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Our View: Race-norming

Old racist ideas die a slow death

The NFL announced recently that it would stop using race-norming in the $1 billion settlement of traumatic brain injury claims by football players. The league will also review past scores for any potential race bias, according to The Associated Press.

“Race-norming” is the practice of adjusting test scores to consider the race or ethnicity of the test-taker. It assumes that test results will be different based on race and/or ethnicity.

The original intent of race-norming, begun by the federal government in 1981, was to counteract proven racial bias in aptitude tests administered to job applicants and those undergoing psychological tests. Its reasonable aim was to level competition between Black and white job candidates. Early critics of race-norming thought it provided unfair advantage to Black people.

Race-norming was outlawed in employment practices by the Civil Rights Act of 1991.

In the NFL’s medical assessment of brain injuries, race-norming assumed Black players started out with lower cognitive function than white players, thus any cognitive loss because of brain injury would be judged less than similar losses suffered by white players – and “made it harder for Black players to show a deficit and qualify for an award,” according to an ESPN article.

That this is happening today is almost impossible to believe. It’s the very definition of systemic racism. Race has no bearing on cognitive function. Furthermore, race, like ethnicity, is largely a social construct; who we call “Black,” “white” or “Hispanic” has little to do with genetic difference and more to do with our ideas about identity.

The NFL didn’t just suddenly decide to do the right thing. A pair of Black players filed a civil rights lawsuit over the practice, and the wife of a former NFL player started a petition drive that resulted in 50,000 petitions dropped on the doorstep of the federal courthouse in Philadelphia – where the judge overseeing the brain injury settlement initially had thrown out the lawsuit. (The judge is now considering a report on the subject.) Black former players with brain injuries and their families hope the details of the payouts will come to light, forcing the reconsideration of potentially discriminatory decisions.

A flurry of news reports about race-norming and its ubiquitous application in medicine also have surfaced. Writing for Slate, Mary Harris noted, “It’s used throughout medicine in a number of tests and equations … . A physician takes some measurements, inputs them into a computer, and then punches in some other information: your gender, your age – and, a lot of times, your race.”

On its face, using race in medical assessments makes sense. We know that specific racial and/or ethnic groups have higher rates of certain diseases, like diabetes or particular cancers. In those cases, wouldn’t plugging race and/or ethnicity into the diagnostic equation make sense? Of course it would.

But the reliance on such equations without disclosure to patients as to their use and purpose presents ethical concerns. Unconscious racial bias may result when medical personnel make decisions about the race or ethnicity of an individual (which may be inaccurate) or when a patient is of multiple races or ethnicities or declines to state those identifiers. Such bias can impact the quality, timeliness and appropriateness of health care.

Until and unless medical software can correct for racial and ethnic biases in data collection and analysis and medical personnel’s use of these equations – which seems unlikely – race-norming should be severely limited or perhaps abandoned altogether. What if medical personnel asked patients about race and ethnicity when it was appropriate, and discussed their pertinence to the medical issues at hand?

We hope the judge reconsiders hearing the Black players’ case and that the impacts of race-norming on previous decisions in the NFL’s traumatic brain injury assessments are made public – and revised to reflect reality, not racism.

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