I am not your minority

“Leaving aside all the physical facts which one can quote, leaving aside rape or murder, leaving aside the bloody catalogue of oppression, which we are in one way too familiar with already, what this does to the subjugated—is to destroy his sense of reality… the country which is your birthplace and to which you owe your life and your identity has not in its whole system of reality evolved any place for you.”

James Baldwin, I am Not Your Negro¹

Opening pages of The Lancet or The New England Journal of Medicine from the early-to mid-20th century exposes phrases like “a boy, aged 2½, of full-blooded negro stock” with “haemoglobinuria” or “a 21-year-old colored man” with myalgias.^2,3 Reading terms like “Negro” and “colored” today might tense the muscles in revulsion or shame, yet such language was commonly used by medical academicians to describe Black patients in earlier eras. As Black descendants of the enslaved successively changed their group identity from “Colored” to “Negro” to “Black” (“negro/a/x/e” or “preto/a/x/e”) and, in the United States, to “African American,” academic medical professionals have attempted to incorporate these terms into their clinical and scholarly lexicon.⁴ Yet, Western medicine continuously defaults to Whiteness as normative in ways that reinforce racial essentialism and overlook White supremacy.

Minoritization as a political act

Referring to Black and Brown people as racial and ethnic “minorities” misleads and misdirects attention from racial oppression. The word “minority” implies that Black and Brown people are fewer in quantity or lesser in quality compared to the White “majority.” Worldwide, darker-skinned populations outnumber fair-skinned (i.e., White) people and will become the quantitative majority in the United States within 20 years.⁵ Further, the reason darker-phenotyped American individuals currently exist in smaller numbers relative to White Americans results from White supremacist policies of abduction and enslavement, restrictive immigration, educational and employment deprivation, reproductive control, carceral discrimination, and healthcare exclusion. Recent updates to the AMA Style Guide on reporting of race and ethnicity aligns with our recommendations,⁶ but the rationale does not adequately name these intentional sociopolitical arrangements throughout North American history. Terms like “racially minoritized” or “racially oppressed” better highlight the active processes of structural racism than “racial minorities.” The phrasing “racialized health inequities,” as opposed to “racial disparities,” implicates racism and racialization as agents of inequality rather than indicting race.

Similarly, particularly when discussing racialized health inequities, shortcuts referring to racially minoritized populations based on collective color—like “people of color”—suggest that racial identities beyond Whiteness inherently confer pathology while maintaining that Whiteness signifies the normal, healthy comparator. Yes, the term “Black, Indigenous, and other people of color” (BIPOC) centers the historical oppression of Black and Indigenous populations that have experienced chattel slavery, genocide, and displacement. However, indiscriminately clustering these alongside the experiences of phenotypically, socially, and economically distinct people belies the variation in risk exposures encountered by diverse populations. Instead, naming populations of interest and the rationale (e.g., “Black descendants of the enslaved given legacies of racist violence perpetuated US healthcare organizations”) adds precision and avoids the pitfalls of biologizing race and normalizing Whiteness.

Whiteness as a marker of advantage vs. minoritization as a marker of risk

In Black Skin, White Masks, Martinican psychiatrist and philosopher Frantz Fanon describes an “epidermal racial schema” that presumes White people as intelligent, benevolent, and egalitarian whereas the “white gaze” negated racially minoritized persons.⁷ Extensive scholarship explores how although racial classification alone is not a risk factor for adverse health outcomes, racism can harm health.^8,9 The so-called “deficit framing” of health disparities research configures Black, Indigenous, Latinx, and Asian populations as the “problem” patients requiring intervention. Relatively less research emphasizes how Whiteness—or racialized sociopolitical advantage—accords White people protective health benefits as the beneficiaries of racial capitalism. A “deficit frame” may inappropriately target individualized behavioral, pharmacogenetic, or clinic-based interventions. Focusing concentrations of advantage emphasizes redistributive policy reforms to promote equity in structural determinants of health. Language highlighting these systems includes “racially advantaged” or, when comparing populations, using “racially centered” as a contrast to “racially marginalized” instead of more conventional categories like “White” and “non-White.”

Tomorrow's minority is today's Negro

Medical scholars will inevitably look back on White-normative, deficit-framed language like “minorities” and “racial disparities” with a similar disdain that current scholars understand socially antiquated terms like “Negro” and “colored.” We call for a shift in language and attention to honor the murdered Black and Indigenous people at the hands of U.S. physicians and political actors.¹⁰ We are more than non-white. We are not your minority.

Contributors

CB, JPC: conceptualization, writing – original draft, and writing; EVSMc: writing – review & editing, supervision.

Declaration of interests

We declare no competing interests.