Lyman Briggs College and Department of Philosophy, Michigan State University, Holmes Hall, 919 E. Shaw Lane, East Lansing, MI 48825, USA.
Prev Med. 2012 Nov;55(5):405-8. doi: 10.1016/j.ypmed.2012.08.022. Epub 2012 Sep 8.
Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, Finnish descendants have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public.
针对高危人群进行公共卫生干预是公共卫生促进项目的经典工具。当种族群体被确定为高危人群时，这种做法就变得更加棘手了。我提出了在特定健康问题上，被确定为高危的种族群体中存在低危亚群时出现的特殊伦理和认识论挑战。我关注了两个例子。黑人移民群体的高血压风险与美国出生的非裔美国人不同。同样，芬兰裔后裔的囊性纤维化发病率远低于其他白种人。在这两种情况下，这些亚群的特殊性在很大程度上被包括最近美国政府饮食建议在内的重要公共卫生工作的设计者所忽视。我认为，出于以下几个原因，修改公开传播的风险信息以承认这些例外情况是可取的。首先，认识到低危亚群将允许更有效地利用有限的资源。将这一有价值的信息传达给亚群也将促进说实话。最后，提出一个更细致入微的、基于经验支持的、哪些群体已知处于疾病风险之中的代表性描述（而不是仅仅关注种族类别），将有助于对抗公众中存在的有害的生物种族本质主义观点。
