Not enough time has passed for us to understand why the tide of “progressive” political excess has risen so quickly. Yes, it accelerated after the death of George Floyd, but there are reasons why Floyd’s death unleashed what was already waiting to happen. I myself don’t really understand the phenomenon of “Wokeness”, and why so many people seem to have been driven mad.
Nobody wants to think of themselves as racist, but now we are told that not only are we all racists, but that we’re unconscious of that fact, and that the very structures of government, politics, and universities have racism embedded in their bones and sinews. And in this we’re all complicit. Some of this is true, as the voting rights bills suggest, and it behooves us to find the truth in all the shouting around us.
But the excesses—the shaming, the demonization, the self-abasement, the rush to judgment in every act, the drive to efface the past—often make me despair of the whole enterprise of antiracism, at least as conducted according to the Tenets of Critical Race Theory. It’s not so easy to separate the genuine inequalities that need to be fixed with the cries of the “progressive” left that we need to tear down the whole system and hand over political power to them.
But we can pretty much brush off extreme cases of self-abasement, so common in university “declarations” like the following. Harvard’s Medical School has a Program in Global Surgery and Social Change, and its goals are admirable: to extend what progress the “first world” countries have made in surgery to what they now call “the global South”: those countries with lower standards of living and insufficient medical care. Here are the program’s goals:
The Program in Global Surgery and Social Change (PGSSC) is a collaborative effort between Harvard Teaching Hospitals, the Department of Global Health and Social Medicine at Harvard Medical School, Boston Children’s Hospital and Partners In Health (PIH).
Our strategy is two-fold:
- Global surgical systems strengthening through Research, Advocacy, and Implementation Science, using the framework of the Lancet Commission on global surgery. You can learn more about the Lancet Commission on global surgery on the PGSSC Resources page.
- To produce leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. Through the Paul Farmer Global Surgery Fellowships and research associate positions, it aims to empower surgeons, surgical trainees and medical students around the world with the skills they need to improve the health of some of the world’s most impoverished people.
That is all well and good, but then the Program got mixed up in the anti-racism business, and in a pretty strident way, and issued this statement, which I reproduce only in part.
Racism murders. Racism destroys. Racism dehumanizes. We live in a racist world and all play active and passive roles in perpetuating racism: the system of prejudice and discrimination based on the ambiguous social construct of race backed by unequal and unjust power dynamics. Racism is inherent to every aspect of our lives; it is woven into the fabric of society and consequently its effects interface with our work as the research associates, fellows, and faculty at the Program in Global Surgery and Social Change. Therefore, the absence of conspicuous racist actions is not enough. We must be actively anti-racist. We absolutely, unapologetically denounce our wretched racist system and its proponents without exception.
Racism systemically places higher value and opportunity in the hands of a specific race, and as a direct consequence disadvantages another racial group. It is this benefiting of one group to the detriment of another that has led us to focus on anti-racism. The work of antiracism is allied to that of anti-discrimination and the evaluation of inequities based on gender, sexual orientation, caste, religion, ability, tribal affiliation or socioeconomic status. However, given the distinct relationship of racism, colonialism, and global health, we in the global health community have a moral imperative to shine a bright light specifically on racism within our sphere.
Racism is inherently linked with colonialism. Our work in global health is rooted in colonialism, which provided power to white Europeans through subjugation and exploitation of others. Colonialism subsequently allowed for the creation of the construct of race to justify the dehumanization of those the colonizers exploited. This practice has lived on in global health through the racist belief that those same colonial powers possess medical knowledge that is superior to that of the cultures they denigrated. Consequently, global health is built on a foundation that, at its core, is antithetical to the principle of shared human dignity and respect. Affirming our commitment to anti-racism also affirms our commitment to being anti-colonial.
Academic institutions in high income countries are complicit in and the product of centuries of historic institutional colonialism and racism with over-representation of white voices that are heard on a global scale. We interact with a diverse group of international partners, but cannot truly be equitable partners until we acknowledge and address the place of power and privilege from which we operate.
Here we see the familiar denouncement of racism (seriously, is there any rational person who doesn’t already denounce it?), the chest-beating and self-abasement, and the accusations that all of us are complicit in perpetuating systemic racism. And, like Ibram Kendi, it argues that it’s not enough to refrain from being racist, but we must all actively work, and work in a certain way, to be “antiracists”. Whoever is not antiracist, says Kendi, is racist. It is as if there is only one issue in the world on which we should be working.
Now eliminating global inequality in medical care is an excellent goal, but I fail to see how these kinds of statements will help solve the problem. What we need is the kind of recognition of moral deserts that got Dr. King and his associates the civil rights laws they sought. Why shouldn’t we be helping others who are human and suffer in ways we understand? What we get instead is annoying hectoring, coupled with the strange declaration that promoting global health in Harvard’s way is racist because the practice of medicine in First World Countries is more advanced than in underdeveloped countries. (The fellowships given out by Harvard’s programs are, after all, spent learning at Harvard.) I call your attention to goal #2 of the program given above:
To produce leaders in Global Surgical and Health Systems through Research, Advocacy, and Care Delivery. Through the Paul Farmer Global Surgery Fellowships and research associate positions, it aims to empower surgeons, surgical trainees and medical students around the world with the skills they need to improve the health of some of the world’s most impoverished people.
This is the exportation of Harvard-style medicine to other countries. Isn’t that the conscious promulgation of “superior medical knowledge”?
This is, of course, a species of medical colonization, for who determines what skills medical workers in poorer countries need? It’s not colonization in the sense of taking advantage of poorer nations, but it’s colonization in the sense of believing that one indeed has “medical knowledge superior to that of the countries they [once] denigrated.”
There’s a lot more, as well as three subsections swearing what Harvard will do to promote antiracism in various areas, including “People,” “Culture”, and “Civic Engagement”, which itself has two sub-subsections, “Academia” and “Economic Injustice”. Here’s the Academia part. I reproduce it because I think it’s misleading about the degree of racism in academia, at least in my experience:
Academia: We acknowledge the role that academia plays in perpetuating structural racism. Academic excellence requires equity, yet despite statements denouncing prejudice, many academic systems are fraught with biases. Notably, it is often Black, Indigenous, and People of Color who are expected to be, and inevitably are, the most engaged in issues of structural racism in academia. This engagement results in activities and efforts leading “diversity, equity and inclusion” initiatives that are not traditionally valued in academic promotion criteria. This reality highlights the need for a paradigm shift in two ways – who shoulders anti-racism efforts, and how anti-racism work is valued and supported institutionally to ensure that personal and professional goals are being met. We will engage in the broader academic system, outside of our specific purview of global health, to catalyze meaningful change in the culture of academia.
Anybody familiar with academia will sense the tension in this statement. And I’ll finish by adding that inequities (differential representation of groups) in academia does not constitute prima facie evidence for structural racism present in academia now.