The use of the taxonomic category African American, either in public or health or other disciplines, fundamentally reflects the historic and contemporary systems of racial stratification in American society. The term "African American," as a categorical descriptor, includes many different segments of the American population referred to as "black" or Americans of sub-Saharan African ancestry. It is also a product of the group self-definition process in which African Americans have historically engaged as an expression of identity, power, defiance, pride, and the struggle for human rights. These designations were often in contradistinction to official government classifications and popular characterizations, which frequently reflected prevailing ideas about white supremacy intended to denigrate African Americans.
The historical roots of the nominal identity of African Americans date back to the early nineteenth century, when there were intense debates
From the 1830s to the middle of the 1890s, Colored American and the more commonly used derivation Colored were the most popular terms. At the beginning of the twentieth century, Negro gained considerable support as a generic term, becoming by 1920 the most commonly used expression of race. Increasing dissatisfaction with the term Negro, most noted in the late 1930s, culminated with the Black power movement of the 1960s.
During the latter period of heightened cultural nationalism, "Black" and "Afro-American" emerged as key terms for race designation and were frequently used interchangeably. More recently, in the late 1980s, "African American" was posited as the most appropriate and comprehensive race designation. This current designation not only reflects a historical lineage, but it also establishes an identity that is rooted in cultural and ethnogeographic origins, rather than skin pigmentation as defined by United States politics and policy.
One reason for the attention African Americans have given to group designations is that group classifications by the white majority were highly instrumental in attempting to justify slavery, deny basic human rights, and restrain social opportunities. These oppressive practices had the effect of subordinating African Americans. Richard B. Moore in a book entitled The Name "Negro": Its Origin and Evil Use described how the skin color and other physical features of Africans who were brought into slavery "were identified in the mind of the people generally with ugliness, repulsion, and baseness." During earlier periods of the twentieth century, white media, publishers, and the scientific community largely refused to capitalize group designations such as Black, Colored, Negro, or African. This practice was in clear contrast to references in print to whites or the Caucasian "race." Moreover, scientific research and theories about so-called racial group differences (e.g., eugenics) were highly influential in promoting white supremacy.
Public health and medicine have historically reflected the racial inequities of American society as manifested in discrimination in medical care, research ethics and applications, professional education, and ideas about the disease etiology. Physicians in the antebellum period gave different treatment to blacks because of the belief that the black physiology was inferior to whites and thus differed with regard to intelligence, sexuality, and sensitivity to pain. These racist beliefs in the subhuman qualities of the "Black race" were responsible for blacks being used as subjects in excruciating medical experiments. For example, between 1845 and 1849, Dr. J. Marion Sims, the father of modern gynecology, subjected three African-American women in Alabama to 30 operations without anesthesia to perfect a surgical technique to repair vesicovaginal fistulas. During the same period, another physician in Georgia, Dr. Thomas Hamilton, subjected black bodies to high temperatures by burying them with their heads above ground in his quest to test the remedy for heatstroke so that slaves could work longer hours in the field. This tragic legacy of unethical race biology research was evident in the infamous Tuskegee syphilis study, in which 399 black men in Alabama unknowingly participated in a study (from 1932 to 1972) to determine the health consequences of untreated syphilis, even though there were known treatments for the disease during this period.
Some scholars have asserted that a lasting effect of this type of institutional racism has been the reluctance of many African Americans to seek medical care. The apprehension of being given different and inferior treatment or being used as guinea pigs in unethical medical research is also believed to have led to the present distrust by African Americans of prevention and treatment in HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome). Indeed, the persistence in the disparity of health outcomes between African Americans and the white population was the subject of a governmental report in 1985 documenting 60,000 excess deaths among African Americans.
Implicit in most discussions of race and health is the suggestion of a direct "racial" or genetic lineage between African Americans and Africans, advancing the notion of a defective gene pool in these populations. Ancestors of most African Americans were primarily from West Africa, and
Within the field of public health, there has been extensive discussion of what the term "race" actually means and its overall value. One problem is that it is seldom defined by researchers. References are frequently made to biologic, cultural, and socioeconomic factors, as well as racism and political differences, without explicitly stating their meaning or relevance. For example, although the term "African American" is generally used inter-changeably with "Black" or "Negro," this is not the case with the descriptor of "non-white," which was widely used prior to 1960. This "racial" category included mostly African Americans but also Hispanic populations, Asian Americans, and Native Americans.
About 30 million persons were identified as African American in the U.S. Census of 1990. From the perspective of public health research, practice, and policy, it is not possible to view them as a monolithic or single group. While they have many commonalities, especially in terms of political opinions and interests, geographic concentrations, and some cultural patterns, it is crucial that public health professionals recognize within-group differences. Social heterogeneity among African Americans regarding health practices or risk factors and outcomes must be carefully examined in terms of age, gender, geographic location, migratory status, social class or socioeconomic status (e.g., education and income), and nativity.
The history of social designations applied to African Americans suggests that the nominal identity of this group may change in the future to reflect the evolution of internal group consciousness, political interests, and social heterogeneity or diversity. Some groups such as "biracial" persons or foreign-born immigrants from African or Caribbean countries may choose in increasing numbers not to be viewed strictly as African American. These issues point to the dynamic nature and significance of racial classification—it has changed and will continue to change. It is also important to note that African American as a racial classification in the United States reflects the unique historical experience and journey of identity in ways that render international comparisons problematic.
In summary, being classified as African American is quite significant because it reflects an important social group transformation and reality in terms of group identity, political orientation, life chances or social opportunity, normative standards and lifestyles, and discriminatory behavior. These are some of the factors that strongly relate to disease susceptibility, quality of life, morbidity and mortality, and longevity. It is only when the reality of racial classification carries little social impact that the term will become obsolete. At the present time, it is unlikely that serious consideration can be given to eliminating the use of racial designations such as "African American" in public health.
COLLINS O. AIRHIHENBUWA
Airhihenbuwa, C. O. (1989). "Health Education for African Americans: A Neglected Task." Health Education 20(5):9–14.
Charatz-Litt, C. (1992). "A Chronicle of Racism: The Effects of the White Medical Community on Black Health." The Journal of the National Medical Association 84:717–725.
Collier-Thomas, B., and Turner, J. (1994). "Race, Class and Color: The African American Discourse on Identity." Journal of American Ethnic History 14:5–31.
Cooper, R. S. (1998). "A Note of the Biological Concept of Race and Its Application in Epidemiologic Research." American Heart Journal 108:715–723.
David, R. J., and Collins, J. W., Jr. (1997). "Differing Birth Weight Among Infants of U.S.-Born Blacks, African-Born Blacks, and U.S.-Born Whites." New England Journal of Medicine 337:1209–1214.
Gamble, V. N. (1997). "Under the Shadow of Tuskegee: African Americans and Health Care." The American Journal of Public Health 87:1773–1778.
Gould, S. J. (1996). The Mismeasure of Man. New York: Norton Press.
Jones, J. (1981). Bad Blood: The Tuskegee Syphilis Experiment: A Tragedy of Race and Medicine. New York: The Free Press.
King, G. (1997). "The 'Race' Concept in Smoking: A Review of the Research on African Americans." Social Science and Medicine 45:1075–1087.
King, G., and Williams, D. R. (1995). "Race and Health: A Multidimensional Approach to African-American Health." In Society and Health, ed. by Amick, Levine, Tarlov, and Walsh. New York: Oxford University Press.
Moore, R. B. (1992). The Name "Negro": Its Origin and Evil Use, 2nd edition. Baltimore, MD: Black Classic Press.
Polednak, A. (1989). Racial and Ethnic Differences in Disease. New York: Oxford University Press.
Stanton, J. (1960). The Leopard Spots. Chicago: University of Chicago Press.
Thomas, S. B., and Quinn, S. C. (1991). "The Tuskegee Syphilis Study, 1932–1972: Implications for HIV Education and AIDS Risk Education Programs in the Black Community." The American Journal of Public Health 81:1498–1504.
U.S. Department of Health and Human Services (1985). U.S. Department of Human Services. Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: U.S. Government Printing Office.