The Racialization of Valley Fever: Influence of 20th Century Eugenics on Control of an Emerging Disease

The purpose of this work is to bring a new perspective to the study of coccidioidomycosis, discussing exactly where our assumptions about etiology arose, and whether they are grounded in data, history, or both. This has both medical and policy implications, as the racialization of the disease is represented across medical, governmental, and lay publications. 

Racial metrics in health have repeatedly been demonstrated to impede quality care. For example, an equation intended to evaluate kidney function in patients waiting for transplant, adjusted values for Black patients that underestimated risk for severe disease, leading to adverse health outcomes (Boulware, Purnell, and Mohottige 2021). While race as a social category can highlight risk arising from social factors, such as structural racism and persistent disenfranchisement, treating it as a biological concept perpetuates these inequities. Examining how the racialized narrative of coccidioidomycosis arose is important to determining how we should proceed in light of new genomic research, ensuring that this promising work is not instead used to perpetuate historical harms and further disenfranchise the groups at highest risk.

Challenging the racialized narrative of coccidioidomycosis risk raises the possibility that a far broader population is at high risk for severe disease, pushing for a reevaluation of existing coccidioidomycosis programs that includes social determinants of health in risk frameworks, rather than an assumed “inherent” genetic risk for severe disease. A justice-oriented public health approach has promise, in that it addresses environmental risks rather than problematizing the bodies of the people most affected (Rios 2018). This equips public health systems and the communities most affected to create effective responses to the growing threat of this emerging disease.

I anticipate the majority of the research for this project to have been completed by the time of the residency in 2026. At that point, the major goal will be to pull it together into a book. This is what I hope to have as my primary focus during my residency; focused writing time, while in a community of scholars who can spur me to think in new ways about the manuscript and research. The expected product will be a completed book.

Citations:

Boulware, L. Ebony, Tanjala S. Purnell, and Dinushika Mohottige. 2021. “Systemic Kidney Transplant Inequities for Black Individuals: Examining the Contribution of Racialized Kidney Function Estimating Equations.” JAMA Network Open 4 (1): e2034630. https://doi.org/10.1001/jamanetworkopen.2020.34630.

Rios, Sarah Maxine. 2018. “Valley Fever: Environmental Racism and Health Justice.” UC Santa Barbara. https://escholarship.org/uc/item/92x9s6jd.