, either at our universities at our institutions, it might mean thinking about the ethics section in your work a little bit differently. How does this impact marginalized groups like black Americans, it might even mean teaching different articles or different topics in our bioethics class or in our health care classes. It may even be having us to just think about who we collaborate with in our work that may so I think that sometimes aims we have to move a little bit differently to get different outcomes. And I think if bioethics really cares about justice and vulnerable populations and health equity, we might have to make some different kinds of moves.
Could I ask you a question? And maybe this is like a little bit of a step back kind of question. But I think you've said something in your plenary address about why you called it black bioethics instead of African American bioethics, for example. And so I wondered if you could say something about that maybe.
Right. So I call it black bioethics. In my work, I also refer to black people, rather than African Americans. I do use African American terminology when I'm citing literature that uses that for the integrity of the research. But personally, I use black because I think that it incap encapsulates a wider population. And I think that a lot of black people in America, in particular, because our history was taken from us, because of the slave trade because of segregation. A lot of black people are not tied to their history. And that's, that's really a sad thing. But I think it's a reality for a lot of black Americans. And so sometimes a lot of black Americans, especially younger generations, I believe, are not as attached to their African American roots, and also may not know of their African origins, they just may assume because of their skin color, they may just assume that they are. But I think that in America, black is really a culture in and of its own. And so I think a lot of these issues are not just about African Americans, but they're about black, they are about Black culture, they are about about black people being left out of bioethics, or about black people being left out have equitable health conversations. And so I think sometimes Black is just a little bit more comprehensive than African American, that doesn't mean that it's not sometimes appropriate to use African American. It absolutely is when you're talking about ancestry, talking about nationality, those kinds of things. When you're talking about culture. For me, I like to use black and it's also something personal to me, I identify as black. I, again, because of this history has been sort of taken away from my family. I'm not exactly positive about my African ancestry. I'm assuming it's there. And but I don't have the exact, you know, way to pinpoint it. And so I think that, and then I think a lot of people, too, are very nervous about the sort of, you know, 23 and me and those kinds of ways of knowing your ancestry for various reasons that a lot of bioethicists know. And so I like to use black, I think it's just all in all, a little bit more comprehensive. And I think there's a lot of people who are more attached to the term black than African American.
Right, right. And I think it kind of connects to a question that James Wilson, who's a professor at the University of College London, asked in your plenary, which was kind of about, I think his question was essentially sort of about the context in which black bioethics in your work would sit. So like, do you see going beyond borders? Because do you see it going beyond America, for example, beyond the experience of Americans, black Americans, because you could imagine black bioethics actually is kind of a methodology, in addition to it being connected to the particular experiences of African Americans. So yeah, his question was kind of about, like, how does it move beyond borders? I think,
right. And so for me, I always think about, there are black people, everywhere. Every continent has black people, their race relations may be slightly different. But there's racism. There's colorism, there's discrimination, regardless of where you are in the world, there is anti black racism. And I think we're now because we're more in this globally connected world, we are starting to seeing anti black racism a little bit more and how it works in places like Brazil, or how it works in places like UK. Right. And so I think that black bioethics is really just saying, make sure that when you are doing bioethics work that you don't ignore this, this marginalized population, that when you are doing bioethics, you don't think about your work only and not at the end, think about how this work may either contribute or dismantle anti black racism. And that can be any part of the world that you're in. And I really think that it's it's not just about people specifically working on health equity and the health of black Americans like me, you could be working on any topic in bioethics and still contribute to the marginalization of a group regardless of where you are in the world. And black bioethics is saying, maybe we need to take a step back or not work and see if we are if we're making the problem worse, or if we're making it better even in our small little corner of the world. So like For instance, I also study the ethics of biomedical enhancement. Right? It's not directly related about race, it's not directly related to black Americans. But when I'm doing that work, I have to think about, am I advocating for technology that's going to make health equity worse for black people? I have to think about, am I saying, Yeah, we should all be enhancing our bodies. How does this benefit, equitable access to health care? How does this affect the political and social standing of, of black people. And so that's just an example of work that doesn't directly involve African Americans or black people. But it's something that I have to think about. And one thing that I said during the q&a session of the Plenary is just because you work on a particular population, doesn't mean that you should ignore all the others and ignore all the ways that your work could be hurting another group, you could be studying disabled people, you could be studying transgender people, that doesn't mean that I can completely ignore Latinx people doesn't mean I can completely ignore children, right? Just because you work on one group that doesn't give you a sort of pest to not think about how your work can harm other people.
Yeah, it's kind of like, in a way, it highlights the importance of thinking intersectionally. About
Absolutely, yeah. And that's really what it's saying. It's saying like, first let's think about adding in the voices of the people that we study, let's make them a part of it, let's not ignore them. But then also, we are all people that are walking around with multiple identities, multiple intersecting identities. And so even if I'm talking about black people, I'm also talking about all of the identities that they can occupy. And that means being black and disabled, that means being black and transgender, that means being black and Latinx, or biracial, that means being black and poor. So even if I'm talking about one group, I'm actually talking about multiple and I think we just need a little bit more of that in our bioethics work to make sure that we again, stay relevant when we are in an age of questioning expertise.
So I wonder, because we have quite an international audience for the podcast. I was just wondering if there are any contemporary health issues that you've found in your research? Also, because you're writing a book on black health that will be coming out with Oxford University Press? So is there are there particular health issues that you're sort of focusing on now that draw out this important kind of point of contrast for for bioethics?
Yeah, you know, I mostly study those areas where black people have poor health in most other groups. So even things like just access to health care, black people, along with Latin X people are some of the groups that have the least amount of access in America, particularly with not having universal health care, the least amount of access to health insurance, and that really affects how, how you have access to the kind of care that you need. And so a lot of my work really looks at how all these things are connected, right? Like people to have access, don't have to start, black people don't have as much access to higher paying jobs, we tie health insurance to jobs. And so if you don't have access to those jobs, you then don't have access to the health care that you need, then that makes you sicker, then that makes you have to pay more out of pocket than that makes the poor because now you're spending more money on health care, right? So it's all cyclical. So that's kind of what I do. But there's lots of areas that have that same sort of example. So like black people sleep less than other people, particularly black men, right. And we know how important sleep is academics, right? We all know how important sleep is and how you it's harder to function when you don't. And but it's all connected sleep is connected to cardiovascular disease. Black people have worse outcomes in cardiovascular disease, right? Some of the across the world. Black people have the highest rates of hypertension, Hypertension is called a silent killer for a reason. Right. And so then there's limb disparities, limb amputation disparities from diabetes, they're right black people have their limbs amputated more than white people when it comes to complications from diabetes. Having their breasts removed after cancer diagnosis, more black women have that even though they don't have as many diagnosis as white women. So these kinds of disparities you see them all over and it's it's very connected to their identities and how their social and political identities sort of function in their part of the world and then creates these poor health outcomes that have these sort of gender Rational effects can affect their children and grandchildren or great grandchildren. And so this is really how you see black families sort of being stuck in things like poverty being stuck in things like black health. And so that's really what my work is about is just sort of revealing how all of these social inequities, political inequities are connected to health inequities for black people, and then looking at these very specific areas like sleep, cardiovascular disease, birthing, mortality, those kinds of topics, where black people have some of the worst outcomes across the world.
Yeah, wow, that's really impactful. Have there been any, any particular challenges to you during this research? Are you doing empirical research?
Right? So yes, and no. So this particular project, the book project is not I wanted to make sure that I was highlighting a lot of the narratives that are already published that there are a lot of black people who are telling their story. And I think that they need to be amplified. And so I really wanted to include those here and say, Look, here is this whole database on black women and telling your story about cardiovascular disease that doesn't get enough attention, I'm going to include it in this book and include it with the data about black health and about black people's health outcomes with this disease. So this particular project is very narrative heavy. Again, I think it's very important in bioethics that we sort of take away from the notion that only certain kinds of experiences matter, or there's only certain kinds of research and information that's valuable people's narratives, especially those from marginalized populations, that is a type of research that is something that's important that shouldn't be included in our work. So in this particular case, I'm using a lot of published narratives. And I think it's been, it's been a challenge to make sure that I do justice, right? I don't want to take someone else's story, and then not do a good job with it. So that's something I'm always very conscious of. And then, you know, sometimes people when I'm giving these sort of invited lectures, and I'm talking about my work, people always ask the question, why should we care? Right? And for me, I think that it's it's a legit question. It absolutely is. But sometimes they get a little irritated, you know, they think about how can you be presented with all these facts? And then say, Why am I supposed to care? Right? Because a lot of other groups don't get that same kind of question. It's just an automatic, it's a given. And so sometimes that happens, so but most of the time, the reception is really good. People are into it. People want to think about it more especially work along with me in thinking about some of these answers. So though, I would say that sometimes that's the challenge, doing justice can be a challenge. And then a lot of this work is historical. A lot of times you have to go back at the history of black Americans in particular, but the history of how black people got to be in their part of the world, their experiences with colonialism, write their experiences with discrimination, and then trace it back to how we where we are today and how we got here. And sometimes reading that history is is very tough, right? It can be violent, it can have lots of actions that maybe you don't want to read about all day long. It can be just heartbreaking. So sometimes that's a personal challenge. For me, especially being a part of the group that I'm studying, I have to make sure that I do a lot of self care when I'm reading this. I can't read slave journals all day long, I have to set aside a little bit of time to read it and then move on. Right. And I mean, slave journals, I mean, those written by the enslavers right, are reading medical journals written by physicians that have certain views about enslaved black people that can be really, really trying on the soul. So for me, it's also about taking care of myself. When you are a part of the group that you're studying. I think you have to frequently think about taking care of yourself.
Yeah, that feels like an important message.
I do. Yeah, I think you know, sometimes academics don't take care of themselves in a lot of ways. But when you are studying yourself, you're studying your people. You're sending people that look like you that live like you that look like your parents look like your your siblings or whoever. It's important to set some time aside to disconnect from that. Don't read the work 24/7 take some breaks, give yourself give yourself time and then also give yourself some grace. Right. Be very kind to yourself while you're doing this kind of work.
Yeah, yeah. Well, this has been such a great discussion and I'm so looking forward to the book and so glad that I got to hear your plenary. I wonder if there's like a kind of primary takeaway message that you'd like people to continue to think About between now and when they get to read more of your work, right,
I would just encourage people to think about or garlis of what academic discipline is there and to think about if their work is contributing or dismantling anti black racism, that's really what I think it's all about. And it doesn't have to be in these grand gestures. It can be very small. It can, it doesn't always have to be something that requires tons of funding. It can be just the way you write people who you include in your work people that you include in your your list of co authors, right people you invite to lectures on your campus. So just thinking about how your work contributes or dismantles anti black racism, I think will do a world of good for bioethics and for whatever profession that you're a part of.
Thank you so much.
Thank you. I appreciate it. Yeah,
it was great to have you. And thanks for listening to this episode of FAB gab. You can keep your eyes peeled for Keisha Ray's book, black health, which will be forthcoming at some point with University Oxford Press. FAB Gab is hosted and produced by me, Kathryn MacKay. You can find our other episodes on Spotify, radio, public anchor or wherever you get your podcasts with quality. Thanks again for listening. Bye