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Joseph L Graves, "Why Black People Die Sooner: What Medicine Gets Wrong about Race and How to Fix It" (Columbia UP, 2025)
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Joseph L. Graves Jr.
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Hello everybody, this is Marshall Po. I'm the founder and editor of the New Books Network. And if you're listening to this, you know that the NBN is the largest academic podcast network in the world. We reach a worldwide audience of 2 million people. You may have a podcast or you may be thinking about starting a podcast. As you probably know, there are challenges basically of two kinds. One is technical. There are things you have to know in order to get your podcast produced and distributed. And the second is, and this is the biggest problem, you need to get an audience. Building an audience in podcasting is the hardest thing to do today. With this in mind, we, we at the NBM have started a service called NBN Productions. What we do is help you create a podcast, produce your podcast, distribute your podcast, and we host your podcast. Most importantly, what we do is we distribute your podcast to the NBN audience. We've done this many times with many academic podcasts and we would like to help you. If you would be interested in talking to us about how we can help you with your podcast, please contact us. Just go to the front page of the New Books Network and you will see a link to NBN Productions. Click that, fill out the form, and we can talk. Welcome to the New Books Network.
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Stephen Pimpair
Welcome to the New Books Network. I'm Stephen Pimpair, host of the Public Policy Channel, and we are joined today by Joseph L. Graves, Jr. Who is the author of why Black People Die Sooner, what Medicine Gets Wrong About Race and How to Fix it from Columbia University Press. Joseph, welcome. Thank you for joining us today.
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Joseph L. Graves Jr.
Well, thank you for having me.
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Stephen Pimpair
So I wonder if we might begin by asking you to tell folks a little bit about yourself and what it is that brought you to write this book.
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Joseph L. Graves Jr.
Well, I am the Mackenzie Scott Endowed professor of biology at North Carolina A&T State University. I have been interested in the question of how people think racially in societies since the 1990s. This book, why Black People Die Sooner, is actually my fourth book on the subject for folks who might want to get some background. So this has been an issue that's been at the forefront of my thinking for a long time. These misconceptions are ongoing in our society. They are damaging and they need to be stopped. So that's why I wrote why Black People Die Sooner.
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Stephen Pimpair
Sure. So why don't we start with maybe a little bit of table setting, if you would lay out for people just what it is that we know about differences in life expectancy, expectancy between African Americans and European Americans.
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Joseph L. Graves Jr.
Well, let's start with the present. So things over the last century, lifespan between these two populations have actually gotten closer, but it's still a four to five year differential. Now, at the beginning of the importation of Africans and has enslaved people into North America, those differences were much larger. And so through slavery and then Jim Crow and what I now call the period of mass incarceration, this has been a persistent problem. Now someone, and I'm sure a lot of your listeners are saying, well, you know, that's really not that big a deal because, you know, people, populations are genetically different, therefore we should expect that there would be some differences in lifespan and there may really be no social component to this whatsoever. And what I've been pointing out for the last 30 years is in fact, the genetic differences between persons of European and African descent are actually minuscule, and they're certainly not large enough to account for the massive disparities we see in patterns of morbidity and mortality, that is of sickness and death that we see in this society. So genetics doesn't explain it.
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Stephen Pimpair
Is it worth, before I ask you to sort of offer better explanations, is it worth maybe asking you to talk just a little bit more about the kinds of explanations that you think are wrong and to the point of the book, the ones that you find permeating medicine and research?
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Joseph L. Graves Jr.
Yes. So we'll start with the historical explanations which actually had their roots in Western Christianity. And that was the idea that first, you know, God created humans, Adam and Eve, and that during the time in which humans on this planet were on this planet, that people began to degenerate from this perfection which existed in the Garden of Eden. And of course, the darker you were, the more you had degraded. And so for the, you know, first Europeans who came in contact with Africans, they assumed inferiority and that inferiority was the act of a divine creator. Now, these views persisted in American science through the 19th century. So instead of the degeneration of Adam and Eve theory, the leading American biologists, people like Louis Agassiz, Samuel Morton, you know, people like Samuel Cartwright, believed that human beings had been specially created as separate species. So not biological races in the way we understand them today, but in fact, separate species created again by a divine creator. And that the divine creator had in, in fact, created some people superior, and those people were Europeans and some people inferior. Those people were Africans. And then Africans, in fact, had been created to serve Europeans, so to be enslaved. And so this was the science of the 18th and 19th century in the Western world. Now, this, of course, changes with the publication of on the Origin of species in 1859, in which Charles Darwin presents an idea of descent with modification. Now, in the first edition of the Origin, Darwin didn't talk about people whatsoever, but he did in the sixth edition, and he did in his book.
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Stephen Pimpair
Which.
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Joseph L. Graves Jr.
Is literally right here on my shelf. So. And I'm drawing a blank on the title, so you might want to edit this later. The Descent of Man's Selection in Relation to Sex. And so in that book, he talks about common descent and he talks about the fact that human beings are far more alike each other than they are different from each other. And we begin a modern scientific explanation of human biological diversity. So by the time we are in the late 20th century, we have pretty much established that, yes, there's geographically based genetic variation in human beings, but there's not enough to actually unambiguously apportion people into biological races. And then we also now have a modern evolutionary understanding of the origins of disease. What are the sources of disease that we see in human populations? And with that modern evolutionary understanding, I equivocally argue that there's absolutely no genetic reason for these differences in patterns of morbidity and death that we see in Western societies. This is entirely driven by the social structures and not evolutionary genetic differences between groups of people.
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Stephen Pimpair
So, perfect. So walk us through. Right. Maybe, if you will, as you do in the book, maybe take particular kinds of diseases and walk us through how we account for the variation that we absolutely do according to the thing that we identify as race.
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Joseph L. Graves Jr.
Sure. So I'm going to start with simple genetic diseases. So when I say simple, these are diseases that are influenced by one or two genes. So one of the ones that's most commonly racialized has been sickle cell anemia. And the idea. And that again, there's a History of this with the discovery of the disease in the Western world being in persons predominantly of tropical African descent. And so the idea again was that, well, this must be something about them as tropical Africans, not about this particular trait being the result of some other environmental parameter. Now, it was later on discovered that, in fact, that that environmental parameter was the presence of falciparum malaria. In other words, this genetic variant, the hbs, or sickle cell variant, provided greater resistance to malaria when it was in the heterozygous condition. Meaning you had one gene that was okay, and then one that was the sickle cell trait. You had greater resistance to malaria. Now, if you had two sickle cell genetic variants, then you had sickle cell disease. And that, of course, is a terrible disease which lowers lifespan for individuals who carry that trait. But on the other side of the coin is if you didn't have the sickle cell trait in malaria zones, then you are at a higher probability of coming down and becoming sick and dying from malaria infection. So these individuals who had one malaria resistant gene and one normal hemoglobin, had greater survivorship. Now, we could show mathematically that as a result of that, the sickle cell variant would persist in populations. It would never increase, but it would be there all the time. And therefore, throughout the tropics and the subtropical zones, we find populations that have elevated frequencies of the HBS sickle cell allele. And that goes from, you know, southern Spain through southern Italy, Sicily in the Balkans, Greece in the Saudi peninsula, in subtropical Africa, tropical Africa, and all the way over to India. And so, therefore, the idea that the sickle cell trait is a black or African disease is fundamentally wrong. Now, that idea comes into play because the people who had the highest prevalence of sickle cell anemia in the United States and in the UK were people who came from those regions. Now, if, for example, slavery had brought people from Yemen to the United States to be slaves, then we would have thought of it as a Yemeni disease, not an African disease. So sickle cell is one example. Another one that's commonly thought of is the idea that hypertension is associated with being tropical African. And I point out in the chapter that, again, that's entirely wrong. So medicine came to the conclusion that hypertension was an innately African feature in the 1930s. But in actuality, the explanation for that idea is actually pretty weak. It started with ideas of who survived the transatlantic slave trade, with the notion that, you know, to survive the transatlantic slave trade, you had to have the ability to concentrate salt to deal with dehydration during the long voyage. And also the idea that in central and western Africa there was a deficit of salt available to those people and therefore they evolved again the need to be able to concentrate salt because salt was so rare in their diet. Turns out that's absolutely false. There was an active salt trade from the coast of Africa to this interior of Africa throughout the entire time period. So, and another thing that I point out is that the idea that tropical Africans would be the ones who evolved greater salt retention in the western hemisphere doesn't really make sense because you were taking tropical Africans and moving them to subtropical climates like say Virginia, North Carolina, South Carolina, Georgia, at the same time you were taking Northwest Europeans from the temperate zone and moving them to subtropical zones. No one ever argued that there should be greater predisposition to concentrate salt in Europeans coming from temperate zones to subtropical zones. Instead, they argue that tropical Africans going to subtropics should have a greater need to concentrate salt, which makes absolutely no sense. And in fact, when we look at the genomic underpinnings of hypertension, there's actually a greater frequency of the hypertension risk alleles in Europeans in Euro Americans than there are African Americans. Which again makes my initial argument that selection should have operated to make Europeans more capable or necessary or to improve their ability to concentrate salt to deal with the word I'm looking for here is heat. So that again simply doesn't make any sense.
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Stephen Pimpair
But do we in fact still now in the contemporary period, see higher rates of hypertension among African Americans than European Americans?
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Joseph L. Graves Jr.
Yes, that is still true. So how do you explain that it's environment.
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Stephen Pimpair
So walk us through that.
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Joseph L. Graves Jr.
Why is there greater hypertension in African Americans? Well, one of the things you can point to is diet. Another thing which is directly related to hypertension is chronic stress. And so in a society that is racialized, people who are the victims of that racial oppression are going to have more day to day bombardment of things that will elevate their blood pressure. So this is in fact really well known. So if you were to remove that structural racism, then you would expect that individuals who've been exposed to it would lower their blood pressure. So yes, it's not genetic differences, it's the social conditions under which people live.
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Stephen Pimpair
Is it too simplistic to say most of the variation can be explained by poverty rather than race?
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Joseph L. Graves Jr.
Poverty is certainly a major player, but poverty alone, isn't it? Right. Because actually when you look at professional African Americans like myself, we also show elevated rates of hypertension. And I'M not poor.
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Stephen Pimpair
Right.
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Joseph L. Graves Jr.
Medical doctors.
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Stephen Pimpair
But you experience being black in America.
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Joseph L. Graves Jr.
Yeah. But you experience being black in America. Yes. So poverty is certainly a big one because again, poverty rates are racialized in the United States. So that alone could account for the differential in hypertension. But I want to point out, as I said earlier, it's not just poverty, it's also racism as it operates against people across socioeconomic groups.
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Stephen Pimpair
I wonder if I can ask you to talk a little bit then about something, unfortunately, a bit more recent. Covid and the. The disparate racial impacts that. That hid that. That that had, and the story that. That we should latch onto in order to understand that, and then that may lead us into a conversation about what we do about this.
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Joseph L. Graves Jr.
Yeah. So very early on, when the pandemic had not yet reached the United States, people in my field were warning the Trump administration that we needed to take action. In fact, I was on a number of podcasts, I was on several news broadcasts, Fox News in Atlanta, making the prediction that when the SARS COVID virus hit the United States, that it would differentially impact black and brown people because of the way they live and the fact that transmission would be much higher in those communities. And sure Enough, once SARS COV 2 hit the United States, that is exactly what we saw in the early portion of the pandemic. But of course, then ironically, in the later portion of the pandemic, after vaccines were available, it was now people who adhered to the Trump administration's belief system, including the lack of need for vaccination, the lack of need for social distancing, the lack of need for masking. And then suddenly the patterns of prevalence of SARS CoV2 infection and death increased in that population, when initially it had been poor people, particularly African American Latinos, who had been the victims of SARS.
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Stephen Pimpair
And some of that just to flesh that out a little bit. Right. Is again, it's not race per se, it's the ways in which we stratify labor markets, right? So people who were working most famously in meat processing plants, right, packed very close together, maybe already less likely to have good access to health care because of concerns about producing enough meat, sped up the production lines packed even more closely together. Again, it's because of the people who most likely get to be channeled into those jobs that we ratchet up their risk of infection, disease, and ultimately death.
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Joseph L. Graves Jr.
Yeah. Again, early on in the pandemic, I wrote a piece for Science for the People Online magazine called Their Money Our Lives, in which I pointed out that people in meatpacking plants were certainly going to be far more likely to come down with SARS Covid 2 for the reasons that you just described, but also people who can't stay home. So the reason I'm talking to you now, because, I mean, quite frankly, I thought I was going to die because I catch every respiratory virus that comes around. And before there was a vaccine for SARS CoV2, I was absolutely convinced that I was going to die. But because I am a university professor, I had the capacity to teach my classes online, to isolate my family. And so we were very careful about what we allowed in the house, about going out, about being masked, about keeping social distance. And I was able to survive SARS cov2 but again, poor people who had to go to work had to ride public transportation, who lived in crowded housing developments. In fact, in New York City, one of the Strongest Predictors of SARS Covid 2 Transmission and Infection rates were former redline communities. And redlining, of course, for your listeners, was the practice that was carried out by US Financial institutions in which they rated the capacity of individuals to receive housing loans based upon the racial composition of the community. And so red was the color they gave to the least desirable real estate, which, of course, was populated by black and brown people. And so that's what we saw in SARS CoV 2 in the early portion of the pandemic, is that redline communities, people had used public transportation, people had to go to work, were the ones that were more likely to come down with the virus.
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Stephen Pimpair
So we've circled around this a little bit, the relationship between, put very crudely, capitalism and race. I wonder if we might use that as a segue to have you think through what it is that we do about this and how we further close these disparities, ideally in a world in which we're not doing it by hiring the morbidity, raising the morbidity and mortality rates of other groups.
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Joseph L. Graves Jr.
Yeah, so certainly we don't want to do that. And so, yeah, the term racial capitalism has been used to describe the joining of capitalist economy and racism at the very start. Now, it didn't have to happen that way, but that's how it happened. And that's the society we live in today. And so some people would argue that it is possible to reform capitalist economic systems so they fairly treat people by socially defined race. Now, I would argue that there's no evidence of that. I mean, it. Again, it's not necessary that racism is associated with capitalism, but it was rooted at the very beginning of the society. It's not going anywhere. In fact, everything we've been seeing lately indicates that it's getting far worse. And so then of course, the other side of that argument is that the only way that we're going to eliminate racism is by eliminating capitalism as an economic system. Now, that's a difficult argument for people to hear because they have all sorts of preconceptions about what the alternative is. That is socialism. When they think about socialism, they think about what happened in Russia. They think about, you know, Stalinism. They think about, you know, the denial of human rights there. They think about, you know, the forced collectivization of farms. And they think, well, hey, you know, I don't want that happening in my country. Ironically, they don't think about more modern examples of socialism like we see in Norway, where people in Norway consistently rate themselves as the happiest people in the world. They have a large portion of their industrial plant that is socialized. They still have private ownership in some aspects of their economy. They pay relatively high income tax in Norway. But then everybody there has their basic needs taken care of. So I envision a transition to a more socialist economy in the United States that is done by people recognizing that our collective good will be fostered by having an economic system that realizes that we are better off socializing essential needs in the economy. There are certain things that private individuals should not own, like, for example, health care. But again, that is a difficult argument to make in the United States. Now, I'm entirely willing and capable of making that argument. And I think many advanced thinkers are making that argument as well. The difficulty, of course, is convincing people who have been so brainwashed by the existing cultural ethos that they should move away from something that they may not be benefiting from, but are comfortable with.
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Stephen Pimpair
If you'll indulge me, I'm going to ask a question. It's a little bit outside the four corners of the book, but hearing you talk, I'm thinking about sort of the classic Nordic welfare states of the late 20th century, in particular these elaborate regimes, as you've just described, that may have very high tax rates, but in exchange for that, you live a very good life. You've got access to education and to healthcare and to. To housing and to general high levels of life expectancy, to generally low levels of infant mortality, et cetera, et cetera, as those countries have seen increasing rates of migration from Northern Africa and the Middle east, that social solidarity has fractured and those welfare states have been weakened. And one set of explanations for that is it's because you're taking homogeneous, racially homogeneous societies and complicating the racial composition.
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Joseph L. Graves Jr.
So I think the problem there is immigration.
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Stephen Pimpair
Not race per se, but immigration per se.
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Joseph L. Graves Jr.
But. But again, it's part of the variable, because if they were, for example, northern Germans migrating to Sweden and Norway, right. It would be harder to identify who's an immigrant and who isn't. But the fact that you're now taking people who are escaping drastic poverty in the former colonized world and then attempting to move to these welfare states that you just described where things were going really well. So that influx of immigration puts taxes on the social system. And now you can identify an immigrant by saying, well, you're clearly not of Swedish descent, right? So, yeah, that is clearly a issue. And this again speaks to the fact that most of our problems in the 21st century are no longer local problems. They're regional problems and they're global problems. So the idea that we're going to be able to have certain societies that maintain a really high standard of living while the rest of the world has a very low standard of living and is struggling to get by day to day is simply not sustainable. So again, going back to some of the early theorists of how we can create a sustainable world economy, they always understood that we needed to work together globally to solve these problems. And again, with the current administration's view of America first, that goes exactly in the opposite direction of what we should be doing. For example, we don't have climate accords because the United States won't take part in them. And yet if we're concerned about everyone's well being and health, climate change is one of the most dangerous trends that is going to lead to greater mortality and death across the board. But again, it's first going to be seen amongst the poorest people who unfortunately in the Western world are also racialized.
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Stephen Pimpair
You are listening to the Public Policy Channel of the New Books Network and we have been speaking with Joseph Elgraves Jr. The author of why Black People Die Sooner, what Medicine Gets Wrong About Race and How to Fix it from Columbia University Press. Joseph, thank you for joining us today. Much appreciated.
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Joseph L. Graves Jr.
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Stephen Pimpair
Limu.
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Joseph L. Graves Jr.
Is that guy with the binoculars watching us? Us. Cut the camera.
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Stephen Pimpair
They see us.
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Joseph L. Graves Jr.
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