By Austin Lam.
A recent article highlighted an uncomfortable yet unassailable issue: “the way the public health narrative around coronavirus has reversed itself overnight seems an awful lot like … politicizing science.” Alternatively, another article frames this political element as itself the impetus to justify protests against systemic racism in the context of racism as a public health crisis. In other words, the issues surrounding COVID and systemic racism are inextricably intertwined.
Given the chaotic background, there has to be a reckoning with regard to the rationales underlying COVID-19 public health efforts and those justifying antiracist protests. The calculus put forth by some is utilitarian in nature and it is unsettling. In other words, racism harms and kills more than COVID; therefore, the protests are justified.
Are we saying that the calculus is to advocate for BIPOC (Black, Indigenous and People of Color) lives through antiracist protests versus the lives put in jeopardy by COVID spread (e.g., the elderly and immunocompromised)? Surely not. So, if not, then how can we put the pieces of this puzzle together?
One way is that we abandon the utilitarian calculus because it does not hold in the first place per reductio ad absurdum. Instead, we can conceptualize racism as a public health crisis (i.e., in the same conceptual class as COVID) – in which case, the antiracist protests can be properly differentiated, ostensibly, from anti-lockdown protests. In other words, we can reframe racism itself as a public health problem, in which case, it is of the same conceptual class as COVID as a public health crisis, and therefore the antiracist protests can be justifiably distinguished from the anti-lockdown protests (the consequences of ‘lockdown’ do not themselves constitute a public health crisis per se, however awful they may be).
But we encounter a problem with this alternative framing of systemic racism as a public health crisis. We are wrongly conflating a public health crisis and a moral as well as political problem that incidentally has health implications; COVID is the former and systemic racism is the latter.
The conflation risks an erroneous conceptual scheme of over-reaching medicalization. Racism is abhorrent and needs to be effectively addressed, but we can say that systemic racism and the need to extinguish it belong properly to the domains of politics and morality, both collective and personal. Systemic racism can and should be properly conceptualized by political philosophy without making it go under the umbrella of medicine. Issues do not need to be put under the umbrella of medicine to be seen as matters that contribute to poor health. It reflects conceptual naiveté to say that racism is a public health crisis simpliciter. Racism is racism sui generis and it trivializes the harm of racism to medicalize it.
A conflation of a public health crisis with a fundamentally moral and political problem that incidentally has deep and pervasive health implications is what we need to avoid.
Where does this leave us? A path forward can entail: (1) admitting that COVID and systemic racism are qualitatively different problems (belonging to different classes, each being incredibly harmful in their own ways) albeit they are inextricably intertwined, (2) recognizing that a utilitarian calculus of harms and benefits does not work precisely because the logic itself is contradictory to an antiracist view of lives (e.g., it quantifies lives and uses that to weigh against the minority), and (3) then properly distinguishing the justifications of antiracist protests versus anti-lockdown protests from an exclusively political philosophical viewpoint without falsely invoking racism as a public health crisis in and of itself. Systemic racism is a political and moral problem with health implications and must be dealt with as such. The double effect principle can apply here to make the distinction, along with more rigorous political philosophy arguments grounded in a proper conceptualization of rights, particularly the right to protest.
This means that a hard look at how public health interrelates with the right to protest is due, and more generally, how medicine/sciences interrelates with our moral and political realities as well as how our political philosophies can reflect and accurately characterize these complex relationships involving the medical realm without invoking conceptual conflations.
The bottom-line question then becomes: can we reliably and rigorously distinguish the justifications for the right to protest with respect to antiracist protests versus anti-lockdown protests on purely political philosophical grounds? Yes, we can.
We do not need to invoke racism as a public health crisis in and of itself; it is a fundamentally moral and political problem with deep and severe health implications. Thus, of course, health implications and health elements (especially public health in the current discussion) must be considered. But they are not the a priori considerations. Most, if not all, of medicine has political elements; notwithstanding, the starting point must be society’s structures, political and moral. Systemic racism is a moral and political ill per se, not necessarily a medical one although it has bearings on many health factors that disproportionately harm and kill BIPOC lives.
So, how can we make this distinction? First, we can acknowledge that there are undeniable risks to gatherings, including protests, irrespective of intent. Second, we can account for these risks by asking what justifies the right to protest given these risks. Here, an example is the aforementioned principle of double effect: “bringing about a good result even though it would not be permissible to cause such a harm as a means to bringing about the same good end”. While the anti-lockdown protestors have deliberately sought to undermine public health efforts related to COVID in a supposed stance for “freedom”, protests against systemic racism have been occurring to achieve a laudable goal, which itself interrelates in complex and nuanced ways with public health factors and especially with respect to the health of BIPOC lives. The double effect principle does not apply to the former, but it does apply to the latter. This is just one example of how to begin a reliable and rigorous distinction that is fulsome in accounting for the risks that remain present and undeniable.
Without the proper conceptualization, justifications, and grounding, “racism as a public health crisis” will be “nonsense upon stilts”, to borrow the phrase from Jeremy Bentham – easily critiqued and manipulated by those with racist inclinations to mount distrust and denial of scientific and medical expertise. Root and branch reform demands the task of carving out nuanced and principled positions. Nevertheless, careful intellectual considerations should not be mistaken for equivocal gutlessness; instead, a principled and thoughtful stance stands the test of time and the vicissitudes of the world. It inspires emboldened commitment to effectively addressing systemic racism as well as a global pandemic.
Author: Austin Lam
Affiliation: University of Toronto, Faculty of Medicine, MD Program (Medical Student)
Competing interests: None declared
Social media account of post author: Twitter: @austinaldenlam