Medical Apartheid Is A Particularly Gruesome Aspect Of US Caste System


Taking my life in my hands (a common occurence in the time of plague) I stood in line at the pharmacy yesterday to pick up a prescription. Two customers who were in front of me had a long, interesting discussion about covid and the likelihood of a vaccine that can be trusted anytime soon. 

Both Black elders expressed skepticism about the form this might take in their community and the woman identified the source of her distrust as, “medical apartheid.” Her remark has been ringing in my ears ever since. 

Higher infection and death rates for Black, indigenous, and people of color during this pandemic mirror the chronically worse health outcomes for BIPOC even before covid and are exhibit A for systemic racism in this country. 

Higher maternal mortality, infant mortality, and mortality from common diseases like high blood pressure and cardiovascular ailments are accepted by many as a fact of life in the US. A lot of victim blaming goes on and the higher castes look away from the nutritional realities of life in a food desert. 

Having recently read Caste: The Origins of Our Discontents by Isabel Wilkerson, I’ve been thinking a lot about her thesis that status in society isn’t necessarily tied to skin color or religion or circumstances of one’s birth. In the US skin color has been used extensively to establish an underclass that receives poorer nutrition, housing, schooling, and health care. But Wilkerson argues that it wasn’t always thus, and looks at two other caste-driven social orders — India and Nazi Germany — to examine the underpinnings of America’s toxic racism.

Examples of caste in action abound in 2020. 

Germany is bending the EU’s rules to rush their covid vaccine to Israel, but not to Palestinians.

The University of California, Los Angeles showed that it considers college athletes of higher importance than hospital nurses, an example of caste that ignores race but does seem to exhibit a gender bias.

As someone in the caste associated with white skin and middle class economic status, it wouldn’t occur to me to worry that the vaccine offered in my community might be of inferior quality. The fact that I don’t have to worry is the quintessential example of white privilege.

The mass incarceration of BIPOC prior to the age of covid has meant that they are disproportionately in danger from the disease because they are forced into a congregate setting with no power to choose where they’ll go or who they’ll associate with. Prisoners in California just ended the hunger strike portion of their ongoing campaign to call attention to this deadly risk to their health and safety.

Excerpt from Oakland Abolition & Solidarity’s blog post:

CDCr [California Department of Corrections]’s negligent and careless response to the COVID-19 outbreak at CSATF [California Substance Abuse Treatment Facility] has now killed at least three people. Active cases at the prison continue to hover near 1000 and now over half of the facility has contracted the disease. Guards and staff members are still failing to follow safety protocols and continue to move people around the facility creating more and more exposure.

Prisoners all over the nation suffer under a system of forced labor that is little different than slavery. Most are not a danger to society at all but are exploited by those who profit from their incarceration and the work they do. 

People with substance use disorder don’t belong in prison to begin with, but our lack of universal health care means most in the US view prison as a treatment option rather than the punishment it really is. Many in recovery cite the stigma i.e. low caste assignment they struggle with in a social order built to reward some at the expense of others.

Our public health crisis has moved us even further away from any national greatness we might have aspired to, and it is highly unlikely that the president and VP-elect will dismantle the carceral state that helped build their political careers.

Medical apartheid is ugly and evil, and I know I’ll be thinking about how to end it for a long time to come.