The Catalyze podcast: How a ‘national genome’ can reinforce social inequality, with Emily Vasquez ’06, ethnographer of science, medicine, and public health
Emily Vasquez ’06 joined Catalyze on the Saturday afternoon of the 2022 Morehead-Cain Alumni Forum in Chapel Hill this past October. Earlier that morning, she delivered a SEVEN Talk entitled, “The Social Life,” to over 500 Forum attendees.
During this episode, recorded on campus in the Pit, Emily shares with scholar host Elias Guedira ’25 about her ethnography research in Mexico and its parallels to the U.S. healthcare system. Her work investigates how the development of a national human genome has exacerbated social inequalities.
Emily is a Bridge to the Faculty Postdoctoral Fellow in the department of sociology at the University of Illinois at Chicago, where she teaches courses on the sociology of health and medicine and on race and ethnicity in scientific and medical practice. Her research examines how social inequalities are entangled with and reinforced through the production of medical knowledge and technologies. Emily’s work has been published in the journals Engaging Science, Technology, and Society; American Anthropologist; Perspectives on Science; and Medicine, Anthropology, Theory, among others.
Watch Emily’s SEVEN Talk from the 2022 Alumni Forum.
Music credits
The intro music is by Scott Hallyburton ’22, guitarist of the band South of the Soul. The ending song is “We Bubbles,” by Freedom Trail Studio (YouTube Audio Library).
How to listen
On your mobile device, you can listen and subscribe to Catalyze on Apple Podcasts or Spotify. For any other podcast app, you can find the show using our RSS feed.
Catalyze is hosted and produced by Sarah O’Carroll for the Morehead-Cain Foundation, home of the first merit scholarship program in the United States and located at the University of North Carolina at Chapel Hill. You can let us know what you thought of the episode by finding us on Twitter or Instagram at @moreheadcain or you can email us at communications@moreheadcain.org.
Episode Transcription
(Elias)
Emily, thank you so much for joining the Catalyze podcast this afternoon.
(Emily)
Great to be here with you. Thank you.
(Elias)
For our listeners, we should point out that we are sitting in the Pit on campus, so we’re likely to hear alumni and scholars as they head about to their free time activities.
I’m sure fall in Chapel Hill is a bit different than in Chicago. How’s it been returning to campus for the Forum? Are you enjoying your stay?
(Emily)
Oh my goodness. We got so lucky with the most beautiful weekend. I cannot believe this weather. It is the hardest time of year to travel because you don’t know how to pack, right? And it’s weird that days can be like a span of 30 degrees, so 70 degrees at the warmest and 40 degrees later on, but it’s really special to be back here, and we’re just blessed to have such a beautiful weekend. Totally. I’m psyched. I didn’t expect to be this excited.
(Elias)
I am in agreement with that. The weather has been remarkable. Emily, have you been able to reconnect with any of your former classmates?
(Emily)
Yes, really, really close friends I haven’t seen, in part because of the pandemic, but also because before the pandemic, I was doing fieldwork in Mexico for several years, for about four years, and so I just haven’t seen people, haven’t met their kids yet. And so it’s just really wonderful to get to see people’s homes, people who have moved back to Chapel Hill and that sort of thing, so it’s been a wonderful reunion, and I think we just got lucky that we’re all here. Like, I’ve never come to a Forum before, and so it’s just wonderful that it was a really good turnout.
(Elias)
I’m so glad you were able to reconnect with all of your friends and loved ones. I hope you were able to attend our Food Truck
Rodeo, which happened later in the evening. Were there any particular highlights from the night?
(Emily)
Yes, the lobster rolls. I only recently started eating lobster rolls, and I’m so impressed by how, I thought they would be heavy, and they’re kind of light. It was a very good selection of options last night. It was really fun. But it did get chilly.
(Elias)
That it did, real quick. I enjoyed your SEVEN Talk this morning, as well, which you entitled “The Social Life.” I was particularly struck by your commentary on health being viewed as an individual responsibility by the government rather than the outcome of a larger system. What’s one big takeaway that you hope the audience got out of your talk?
(Emily)
That it’s okay for health to be political, for people to engage, for people to take a stand in terms of the kind of society that they want to live in. We happen to live in a country where more money is spent here on healthcare than in all other developed countries, but we have some of the worst health outcomes. Like, I think if you look at the graphs, we’re like twenty-first in terms of country performance on healthcare spending versus health outcomes. And so I don’t think that we are on the right path. And I think something needs to change, and that will require voting. It will require mobilization. It will require people who are going into the field of medicine or health sciences to think about their work in a different way. That it is a bigger social project than just a job.
(Elias)
Thanks so much for making that point, and I really hope that people attending the Forum took away this message and are able to employ it in their futures. For reference, if any of our listeners weren’t able to attend the Forum, we livestreamed all the SEVEN Talks this morning on our YouTube page, so we’ll make sure to link Emily’s in the episode description. Emily, you describe your research as examining how social inequalities are entangled with and reinforced through the production of medical technology. Broadly speaking, what do you mean by that?
(Emily)
Yeah, I think the easiest way into understanding this is to give an example, and one that I’ve just been thinking a lot about lately is the politics around the deaf community and cochlear implants. So there’s been just really a lot of good books. There’s a great book called True Biz that came out this year, a really wonderful movie that people saw, CODA. I had an amazing deaf student who used a cochlear implant in my class. We’ve talked a lot about what it’s like to be deaf with a cochlear implant and without. There is debate, there is controversy in the deaf community over whether or not using that technology, the ability to hear—it’s a very imperfect technology, we should say, we should point out—is better, is desirable, or not. There is so much richness in the deaf community, in terms of communicating with sign language. It’s a form of communication that people who don’t speak sign language or American Sign Language, we just can’t communicate in this way. And it’s something really special in a way that you have a special way that you communicate with your friends that makes that relationship so close. It is something that bonds people. And so, often this decision is made by parents, it could be made by doctors, but it’s rarely made by a child who experiences deafness to have a cochlear implant. But it’s a really permanent kind of change in your life. So here’s what happens in this situation: there’s a possibility for a technology that could enable hearing, that could make a person able to function in broader society the way that it is. But that disincentivizes really learning sign language. It disincentivizes the depth of those relationships that somebody might experience by being in a community of people who share that. And so that’s what I mean by social inequality, is perhaps we have a technology and medical technology here that we think is useful, positive, improving someone’s life, but perhaps we’re not recognizing fully that there are other ways of living life that can be very rich. And we are not valuing those when we value a technological solution. There’s many ways to answer this question, and this particular topic is just very fraught. Like, I think if you’re listening to me now, hopefully these comments are just a starting off point for reading, for watching really great documentaries on this topic, or for talking to people who are deaf and can share this experience.
(Elias)
Thank you so much. Emily. I wanted to move over to your research that you conducted in Mexico. For reference, I noticed that a large portion of your research concerns genomic identities in Latin America. For background, could you outline any differences between American political views leaning towards a socially salient ethnic identity versus traditionally Mexican ones?
(Emily)
I was doing a master’s in public health at Columbia and so thinking a lot about how we study people in the United States, and that is definitely through the lens of the racial regime that dominates in the United States, which is really about discrete categories, black versus white. Very little recognition, especially in like formal statistics of a mixture of people who are an eclectic mix of all kinds of different people and places. I wanted to think about these issues as a sort of comparative. I wanted to go to Mexico and think about epidemiology, think about the categories that are used in medicine and public health, under a different racial regime. The idea of “Latino” is a U.S. construct born and developed and cultivated in the United States, bringing together heterogeneous communities. And so that there’s another scale of understanding identity in terms of indigenous, in terms of mestizaje, in terms of whiteness and brownness in Mexico, that our statistics, our science in the United States doesn’t capture. But I was curious how Mexican epidemiologists were thinking about this. I planned to do this project, which was going to be my dissertation, and just as I sort of was finalizing the plan, about to defend the proposal, a wonderful book came out addressing exactly this, which is called Mestizo Genomics. It’s a collaboration led by Peter Wade, and they’re looking at Mexico, but also Brazil, Colombia . . . I’m trying to think of any other countries are involved in the project, but they did fieldwork with lots of collaborators in genomics laboratories thinking about how is it that people are understanding who it is that they’re studying, what groups within the country are salient, and where do those ideas come from.
My particular question that I wanted to add, and I think I have—I didn’t do exactly the project that I had imagined because sort of so many of the answers had . . . here was the book explaining. But I was very interested in understanding science in each country. Medicine in each country doesn’t exist in isolation, right? How do epidemiologists who collaborate frequently between the United States and Mexico communicate across these different categories, different conceptions? This is also very relevant in, I mean, especially as medicine moves toward a reliance or an interest in big data, pooling data from all over the world. Analyzing this data statistically requires categories. But what categories are to be used? Can we use similar categories when we’re bringing together genomes from the United States and from Brazil and from Mexico? How do we group?
The other question is, in a world where evidence-based medicine really is the norm, would Mexican epidemiologists, would Mexican physicians and public health experts, to what extent would they feel that they could rely on evidence collected in the United States about Latinos? So those were sort of some of the motivating questions. And what assumptions would it require on their behalf to make that leap? And, I mean, just to sort of answer some of the questions that I’m posing, that leap is made a lot. More than I would expect. I think, actually, even though very few people in Mexico and many other spaces throughout Latin America identify as Latino, as you do with an experience in the United States. In medicine, I think this is a particular arena where that kind of diffusion of the category is taking place. So, like, if you go to pharmaceutical conferences, evidence from Latino samples taken in the United States is leveraged to prove that a drug works or how it’s going to work. And so I think this is language that’s becoming, or a belief that’s becoming more and more salient in the medical arena.
(Elias)
I found the part where you started talking about the Latino or Latinx identity being such a U.S. construct. So what categories currently exist in Mexico for defining ethnicity? I mean, when we’re looking at it from an American standpoint, we tend to be glossing over a lot of rich culture, and there’s a lot of value in that. So how does the Mexican government go about, for example, identifying and classing those different identities? And how is this monitored?
(Emily)
Yeah. So as I thought more about and wanted to learn more about this sort of epidemiology across borders and understand how biomedical researchers deal with these differences, I did learn quite a bit about Mexican epidemiology, and I think categories of rural and urban are actually a lot more important than the way that in the United States, epidemiology is organized primarily around race. That said, Mexico, like everywhere, is always changing, major flux. I think there is so much more recognition recently around AfroMexicanidad, like that there are people with African roots, and recognizing, I mean, capturing that in the census, capturing dimensions of discrimination that are related to that in health research. There is, even in the last just couple of years, a lot more recognition around this. And so I don’t want to suggest that the categories in Mexico are static or stable. I think they’re changing and being rethought at the same time that ours are. As perhaps in the United States, we’re trying to deal more with complicating gender, we’re also thinking more about how to deal with mixed race status, for example, in the census and epidemiology. In a good way, I think a lot of people across the health sciences are asking some of these good questions.
(Elias)
For context, we saw how the Mexican conception of an ethnic identity changed over time, as we were talking about the mestizaje or mestizo identity during Spanish colonization, this was propelled by a very nationalistic notion of a cosmic race. Could you kind of unpack what that term means for listeners? And do we see any ripple effects of this very mixed nationalistic identity on the class structure today in Mexico?
(Emily)
Yeah, so really like, this idea of mestizaje, which is being mixed primarily between European and Indigenous descent, was really mobilized in Mexico at the time of the Mexican Revolution to suggest, to create solidarity around an identity that was different from being European. That in [José] Vasconcelos’s work on the cosmic race was unique and uniquely powerful, something around which the kind of lore you build a nation. The issue with mestizaje, which is interesting because it is to an extent inclusive because it’s about a mixture, it’s about not everybody being the same, and yet it is about people being the same in their mixedness. And so there are still exclusions. So when a country promotes mestizaje, as it has been historically promoted in Mexico, at the same time you’re othering the Indigenous and, in Mexico’s case, very much erasing, ignoring the presence of Afro-Mexicans.
And this happens also in genomic data. I wrote a paper called “Mexican Samples, Latino DNA” and talked with Mexican genetic epidemiologists who were doing work on Mexican samples. And when they found African ancestry, a lot of times those samples were removed as outliers because it created too much noise and complication in the kind of analysis that they were trying to do.
(Elias)
But it’s just that. It’s that exclusion, right? This is at a time where we’re still fighting for the inclusion of basic groups in an American society, too. We’re still struggling to even acknowledge the existence of LGBT individuals in schools. So I think it’s something that evolves over time, and it’s extremely interesting to hear how at this stage right now, Mexico is still coming to terms with this colonialistic notion and the repercussions that it’s had in its history. Thank you for speaking about that.
So I kind of wanted to talk about your research, “Mexican Samples, Latino DNA.” And for this research, you were stationed at the Faculty of Science at the National Autonomous University of Mexico and Mexico City. And you acknowledge the motives and findings of genomic research funded by and designed by philanthropic organizations such as the Carlos Slim Foundation. So could you preface our listeners by describing who Carlos Slim is and his link to this genome project that he helped establish?
(Emily)
Carlos Slim is the wealthiest man in Mexico, the wealthiest man in Latin America, and for a while, the wealthiest man in the world. His sort of position on Forbes’s list of the world’s wealthiest was overtaken by Bill Gates about a decade ago, or a little bit more. But his economic power in Mexico is pretty overwhelming. There’s a joke and a really great biography written of him. And it’s two couples . . . sorry, it’s a couple, so it’s two people, they’re talking on a cell phone, and they’re fighting. And finally the guy interrupts the conversation and says, “Let’s stop fighting. The only person benefiting here is Carlos Slim.” Because Slim is a telecommunications mogul and owns cellphone access, so the minutes that they were spending fighting were benefiting Carlos Slim. But certainly far beyond telecommunications, the economic reach is everywhere, to civil infrastructure like airports, laboratories, like medical laboratories, hospitals. People say people in Mexico walk on his streets and sleep in beds with sheets made by companies that are owned ultimately by Carlos Slim.
Around 2007, 2010, Slim really ramped up his philanthropic investments in Mexico and Latin America. It was sort of like a regional look, investing a lot of money into especially health. One of the projects that Slim funded through the Carlos Slim Foundation is called SIGMA, which is the Slim Initiative in Genomic Medicine for the Americas. What’s interesting about this project, the focus was cancer and diabetes. The idea that Slim and the foundation put forth was that it was necessary for there to be science, funded in Mexico and Latin America, looking specifically at “Latin American and Mexican” genomes because they were not sufficiently included. These groups were not sufficiently included in samples, for example, in the most powerful institutions doing genetic and genomic research in the United States and in Britain, the UK. And so there was a rhetoric here about inclusion, once again, that they were funding science that was meant to be on Mexicans by Mexicans for Mexicans. But what’s also very interesting about this particular project is that much of the work, sort of the core leader, the institutional leader, was actually in the United States at the Broad at Harvard and MIT. And I asked the executive director of the foundation, “If the idea is to promote science, to do genomic research specifically on Mexican and Latin Americans, why then are you doing this at the Broad in Boston? And the answer was, well, Mexico established National Institute of Genomic Medicine, but the leaders in the world that are doing this at the speed that we want this done, the genetic analysis, but then, being able to do something with that data, to translate their findings into technologies—and I can tell you more about the technologies that they’ve developed. They wanted to function on a different timeline. And I talk about this sometimes as entrepreneurial time. Like, these sort of very nationalistic ideas that surrounded the investment, they’re in competition also with these other values, like how do we create, how does this basic science analysis get translated into a product that then makes it to people’s bedsides as quickly as possible? I think, coming from a very entrepreneurial world, this is a particular vision or an approach to doing science that the Slim Foundation brought to this part. So what ended up happening, it wasn’t just samples from Latin America, it wasn’t just samples from Mexico that were used or continued to be used in the SIGMA projects. They had a large influx of samples through a collaboration with a California research group. And so the Mexicanness of many of the samples is no longer just Mexican. Some of this information is actually missing to really understand the social identity or the ancestral identity of people that are in the California sample. What’s interesting is some of this work, it is about Mexican DNA, but a lot of the findings are published under the heading of Latino risk, Latino genetic risk.
There’s a sort of a parallel reading of this project or the way that this project went. It is inclusive. It is thinking about Latino identity or perhaps thinking about findings that can be applicable not just in Mexico or throughout Latin America, but, in the case of Slim, when we’re thinking about translation and a marketable product, sort of, coming as quickly as possible, there’s a marketing dimension to what categories can do. And so a category that is panethnic, and then if you’re tailoring a medical device to an ethnicity, which has its own politics, tailoring it to a panethnic identity creates much bigger markets than Mexico alone.
(Elias)
So you mentioned the Carlos Slim Foundation kind of overall being the driving factor in delivering something to the bedside, which had me wondering, can you explain how a country’s choice to invest in a national genome bank centralizes its role in the global economy? And why do you think people are more interested in investing in this field of research rather than clean water or providing clean air to citizens?
(Emily)
Investment in genomics in Mexico preceded, really began before Slim’s investment. Slim’s investment came later. The first investments were public, from the Mexican State Building and National Institute of Genomic Medicine, similar to one of our NIH Institutes. At the time, also in the United States, but around the world, there was a great deal of interest in genetics and genomics. Yes, from a health perspective,—“Where can this take medicine?”—but also a recognition that this could perhaps become an industry. Many people understood genetics and genomics in this developing, emerging world of science—and we’re talking here like very late 1990s, early 2000s—as the source of a new global bioeconomy. And there were fears that middle-income countries that could invest in science, if they didn’t invest in this kind of science, they might be left out from that kind of growing global bioeconomy. And so there were entrepreneurial physicians, scientists, in Mexico who lobbied the government, who mobilized the government, to make major investments in genomic medicine. Yes, with health in mind, but also with the national economy in mind. Especially when it comes to thinking about prevention efforts, it is much more likely, globally, that we will get prevention efforts that in some way lead to profits for someone. It is very difficult to disrupt profitmaking or even disrupt, sort of, the values around capitalist production and that being the strength of a country. That we would disrupt Coca-Cola, we would disrupt Nestle, and actually say, “What you’re doing as a business who does employ many people in our country is really harmful for health.” So we tend to get prevention options that have a money-making possibility. And genetics and genomics absolutely did, does, continues to, and the real profit potential with genetics and genomics comes from making diagnostic technologies, where you would scan someone’s genome and understand what they’re predisposed to versus not predisposed to. The other side is, once you understand better the genetic mechanisms, genomic mechanisms, you can create pharmaceuticals to address them. And so there, sort of, a parallel field developing at the time was pharmacogenomics, which was exactly this idea, that this would then lead to drugs, which is the industry. But no one—there’s not a huge foundation pouring resources into public health interventions that would disrupt capitalist order.
(Elias)
I found it really fascinating during your SEVEN speech when you started talking about activism in Mexico. And I kind of wanted to revert this question back to the U.S. in a little bit. You mentioned the Black Panther movement during the civil rights era and how they actually started to distinguish relationships between medicine, technology, and social inequalities. Can you elaborate how these relationships affect the lives of minorities living today?
(Emily)
Yeah. So thinking about the U.S. context, this question is particularly salient, and it really goes back to precisely what I was talking about before, in terms of what kind of prevention efforts do we get? People come from all over the world to seek specialized medical care in the United States because we have the capability to do things because of investments, public investments, in science that in other countries are not available. So we’ve made a choice in this society to invest in technology, invest in specialization, invest in high-cost treatments. We haven’t put a lot of investment in a) using the evidence that we have about very basic public health interventions. What does this mean? People who have a lot of resources and have great access to healthcare can get some of the best care in the world available, in this country. But in terms of our population and thinking about outside of that one percent, the likelihood of being as healthy as somebody in another developed country, if you’re in the United States, is much lower. And of course, in the United States, we know that resources map onto other social inequalities like race because of historical racism in this country.
And so there’s just a perpetuation, I think, unfortunately, rather than what the Black Panthers envisioned, in terms of remaking healthcare in a way that would help to undo inequality, that would prevent illness in poor, black communities, and therefore, promote not only health, but economic well-being, generational wealth, for example. Those strategies were limited in terms of the Black Panthers’ activism, in terms of them being scaled up. And so we’re left with our current situation, which is the one I explained before with the great potential, if you have resources.
(Elias)
Emily, thank you so much again for spending time with us, and I hope you enjoy the rest of your time at the Forum and in Chapel Hill.
(Emily)
Thank you. This was so much fun.