I tuned in to a couple of colleagues recently as they debated an intriguing news story, published Monday in The Washington Post, that began, "The poor health of residents of the District's predominantly black Ward 8, where the death rate from cancer is 44 percent higher than in the city's white and wealthy precincts west of Rock Creek Park, could be more a function of class than of race."
What was the point? I asked one reporter, who is black.
"It's just another way of making white people feel better," the reporter said. "When you say class is the problem, that's vague. But when you say 'race' is the issue, that means that somebody has been done wrong."
"It's partly class," declared a fellow columnist, who is white. "If you made a right turn in Elton, West Virginia, and all the people were white and poor, you'd find the same maladies and diseases."
That was the point of the story by Post staff writer Malcolm Gladwell, in which Johns Hopkins University sociologist Vicente Navarro charged that there is a "deafening silence" in the United States on the subject of how class difference and income inequities have affected public health.
"By looking only at race, we make it seem like race is the problem," Navarro was quoted as saying. "It is not . . . . Many of the things that are assumed to be characteristics of blacks are, in fact, characteristics of low income."
The black reporter was incensed. "But many blacks are poor because of their race," my colleague said. Indeed, 31 percent of blacks -- and 10 percent of whites -- are poor, according to the U.S. Census.
But that was not the issue, the white columnist retorted.
"Poverty causes the health problems," the columnist insisted. "If you're talking about sickle cell, that's race-related. But if you're talking about lung cancer and eating fatty foods and drinking too much and becoming a victim of violence, those things are associated with poverty, not race."
"But what is the reason so many black people live in poverty?" the black reporter asked.
"That's irrelevant," the white columnist replied.
"Race is totally relevant," the black colleague shot back.
The columnist shrugged. "You can't see the question because you're too concerned, too . . . " he paused.
"Because we're black," I said.
"I hadn't noticed," he replied cleverly.
The columnist was echoing the sentiments of Milton Terris, editor of the Journal of Public Health Policy. "People say to me, 'If we don't know the difference between black and white health, then we won't know what to do about it.' My answer is, why think of it in terms of white and black? Why not think of it in terms of rich and poor?" Terris was quoted as saying in Gladwell's article.
By ignoring the influence of class, added Navarro, we may be guilty of "reverse racism, of making being black the problem."
So does being black make any difference to health, above and beyond being poor? Gladwell's article cited a recent Centers for Disease Control study that analyzed nearly 10,000 black and white adults. The study found that only one-third of the substantially higher rate of premature death for blacks could be explained by income and occupational differences.
Another third was apparently due to differences in risk factors such as high blood pressure, smoking and weight. But a full 31 percent of the difference could not be accounted for by anything except the race of the subject.
"If we assume that this is simply a class-related issue, we run the risk of not focusing on problems that may be related to the segregation and discrimination that still exist in our society," said Linda Aiken, a sociologist at the University of Pennsylvania. "Race has an impact over and above social class."
That was the point my black colleague was making. Race continues to make a difference in the health of black people. And as the debate among my colleagues made clear, race also can make a difference in the way the problem is viewed.