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Monday, October 19, 2026

Progressivism

From Wikipedia, the free encyclopedia

Progressivism is a political philosophy that seeks to make progress in the human condition through reforms aimed at increasing positive liberty. Progressivism arose during the Age of Enlightenment out of the belief that civility in Europe was improving due to the application of new empirical knowledge.

Progressivism as an umbrella term is associated with variants of social liberalism, social democracy and democratic socialism.

Within economic progressivism, there is some ideological variation. Illustrative examples of this include some Christian democracy and conservative-leaning communitarian movements. While many ideologies can fall under the banner of progressivism, all eras of the movement are characterized by a critique of unregulated capitalism and a call for a more active democratic government to safeguard human rights, promote cultural development, and serve as a check-and-balance on corporate monopolies.

Other types of progressivism include techno-progressivism.

Early history

From the Enlightenment to the Industrial Revolution

Immanuel Kant, German philosopher
John Stuart Mill, English philosopher

Immanuel Kant identified progress as being a movement away from barbarism toward civilization. 18th-century philosopher and political scientist Marquis de Condorcet predicted that political progress would involve the disappearance of slavery, the rise of literacy, the lessening of sex inequality, reform of prisons, which at the time were harsh, and the decline of poverty.

Modernity or modernisation was a key form of the idea of progress as promoted by classical liberals in the 19th and 20th centuries, who called for the rapid modernisation of the economy and society to remove the traditional hindrances to free markets and the free movements of people.

In the late 19th century, a political view rose in popularity in the Western world that progress was being stifled by vast economic inequality between the rich and the poor, minimally regulated laissez-faire capitalism with out-of-control monopolistic corporations, intense and often violent conflict between capitalists and workers, with a need for measures to address these problems. Progressivism has influenced various political movements. Social liberalism was influenced by British liberal philosopher John Stuart Mill's conception of people being "progressive beings." British prime minister Benjamin Disraeli developed progressive conservatism under one-nation Toryism.

The first modern socialists of the 19th century followed utopian socialism, and experienced pushback from progressive socialism. This reformist approach was reflected in a readiness to question revolutionary tenets of Marxist orthodoxy, as well as challenges to sections of scientific socialism. G.A. Kleene, a 19th-century economist, defined progressive socialism as Eduard Bernstein's stand against "'Old-School' Marxism." Progressive socialism has historically been associated with reformist openness to question scientific socialism, such as by criticizing the law of growing misery.

In France, the space between social revolution and the socially conservative laissez-faire centre-right was filled with the emergence of radicalism which thought that social progress required anti-clericalism, humanism, and republicanism. Especially anti-clericalism was the dominant influence on the centre-left in many French- and Romance-speaking countries until the mid-20th century. In Imperial Germany, Chancellor Otto von Bismarck enacted various progressive social welfare measures out of paternalistic conservative motivations to distance workers from the socialist movement of the time and as humane ways to assist in maintaining the Industrial Revolution.

In 1891, the Roman Catholic Church encyclical Rerum novarum issued by Pope Leo XIII condemned the exploitation of labor and urged support for labor unions and government regulation of businesses in the interests of social justice while upholding the property right and criticising socialism. A progressive Protestant outlook called the Social Gospel emerged in North America that focused on challenging economic exploitation and poverty and, by the mid-1890s, was common in many Protestant theological seminaries in the United States.

20th century: U.S. Progressive Era, New Deal and post-war consensus

Early 20th-century progressivism included support for American engagement in World War I and the creation of and participation in the League of Nations, compulsory sterilisation in Scandinavia, and eugenics in Great Britain, and the temperance movement. Progressives believed that progress was stifled by economic inequality, inadequately regulated monopolistic corporations, and conflict between workers and elites, arguing that corrective measures were needed.

In the United States, progressivism began as an intellectual rebellion against the political philosophy of Constitutionalism as expressed by John Locke and the Founding Fathers of America, whereby the authority of government depends on observing limitations on its just powers. What began as a social movement in the 1890s grew into a popular political movement referred to as the Progressive Era; in the 1912 United States presidential election, all three U.S. presidential candidates claimed to be progressives. While the term progressivism represents a range of diverse political pressure groups, not always united, progressives rejected social Darwinism, believing that the problems society faced, such as class warfare, greed, poverty, racism and violence, could best be addressed by providing good education, a safe environment, and an efficient workplace. Progressives lived mainly in the cities, were college educated, and believed in a strong central government. President Theodore Roosevelt of the Republican Party and later the Progressive Party declared that he "always believed that wise progressivism and wise conservatism go hand in hand."

Roosevelt made conservation a central concern of his presidency and helped bring environmental protection to the forefront of national politics. He viewed conservation as more than simply protecting nature. Roosevelt also believed that the nation's natural resources should remain available for the benefit of the public rather than being controlled primarily for the advantage of particular individuals or businesses. Roosevelt relied heavily on Gifford Pinchot, head of the Bureau of Forestry, to develop and administer his environmental policies. He strengthened Pinchot's authority by moving responsibility for national forests from the Department of the Interior to the Bureau of Forestry, which operated under the Agriculture Department. The bureau was subsequently reorganized as the United States Forest Service, with Pinchot directing the expansion of federal conservation programs within the national forests. Roosevelt also supported the Newlands Reclamation Act of 1902, which authorized federal dam and irrigation projects intended in part to assist small farmers and brought 230 million acres under federal protection. The Antiquities Act, enacted by Congress in 1906, further expanded federal conservation authority by allowing the president to designate national monuments on federal property. During his presidency, Roosevelt placed more federal land under protection through national parks, nature preserves, and other conservation measures than all previous presidents combined. He also created the Inland Waterways Commission to develop a coordinated approach to water resources, balancing conservation with transportation and economic needs. In 1908, he brought state governors together at the Conference of Governors to discuss conservation and the management of natural resources. Roosevelt subsequently formed the National Conservation Commission to conduct a comprehensive assessment of the country's natural resources. However, resistance to the scope of Roosevelt's conservation program curtailed further initiatives near the end of his presidency. The disputes surrounding his environmental policies also helped set the stage for the Pinchot–Ballinger controversy under President Taft.

President Woodrow Wilson was also a member of the American progressive movement within the Democratic Party. Progressive stances have evolved. Imperialism was a controversial issue within progressivism in the late 19th and early 20th centuries, particularly in the United States, where some progressives supported American imperialism while others opposed it. In response to World War I, President Woodrow Wilson's Fourteen Points established the concept of national self-determination and criticised imperialist competition and colonial injustices. Anti-imperialists supported these views in areas resisting imperial rule.

During the period of acceptance of economic Keynesianism (the 1930s–1970s), there was widespread acceptance in many nations of a large role for state intervention in the economy. The "progressive" brand was frequently identified with supporters of the New Deal by the year 1936. While the more progressive Second New Deal was more controversial in the public, the progressive consensus of the New Deal was strong, and even future moderate Republican presidents like Dwight D. Eisenhower and Richard Nixon worked to preserve it. The New Deal provided the context for future expansive progressive programs, especially the Great Society measures of Lyndon Johnson's administration. With the rise of neoliberalism and challenges to state interventionist policies in the 1970s and 1980s, centre-left progressive movements responded by adopting the Third Way, which emphasised a major role for the market economy. There have been social democrats who have called for the social-democratic movement to move past Third Way. Prominent progressive conservative elements in the British Conservative Party, such as from the likes of Rab Butler, promoted the post-war consensus, and others have criticised neoliberalism.

Into the 21st century and social democratic turn

Influence of the Nordic Model

Gerhardsen at a rally in Bergen in the late-1960s

Many analysts have noted that 21st-century progressivism has focused on tax-funded social benefits inspired by the Nordic model, noting Bernie Sanders as an example of this advocacy and policy approach. Norway's progressive tradition has roots that reach back even before the modern welfare state. In 1884, 171 prominent Norwegian figures, including five future prime ministers, helped establish the Norwegian Association for Women's Rights. The organization campaigned for women's access to education, the right to vote, the right to work, and greater equality between men and women. These efforts helped establish women's equality as an important part of Norwegian political life. By the 1970s, gender equality had become an increasingly important part of government policy, with the state creating institutions to promote equality and combat discrimination.

Einar Gerhardsen was a central figure in the development of Norwegian social democracy. After beginning in the socialist labour movement and briefly aligning with its communist wing, he and the Norwegian Labour Party pushed for reform-minded democratic socialism. His political rise was interrupted by the German occupation, during which he became involved in the resistance, was arrested and tortured, and spent much of the war imprisoned in Norway and Germany. After liberation in 1945, Gerhardsen helped lead the country through reconstruction, serving several terms as prime minister. Under his leadership, Labour governments expanded state regulation, industrial development, progressive taxation, redistribution, and social security. These policies helped reduce poverty and unemployment while laying much of the foundation for Norway's modern welfare state. Gerhardsen's legacy therefore came to represent both democratic government and greater economic security and social equality.

International organizing

Progressive Alliance

Founded in Leipzig, Germany, on May 22, 2013, the Progressive Alliance is an international political organization made up primarily of social democratic political parties and organizations. The organization was established as a substitute for the already-existing Socialist International, of which many of its constituent parties are either present or previous members. In January 2012, Sigmar Gabriel, then chairman of the Social Democratic Party of Germany (SPD), decided to terminate the SPD's annual membership fee of £100,000 to the Socialist International. Gabriel criticized Socialist International for admitting and maintaining undemocratic political movements, leading to the establishment of the Progressive Alliance. The organization has a stated goal to become the worldwide network of "the progressive, democratic, social-democratic, socialist, and labour movement."

PI logo

In May 2020, Progressive International was formally founded and launched on 11 May 2020, responding to a 2018 open call by the Democracy in Europe Movement and the Sanders Institute for united progressive forces around the globe. The open call was echoing two twinned appeals published in 2018 by U.S. senator Bernie Sanders and Yanis Varoufakis, who is a Greek economist and self-described libertarian Marxist, to form an international movement to combat the rise of hard right authoritarianism and potential neofascist global influence represented by U.S. president Donald Trump. PI's founding was supported by a group of 40 advisors including Ece Temelkuran, Katrín Jakobsdóttir, Yanis Varoufakis, Carola Rackete, Nick Estes, Vanessa Nakate, Noam Chomsky, Arundhati Roy, Naomi Klein, Niki Ashton, Rafael Correa, Fernando Haddad, Celso Amorim, and Alvaro Garcia Linera. PI seeks to combat authoritarian nationalism around the world and is opposed to what it describes as disaster capitalism.

Europe

Norway

Norwegian social democracy
Einar Gerhardsen, Prime Minister of Norway for 17 years starting with a sweeping Labour victory in the 1945 Norwegian parliamentary election, who greatly strengthened Norway's welfare state
 
Gro Harlem Brundtland, three-time Prime Minister of Norway who was the first female to serve in the position and moderated social democratic governance with degrees of market liberalization

Rather than viewing economic growth and social welfare as competing goals, Norwegian governments have generally attempted to combine a productive economy with a strong social safety net. After Gerhardsen, the next major transformational stage in the development of Norwegian social democracy was associated with Gro Harlem Brundtland, who followed Gerhardsen's generation and became Norway's first woman prime minister. Brundtland served three separate periods as prime minister: briefly in 1981, from 1986 to 1989, and again from 1990 to 1996. Her long political career made her an important symbol of women's increasing participation in Norwegian political life, and she became affectionately known as Landsmoderen, or "Mother of the Nation." Brundtland represented a somewhat different form of social democracy from the industrial-centered model associated with the early Labour governments. During the economic difficulties of the 1980s, Norway faced problems including falling oil prices, economic stagnation, and pressure on government finances. Brundtland responded by accepting some market-oriented reforms rather than attempting to preserve a completely state-directed economy.

Gender equality was also central to Brundtland's political approach. In 1986, she appointed a cabinet in which approximately 40 percent of the ministers were women, a remarkable change for the period. Her governments expanded paid parental leave and developed state-supported childcare, helping make it easier for both men and women to participate in the workforce. These policies reflected a broader idea that gender equality was not simply a question of individual rights. It was also connected to the economy because a society that enables women to work and pursue careers can make fuller use of its population's skills and abilities. Brundtland also helped connect Norwegian social democracy with the growing environmental movement. As chair of the United Nations World Commission on Environment and Development, she led the work that produced the influential 1987 report Our Common Future. The report helped popularize the modern concept of sustainable development, arguing that economic development should meet the needs of the present without preventing future generations from meeting their own needs. This approach connected three goals that had often been treated separately: economic growth, social equality, and protection of the environment. Brundtland helped broaden the meaning of Norwegian social democracy and expand it toward more inclusive capitalism.

The Labour Party continued to change after Brundtland's era. Jens Stoltenberg, who served as prime minister from 2000 to 2001 and again from 2005 to 2013, represented a more modernized form of social democracy sometimes associated with the Third Way. Like other center-left leaders of the period, Stoltenberg placed greater emphasis on economic efficiency, international competition, and the use of market mechanisms. His governments continued the movement toward partial privatization and reform of some state-owned enterprises while maintaining Norway's extensive welfare system. Norway had discovered large quantities of oil in the North Sea beginning in the late 1960s, creating enormous potential wealth. Rather than spending all of the oil revenue immediately, Norway placed much of it into a sovereign wealth fund. The fiscal rule established a framework for determining how much of that wealth could be used in the national budget, helping prevent the economy from becoming overly dependent on oil revenue and preserving wealth for future generations.

The next major phase came under Jonas Gahr Støre, who became prime minister in 2021. Støre inherited a country with a highly developed welfare state and substantial wealth, but also faced new challenges. These included concerns about economic inequality, the future of the welfare system, and the growing urgency of climate change. His government presented itself as seeking a more equitable economic model, with greater emphasis on reducing inequality, protecting workers, and maintaining accessible public services. Støre's approach has placed particular emphasis on finding a balance between economic security and environmental change. Norway remains a major producer of oil and natural gas, so moving toward a lower-emission economy presents a difficult challenge. Støre has sought to reduce emissions while also protecting employment and preventing greater inequality. His government has therefore treated the transition toward a lower-carbon economy as a process that should create new industries and jobs rather than simply eliminate existing economic activity.

Norwegian social democracy continues to be shaped by debate within the broader left. After the 2025 parliamentary election, Labour remained the largest party in a left-leaning bloc but depended on smaller parties such as the Socialist Left, Greens, and Reds, which generally press for stronger climate policies and greater economic redistribution. Major disagreements include oil policy, with Labour supporting continued petroleum production while parties farther left advocate a faster transition away from fossil fuels, as well as taxation and investment, where smaller left-wing parties favor greater redistribution and, in some cases, tighter ethical restrictions on Norway's sovereign wealth fund. While Labour currently occupies a relatively moderate position compared to its historically economic progressive legacy under Gerhardsen, socialist and Green parties continue to push for a more expansive social democracy encapsulated by stronger environmental and redistributive policies.

Norway's commitment to equality continued to expand beyond economic class. Beginning in the second half of the twentieth century, Norwegian governments increasingly adopted legal protections against discrimination based on factors such as ethnicity, religion, disability, and sexual orientation. Gender equality also became firmly established in Norwegian law and public policy. Norway's progressive approach to LGBT rights developed alongside these broader changes. The country became an early leader in legal protections for gay and lesbian people. In 1993, Norway established registered partnerships for same-sex couples. In 2008, the Storting approved a common marriage law for same-sex and opposite-sex couples, which took effect on January 1, 2009. The law gave same-sex couples the same legal right to marry and also expanded their rights concerning adoption and assisted reproduction. Later legislation further strengthened protections against discrimination based on sexual orientation, gender identity, and gender expression.

United Kingdom

Greens taking part in the 2011 London anti-cuts protest in the United Kingdom

20th century progressivism in the United Kingdom highlights enduring tension and factionalism between more avowedly left-wing progressives and those who incorporate more syncretic politics into their progressivism. Groups like the Institute for Public Policy Research, the Fabian Society, and Progressive Britain are organizations represent a wide variety of U.K. progressive thought. Progressivism in the United Kingdom has seen shifts from New Labour's early dominance to the rise of cultural liberalism, environmentalism from the Green Party, and grassroots democracy movements with a variety of focuses, including pro-Palestine anti-war causes, radical democracy, and universal basic income. Tony Blair's government represented a significant period of progressive growth, although his politics were more centrist than previous progressive movements that leaned further left, and his government faced criticisms for its Third Way market-oriented policies and emphasis on deregulation. The Blairite consensus was dominant within U.K. progressivism from the mid-1990s and through the end of Blair's premiership, which ended in 2007. New Labour continued to evolve with the subsequent Labour leadership of Gordon Brown and was formally abandoned by his successor, Ed Miliband, for One Nation Labour in 2010.

Jeremy Corbyn (right), U.K. Labour leader from 2015 to 2020, and Keir Starmer (left), U.K. Prime Minister from July 5, 2024 to July 22, 2026

Jeremy Corbyn represented a staunch return of the Labour party platform to its more historic democratic socialism with a focus on nationalization, robust public spending, and both anti-austerity and anti-war stances. Corbyn appealed to a progressive left base disillusioned with previous Labour governments, but he was a controversial figure in the party who oscillated between a loyal base of support and electability concerns. Subsequent leader and eventual prime minister Keir Starmer shifted Labour toward pragmatic, economically cautious centrism, striving for electability by striking a balance between broad public appeal, traditional Labour beliefs, and Starmer's own conviction that economic changes made previous more left-wing economic positions untenable.

The animosity between Corbyn and Starmer intensified with Starmer's suspension of Corbyn from Labour in 2020, accusing Corbyn of an inadequate response to antisemitism. Corbyn was supported against these accusations by Progressive International. Starmer said in 2023 that "the very best of progressive politics is found in our determination to push Britain forward," but "there are precious things – in our way of life, in our environment, in our communities – that it is our responsibility to protect and preserve and to pass on to future generations. If that sounds Conservative, then let me tell you: I don't care." Corbyn supported the foundation of the socialist Your Party in 2025 with Zarah Sultana in a further schism for U.K. left-leaning progressive politics. Facing challenges from Brexit and increased right-wing presence, contemporary progressivism in the United Kingdom can be characterized by increasing cultural liberalism and factionalism surrounding the role of capitalism in society. Starmer was viewed largely unfavourably by the British public during his tenure as prime minister. His net approval rating began slightly positive, declining over the course of his premiership to an average of −46% by November 2025. By the end of 2025, opinion polls rated Starmer as one of Britain's most unpopular prime ministers, being compared to Liz Truss. Labour's losses in the local elections in May 2026 and discontent over policy led to calls for Starmer to resign as leader, and to the resignation of several members of the government, including Health Secretary Wes Streeting.

Andy Burnham, incumbent Prime Minister of the United Kingdom

Andy Burnham, who at the time was mayor of Greater Manchester and cited as Britain's most popular politician was blocked by Labour's National Executive Committee from running in the 2026 Gorton and Denton by-election. On 18 June 2026, a by-election was held in Makerfield after sitting MP Josh Simons resigned to allow Burnham to stand for a seat in Parliament and potentially challenge Starmer for the Labour leadership. It was the first time since the 1965 Leyton by-election that a by-election was caused to provide a vacancy for a person not currently in Parliament. Burnham won the by-election with almost 25,000 votes and a majority of over 9,200 votes. Four days following the election, Starmer announced his resignation, leading to a leadership election. After being nominated by over 90% of Labour MPs, Burnham was elected unopposed as leader, becoming prime minister on July 20, 2026, as the first Labour and Co-operative Party MP to hold the post. Burnham has been cited as pushing a more progressive and left-populist agenda in his premiership than Starmer especially regarding Burnham's noted preference for market socialist policies.

Latin America

Argentina

Néstor Kirchner, 55th President of Argentina, and Cristina Fernández de Kirchner, 56th President, in September of 2010–one of their last public appearances before Néstor's death

Kirchnerism in Argentina refers to the political strategies of Néstor Kirchner and Cristina Fernández de Kirchner, who were successive Presidents of Argentina. In favor of his wife, Néstor Kirchner chose not to run for reelection in 2007 after taking office on May 25, 2003. After Isabel Perón, Cristina Fernández de Kirchner was the first woman to be elected directly to the presidency of Argentina. Cristina Kirchner has led the Justicialist Party since 2024. Kirchnerist policies are labeled Peronist, progressive, and left-wing. Social services were sponsored by Kirchnerist administrations, which were perceived as blatantly anti-neoliberal. Some political scientists propose the term "Pink Tide neopopulism" to characterize movements that are regarded as a response and a counter to neoliberalism. This is in contrast to the neoliberal populism that was prevalent in the 1990s. Kirchnerism is seen as a response and a counter to neoliberalism. Healthcare and income transfers were greatly increased, most notably by giving 15 million people—roughly 41% of the country's total population—free prescription drugs. Kirchnerists also adopted the traditional Peronist strategy of endorsing wage hikes and participating in labor battles. Argentina's period without widespread strikes during the Kirchnerist governments was only surpassed by the 1946–1955 era of Perón’s government.

Brazil

Luiz Inácio Lula da Silva, 35th and 39th President of Brazil, taking pictures with supporters at São Bernardo do Campo

Lulism in Brazil demonstrates the broad coalitional and reformist nature of contemporary progressivism. Luiz Inácio Lula da Silva's 2022 presidential comeback campaign was a progressive resurgence narrative focused on the working class and anti-corruption, running against incumbent right-wing populist President Jair Bolsonaro. Lula was 17% ahead of Bolsonaro in a poll in January 2022 in what was seen as an early sign of shifting progressive sentiment in the voting population against far-right politics of the Bolsonaro government. In the first round of the presidential election, Lula was in first place with 48% of the electorate, qualifying for the second round with Bolsonaro, who received 43% of the votes. Lula was elected in the second round on 30 October with 50.89% of the vote, the smallest margin in the history of Brazil's presidential elections. Lulism features an overlaps in political parties, including the Workers' Party founded by Lula. While seeing a democratic socialist society as the ultimate goal, Lula has called for a reformist "social liberal" approach to begin resolving poverty gap while acknowledging the reality of existing market structures.

Mexico

Andrés Manuel López Obrador (right), 65th President of Mexico, and Claudia Sheinbaum (left), then Head of Government of Mexico City and eventual 66th Mexican president, in June 2019

Described as a social democratic progressive and left-wing populist, Andrés Manuel López Obrador, or AMLO, was a national politician for over three decades, and ultimately elected President of Mexico following a 2018 landslide victory. López Obrador has been characterized as the "ideological twin" of Bernie Sanders and Jeremy Corbyn, and Corbyn invited López Obrador to the Parliament of the United Kingdom. After winning the 2019 election in Argentina, López Obrador formed a "progressive alliance" with President Alberto Fernández, as reported by El País, marking one of López Obrador's first official trips abroad to Mexico. During his presidency, López Obrador commenced a number of progressive social reforms and encouraged public investment in industries that had been liberalized by earlier administrations. His supporters commended him for reorienting the nation's neoliberal consensus toward bettering the working class's situation and for fostering institutional rejuvenation following decades of extreme inequality and corruption. While credited and praised by supporters for progressive reforms, López Obrador has also received criticism for illiberality and contributing to democratic backsliding.

One of López Obrador's first measures was to raise the minimum wage from MXN $88.36 to MXN $102.68, representing a 16.2% increase—the biggest since 1996. This revision had an immediate impact on average worker salaries, which increased by 5.7%. López Obrador executed his promised "Republican Austerity" upon taking office as well, which aimed to cut spending on political privileges and non-essential government products and services. He canceled presidential pensions and imposed a pay cap for government personnel, ensuring that no one could earn more than the president. López Obrador reduced his own compensation by 60% and chose not to live in Los Pinos, the expensive presidential complex with upkeep costs totaling around MXN $30 billion over the last two administrations. López Obrador auctioned away several government planes and helicopters including the presidential plane "José María Morelos y Pavón", for roughly MXN $1.658 billion. The auction revenues supported hospitals in Tlapa, Guerrero, and Tuxtepec, Oaxaca.

The AMLO presidency also aimed to streamline the bureaucratic structure of the Mexican government, which López Obrador characterized as benefiting elites and mismanaging public finances. The AMLO budgets often included spending cuts to various government agencies, including prosecutors and the public health system, leading to layoffs, salary reductions, and poorer services. To centralize operations and address the reduced workforce, López Obrador often utilized the military for infrastructure projects. López Obrador called for the removal of independent government bodies in February 2024, saying that they duplicated the work of some cabinet ministries, suggesting that their duties be taken over by the Mexican cabinet to save funds and promote government efficiency. The proposal faced widespread condemnation, including from opposition members who criticized it as retribution against autonomous agencies. In the same month, López Obrador successfully proposed a constitutional amendment requiring the minimum wage to consistently rise above the rate of inflation.

Claudia Sheinbaum, a member of the left-wing political party Morena, was widely perceived by her party as the frontrunner to succeed López Obrador, and she eventually received the candidacy of the ruling coalition, Sigamos Haciendo Historia. Xóchitl Gálvez emerged as the opposition frontrunner in Fuerza y Corazón por México. On October 1, 2024, Sheinbaum was sworn in as president, becoming the first woman and person of Jewish origin to assume the office.[a] Ifigenia Martínez, president of the Congress of the Union and a noted figure for the Mexican left, awarded her the presidential sash. The Federal Telecommunications Institute (IFT), the Federal Economic Competition Commission (COFECE), the National Institute of Transparency for Access to Information and Personal Data Protection (INAI), the Energy Regulatory Commission (CRE), the National Hydrocarbons Commission (CNH), the National Council for the Evaluation of Social Development Policy (CONEVAL), the National Institute for the Evaluation of Education (MejorEdu), and the Federal Economic Competition Commission were among the seven autonomous agencies that Sheinbaum consolidated into executive authority. Critics claimed that the measure compromised openness, regulatory independence, and limits on executive power. On 5 February 2025, Sheinbaum offered a constitutional reform to Congress prohibiting immediate reelection and barring family members of sitting officeholders from campaigning for the same public offices. The Senate delayed implementation of the reform until 2030. The bill was published on 1 April.

North America

Canada

Justin Trudeau, 23rd Prime Minister of Canada, at a 2022 protest in Ottawa

While not a member of the Progressive Alliance like the further-left New Democratic Party, Canada's Liberal Party experienced progressive inclination in the 21st century from the premiership of Justin Trudeau, who was a self-described progressive liberal. The Trudeau government's economic vision was initially based on greater tax collections to compensate for increased government spending. While the government has not balanced the budget, it has cut Canada's debt-to-GDP ratio annually until 2020, when the COVID-19 pandemic struck. Trudeau self-described his cultural policy as staunchly feminist and progressive, and his government advocated for the advancement of abortion rights, introduced the bill that made Canadian conversion therapies illegal, established the right to medically-assisted death, and legalized cannabis for recreational use. Trudeau made the announcement in 2021 that a national strategy for child care would be developed with the objective of lowering the cost of day care at a rate of ten dollars per day for each child during a period of five years. The Trudeau administration supported green politics through new pledges to reduce greenhouse gas emissions by 30% by 2030 and to achieve net-zero emissions by 2050 via a federal carbon pricing policy. Additionally, legislation for marine protection was passed by Trudeau's parliament as well as banning six common single-use plastic products[189] and improving evaluations of environmental impact. Despite a generally green stance, Trudeau supported oil and gas pipelines to bring Canadian fossil fuel resources to foreign markets, which was met with opposition from environmental activists.

In March 2022, the NDP agreed on a confidence and supply arrangement with the Liberal Party, including policies such as establishing a national dental care program for low-income Canadians, progress toward a national pharmacare program, labor reforms for federally regulated workers, and additional taxes on financial institutions. The NDP and the Liberal Party terminated their confidence and supply agreement in September 2024. The agreement had been in place since March 2022, however it was terminated nine months ahead of schedule. On January 6, 2025, during a political crisis, Trudeau announced he would resign as Liberal leader and prime minister by 24 March 2025 upon the election of a new party leader, attributing his decision to intraparty dissent. The Liberal Party moved further from its more progressive stances toward the center under new leadership from Mark Carney, who became the first prime minister in Canadian history never to have held elected office. Carney would lead the Liberals to a minority government in late 2025 after advising the Governor General to dissolve Parliament and trigger a federal election.

United States

President Obama (center) nominating Richard Cordray (right) as the first director of the CFPB. Elizabeth Warren (left) conceived of the CFPB and was both its inaugural interim director and special advisor
Senator Sanders and Representative Alexandria Ocasio-Cortez, democratic progressive socialists in the U.S.

In the United States, both the Progressive Era and the modern movement are rooted in the notion that free markets lead to economic inequalities that can be fixed through government action and protect the working class. In the 21st century, progressives continue to favor public policy that they theorize will reduce or lessen the harmful effects of economic inequality and additionally are focused on ending systemic discrimination such as institutional racism; to advocate for social safety nets and workers' rights; and to oppose corporate influence on the democratic process. The unifying theme is to call attention to the negative impacts of current institutions or ways of doing things and to advocate for social progress, i.e., for positive change as defined by any of several standards such as the expansion of democracy, increased egalitarianism in the form of economic and social equality as well as improved well-being of a population. Proponents of social democracy have identified themselves as promoting the progressive cause. Landmark developments in progressive governance include the Consumer Financial Protection Bureau, which was originally proposed in 2007 by Elizabeth Warren, a self-described progressive capitalist who played a key role in its institutional creation. In reaction to the 2008 financial crisis and the ensuing Great Recession, the Dodd–Frank Wall Street Reform and Consumer Protection Act, which was passed in 2010, established the Consumer Financial Protection Bureau as an independent bureau within the Federal Reserve.

U.S. Congressional Progressive Caucus PAC emblem

The Bernie Sanders 2016 presidential campaign rode a wave of left-wing populist and progressive sentiment coming out of the 2008 financial crisis and the Occupy Wall Street movement. The campaign and Sanders himself praised social democratic programs in Europe and supported workplace democracy via union democracy, worker cooperatives, and workers' management of public enterprises. This continued into his 2020 presidential campaign and the Fighting Oligarchy tour with Alexandria Ocasio Cortez, sharply critiquing neoliberal capitalism. Sanders and broader coalitions like the Congressional Progressive Caucus have called for universal, single-payer healthcare, living wage laws, reductions in military expenditure, increased corporate regulation, ending mass incarceration, and strong measures to reverse climate change. Some socialists and major socialist organizations have described Sanders as a democratic socialist, market socialist, or reformist socialist, while others have called him a reformist social democrat. Throughout the mid-2020s, progressive politics in the United States are continually moving toward left-populist economic policies, as seen in the insurgent campaigns of Zohran Mamdani (who was successfully elected the 111th mayor of New York City in 2025), and Senate candidate for Michigan Abdul El-Sayed. As a candidate and as mayor, Mamdani has called for New York City to raise the local minimum wage to $30 by 2030, implementing higher taxes on corporations and high-income earners to fund free tuition at CUNY and SUNY, universal childcare, city-owned grocery stores, and free public transit, while cutting taxes for outer-borough homeowners and reforming New York's property tax system.[b] In the 2026 United States House of Representatives elections in New York, progressive and socialist candidates received much media attention for a successful primary night, defeating more moderate Democratic incumbents in the 10th and 13th districts and winning the open 7th in what was described as a "clean sweep" for Mayor Mamdani and the Democratic Socialists of America.

Types

Cultural progressivism

The term cultural liberalism is used in a substantially similar context and can be said to be a synonym for cultural progressivism, deriving from the concept of moral progress and viewing liberalism as central to the development of culture. Cultural progressives may be economically centrist, conservative, or progressive. For example, American libertarians, who are a prominent strain of neoclassical liberalism, are often characterized by their fiscal conservatism and cultural progressivism. The Czech Pirate Party is classified as a culturally progressive party, and it calls itself "economically centrist and socially liberal." Economist Emily Chamlee-Wright has written that cultural liberalism is one of the "Four Corners of Liberalism" (the other three being economic, epistemic, and political), describing cultural liberalism as "encourag[ing] us to experiment with different ways of living. It allows us to learn that peaceful coexistence in a pluralistic society is possible. And it helps to ensure that minority communities are considered full-fledged participants in the social order." Chamlee-Wright noted a special interchange between political liberality and cultural progressivism, pointing to Jonathan Rauch's contention that "the legalization of gay marriage would not have happened without free speech, which drove cultural progress. But that cultural progress arguably accelerated change that favored a politically liberal outcome." Civil libertarianism is considered a more radical variant of cultural liberalism or cultural progressivism.

Economic progressivism

Economic progressivism—also New Progressive Economics—is a term used to distinguish it from progressivism in cultural fields. Economic progressives may draw from a variety of economic traditions, including democratic capitalism, democratic socialism, social democracy, and social liberalism. Overall, economic progressives' views are rooted in the concept of social justice and the common good, and aim to improve the human condition through government regulation, social protections and the maintenance of public goods. Some economic progressives may show conservative views on cultural issues. These movements are related to communitarian conservative movements such as Christian democracy and one-nation conservatism.

Techno progressivism

An early mention of techno-progressivism appeared in 1999 as the removal of "all political, cultural, biological, and psychological limits to self-actualization and self-realization". According to techno-progressivism, scientific and technical aspects of progress are linked to ethical and social developments in society. Therefore, according to the majority of techno-progressive viewpoints, advancements in science and technology will not be considered proper progress until and unless they are accompanied by a fair distribution of the costs, risks, and rewards of these new capabilities. Many techno-progressive critics and supporters believe that while improved democracy, increased justice, decreased violence, and a broader culture of rights are all desirable, they are insufficient on their own to address the problems of modern technological societies unless and until they are accompanied by scientific and technological advancements that uphold and apply these ideals.

Race and health

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Race_and_health
 

Race and health refers to how being identified with a specific race influences health. In the United States, race is a complex concept that has changed across chronological eras and depends on both self-identification and social recognition. In the study of race and health, some American scientists organize people in racial categories depending on different factors such as: phenotype, ancestry, social identity, genetic makeup and lived experience. Race and ethnicity often remain undifferentiated in American health research.

Differences in health status, health outcomes, life expectancy, and many other indicators of health in different racial and ethnic groups are well documented. Epidemiological data indicate that American racial groups are unequally affected by diseases, in terms of morbidity and mortality. Some individuals in certain racial groups receive less care, have less access to resources, and live shorter lives in general. Overall, racial health disparities appear to be rooted in social disadvantages associated with race such as implicit stereotyping and average differences in socioeconomic status.

According to the U.S. Centers for Disease Control and Prevention, health disparities are defined as "preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations" and are intrinsically related to the "historical and current unequal distribution of social, political, economic and environmental resources".

The relationship between race and health has been studied from multidisciplinary perspectives, with increasing focus on how racism influences health disparities, and how environmental and physiological factors respond to one another and to genetics. In the United States, research highlights a need for more race-conscious approaches in addressing social determinants, as current social needs interventions show limited adaptation to racial and ethnic disparities.

Racial health disparities in the United States

Health disparities refer to gaps in the quality of health and health care across racial and ethnic groups. The US Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care". Health is measured through variables such as life expectancy and incidence of diseases.

For racial and ethnic minorities in the United States, health disparities take on many forms, including higher rates of chronic disease, premature death, and maternal mortality compared to the rates among whites. For example, African Americans are 2–3 times more likely to die as a result of pregnancy-related complications than white Americans. This pattern is not universal. Some minority groups—most notably, Hispanic immigrants—may have better health outcomes than whites when they arrive in the United States. However this appears to diminish with time spent in the United States. For other indicators, disparities have shrunk, not because of improvements among minorities but because of declines in the health of majority groups.

In the U.S., more than 133 million Americans (45% of the population) have one or more chronic diseases. One study has shown that between the ages of 60 and 70, racial/ethnic minorities are 1.5 to 2.0 times more likely than whites (Hispanic and non Hispanic) to have one of the four major chronic diseases specifically Diabetes, cancer, cardiovascular disease (CVD), and chronic lung disease. However, the greatest differences only occurred among people with single chronic diseases. Racial/ethnic differences were less distinct for some conditions including multiple diseases. Non-Hispanic whites trended toward a high prevalence for dyads of cardiovascular disease (CVD) with cancer or lung disease. Hispanics and African Americans had the greatest prevalence of diabetes, while non-Hispanic blacks had higher odds of having heart disease with cancer or chronic lung disease than non-Hispanic whites. Among non-Hispanic whites the prevalence of multimorbidities that include diabetes was low; however, non-Hispanic whites had a very high prevalence of multimorbidities that exclude diabetes. Non-Hispanic whites had the highest prevalence of cancer only or lung disease only. Black Americans have an increased risk of death from COVID-19 compared to white Americans. In a study in Michigan in 2020 regarding COVID-19, it is shown that Black people are 3.6 times more likely to die due to COVID-19.

Between 1960 and 2005 the percentage of children with a chronic disease in the United States quadrupled with minority having higher likelihood for these disease. The most common major chronic biases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention deficit hyperactivity disorder (ADHD), mental illness, cancers and others. This results in Black and Latin adult patients facing a disproportionate amount of health concerns, such as asthma, with treatment and management guidelines not developed with studies based on their populations and healthcare needs.

Although individuals from different environmental, continental, socioeconomic, and racial groups etc. have different levels of health, yet not all of these differences are always categorized or defined as health disparities. Some researchers separate definitions of health inequality from health disparity by preventability. Health inequalities are often categorized as being unavoidable i.e. due to age, while preventable unfair health outcomes are categorized as health inequities. These are seen as preventable because they are usually associated with income, education, race, ethnicity, gender, and more.

Mental health

Studies conducted in the United States have indicated that minorities have similar or smaller rates of prevalence for mental health disorders as their majority counterparts. Blacks (24.6%) and Hispanics (19.6%) have lower depression rates than their White counterparts (34.7%) in the United States. While racial/ethnic minority groups may have similar prevalence rates, the consequences because of mental illness are more prolonged – which may be partly explained due to the smaller access rates for mental health treatments.  In 2018, while 56.7% of the general US population who had a mental illness didn't seek treatment, 69.4% and 67.1% Black and Hispanics didn't access care. Further, in the instances of some mental illnesses, such as schizophrenia, Blacks in the United States have been reported to have higher rates compared to their White counterparts, however, research suggests that this could be due to an overdiagnosis among clinicians and underdiagnosis for other illnesses, such as mood disorders, for which Blacks had lower reported prevalence rates for major depression. These instances of misdiagnosis may be due to "lack of cultural understanding by health care providers,...language differences between patient and provider, stigma of mental illness among minority groups, and cultural presentation of symptoms. Minority groups commonly report experiences with racism and discrimination, and they consider these experiences to be stressful. In a national probability sample of minority groups and whites. African Americans and Hispanic American reported experiencing higher overall levels of global stress than did whites.

Effects of systemic racism

In the United States, the mental health of African Americans has been shown to be negatively impacted by systemic racism, contributing to increased risk of mortality from substance use disorders. This negative mental health can lead to reaching for substances to cope with the mental effects of systemic racism.

Defining race

Definitions of race are ambiguous due to the various paradigms used to discuss race. These definitions are a direct result of biological and social views. Definitions have changed throughout history to yield a modern understanding of race that is complex and fluid. Moreover, there is no one definition that stands, as there are many competing and interlocking ways to look at race. Due to its ambiguity, terms such as race, genetic population, ethnicity, geographic population, and ancestry are used interchangeably in everyday discourse involving race. Some researchers critique this interchangeability noting that the conceptual differences between race and ethnicity are not widely agreed upon.

Even though there is a broad scientific agreement that essentialist and typological conceptions of race are untenable, scientists around the world continue to conceptualize race in widely differing ways. Historically, biological definitions of race have encompassed both essentialist and anti-essentialist views. Essentialists have sought to show that racial groups are genetically distinct populations, describing "races as groups of people who share certain innate, inherited biological traits". In contrast, anti-essentialists have used biological evidence to demonstrate that "race groupings do not reflect patterns of human biological variation, countering essentialist claims to the contrary".

Over the past 20 years, a consensus has emerged that, while race is partially based on physical similarities within groups, it does not have an inherent physical or biological meaning. In response, researchers and social scientists have begun examining notions of race as constructed. Racial groups are "constructed" from differing historical, political, and economic contexts, rather than corresponding to inherited, biological variations. Proponents of the constructionist view claim that biological definitions have been used to justify racism in the past and still have the potential to be used to encourage racist thinking in the future. Since race is changing and often so loosely characterized on arbitrary phenotypes, and because it has no genetic basis, the only working definition we can assign it is a social construct. Race can be an important epidemiologic category, however to suggest that the concept of race has any scientific merit or has a scientific foundation can lead to many issues in scientific research, and it may also lead to inherent racial bias.

Social interpretations of race explains that social views also better explain the ambiguity of racial definitions. An individual may self-identify as one race based on one set of determinants (for example, phenotype, culture, ancestry) while a society may ascribe the person otherwise based on external forces and discrete racial standards. Dominant racial conceptions influence how individuals label both themselves and others within a society. Modern human populations are becoming more difficult to define within traditional racial boundaries due to racial admixture. Most scientific studies, applications, and government documents ask Americans to self-identify race from a limited assortment of common racial categories.

In the United States, race is a cause discrimination, prejudice, marginalization, and even subjugation. Despite the social costs, American researchers argue racial categorization remains beneficial to diagnosis and research. The conflict between self-identification and societal ascription further complicates biomedical research and public health policies. However complex its sociological roots, race has biological ramifications; the intersection of race, science, and society permeates everyday American life and influences human health via genetics, access to medical care, diagnosis, and treatment.

Race and disease

Diseases affect racial groups when they are co-related with class disparities. As socioeconomic factors influence the access to care, the barriers to access healthcare systems can perpetuate different biological effects of diseases among racial groups that are not pre-determined by biology.

Some researchers advocate for the use of self-reported race as a way to trace socioeconomic disparities and its effects in health in the United States. In the United Kingdom, a study was conducted on the Health Checks program by the United Kingdom's National Health Service, which aims to increase diagnosis across demographics. The study was done to address "the reported lower uptake of screening in specific black and minority ethnic communities who are recognised as being more at risk of cardiovascular disease." The lack of attention to certain demographics can be seen as a cause of increased instances of disease from this lack of proper, equal preventive care. One must consider these external factors when evaluating statistics on the prevalence of disease in populations, even though genetic components can play a role in predispositions to contracting some illnesses.

Individuals who share a similar genetic makeup can also share certain propensity or resistance to specific diseases. However, there are confronted positions in relation to the utility of using 'races' to talk about populations sharing a similar genetic makeup. Some geneticists argued that human variation is geographically structured and that genetic differences correlate with general conceptualizations of racial groups. Others claimed that this correlation is too unstable and that the genetic differences are minimal and they are "distributed over the world in a discordant manner". Therefore, self-reported population ancestry is regarded by some as a useful tool for the assessment of genetic epidemiological risk, while others consider it can lead to an increased underdiagnosis in 'low risk' populations.

Single-gene disorders

There are many autosomal recessive single gene genetic disorders that differ in frequency between different populations due to the region and ancestry as well as the founder effect. Some examples of these disorders include:

Multifactorial polygenic diseases

Many diseases differ in frequency between different populations. However, complex diseases are affected by multiple factors, including genetic and environmental. There is controversy over the extent to which some of these conditions are influenced by genes, and ongoing research aims to identify which genetic loci, if any, are linked to these diseases. "Risk is the probability that an event will occur. In epidemiology, it is most often used to express the probability that a particular outcome will occur following a particular exposure." Different populations are considered "high-risk" or "low-risk" groups for various diseases due to the probability of that particular population being more exposed to certain risk factors. Beyond genetic factors, history and culture, as well as current environmental and social conditions, influence a certain population's risk for specific diseases.

Disease progression

Racial groups may differ in how a disease progresses. Different access to healthcare services, different living and working conditions influence how a disease progresses within racial groups in the United States. However, the reasons for these differences are multiple, and should not be understood a consequence of genetic differences between races, but rather as effects of social and environmental factors affecting.

Prevention

Genetics has been proven to be a strong predictor for common diseases such as cancer, cardiovascular disease (CVD), diabetes, autoimmune disorders, and psychiatric illnesses. Some geneticists have determined that "human genetic variation is geographically structured" and that different geographic regions correlate with different races. Meanwhile, others have claimed that the human genome is characterized by clinal changes across the globe, in relation with the "Out of Africa" theory and how migration to new environments cause changes in populations' genetics over time.

Some diseases are more prevalent in some populations identified as races due to their common ancestry. Thus, people of African and Mediterranean descent are found to be more susceptible to sickle-cell disease while cystic fibrosis and hemochromatosis are more common among European populations. Some physicians claim that race can be used as a proxy for the risk that the patient may be exposed to in relation to these diseases. However, racial self-identification only provides fragmentary information about the person's ancestry. Thus, racial profiling in medical services would also lead to the risk of underdiagnosis.

While genetics plays a role in determining how susceptible a person is to specific diseases, environmental, structural, cultural, and communication messaging factors play a large role as well.

Race-based treatment

Minority ethnic groups often face structural and cultural barriers to access healthcare services. The development of culturally and structurally competent services and research that meet the specific health care needs of minority groups is still in its infancy.

Scientific studies have shown the lack of efficacy of adapting pharmaceutical treatment to racial categories. "Race-based medicine" is the term for medicines that are targeted at specific racial clusters which are shown to have a propensity for a certain disorder. The first example of this in the U.S. was when BiDil, a medication for congestive heart failure, was licensed specifically for use in American patients that self-identify as black. Previous studies had shown that African American patients with congestive heart failure generally respond less effectively to traditional treatments than white patients with similar conditions.

After two trials, BiDil was licensed exclusively for use in African American patients. Critics have argued that this particular licensing was unwarranted, since the trials did not in fact show that the drug was more effective in African Americans than in other groups, but merely that it was more effective in African Americans than other similar drugs. It was also only tested in African American males, but not in any other racial groups or among women. This peculiar trial and licensing procedure has prompted suggestions that the licensing was in fact used as a race-based advertising scheme.

Critics are concerned that the trend of research on race-specific pharmaceutical treatments will result in inequitable access to pharmaceutical innovation and smaller minority groups may be ignored. This has led to a call for regulatory approaches to be put in place to ensure scientific validity of racial disparity in pharmacological treatment.

An alternative to "race-based medicine" is personalized or precision medicine. Precision medicine is a medical model that proposes the customization of healthcare, with medical decisions, treatments, practices, or products being tailored to the individual patient. It involves identifying genetic, genomic (e.g. whole genome sequencing), and clinical information—as opposed to using race as a proxy for these data—to better predict a patient's predisposition to certain diseases.

Environmental factors

A positive correlation between minorities and a socioeconomic status of being low-income in industrialized and rural regions of the U.S. depict how low-income communities tend to include more individuals that have a lower educational background, most importantly in health. Income status, diet, and education all construct a higher burden for low-income minorities, to be conscious about their health. Research conducted by medical departments at universities in San Diego, Miami, Pennsylvania, and North Carolina suggested that minorities in regions where lower socioeconomic status is common, there was a direct relationship with unhealthy diets and greater distance of supermarkets. Therefore, in areas where supermarkets are less accessible (food deserts) to impoverished areas, the more likely these groups are to purchase inexpensive fast food or just follow an unhealthy diet. As a result, because food deserts are more prevalent in low income communities, minorities that reside in these areas are more prone to obesity, which can lead to diseases such as chronic kidney disease, hypertension, or diabetes.

Furthermore, this can also occur when minorities living in rural areas undergoing urbanization are introduced to fast food. A study completed in Thailand focused on urbanized metropolitan areas: students who participated were diagnosed as "non-obese" in their early life according to their BMI, however were increasingly at risk of developing type 2 diabetes, or obesity as adults, as opposed to young adults who lived in more rural areas during their early life. Therefore, early exposure to urbanized regions can encourage unhealthy eating due to widespread presence of inexpensive fast food. Different racial populations that originate from more rural areas and then immigrate to the urbanized metropolitan areas can develop a fixation for a more westernized diet; this change in lifestyle typically occurs due to loss of traditional values when adapting to a new environment. For example, a 2009 study named CYKIDS was based on children from Cyprus, a country east of the Mediterranean Sea, who were evaluated by the KIDMED index to test their adherence to a Mediterranean diet after changing from a rural residence to an urban residence. It was found that children in urban areas swapped their traditional dietary patterns for a diet favoring fast food.

Genetic factors

The fact that every human has a unique genome is the key to techniques such as genetic fingerprinting. Versions of genetic markers, known as alleles, occur at different frequencies in different human populations; populations that are more geographically and ancestrally remote tend to differ more.

A phenotype is the "outward, physical manifestation" of an organism." For humans, phenotypic differences are most readily seen via skin color, eye color, hair color, or height; however, any observable structure, function, or behavior can be considered part of a phenotype. A genotype is the "internally coded, inheritable information" carried by all living organisms. The human genome is encoded in DNA.

For any trait of interest, observed differences among individuals "may be due to differences in the genes" coding for a trait and "the result of variation in environmental condition". This variability is due to gene-environment interactions that influence genetic expression patterns and trait heritability.

For humans, there is "more genetic variation among individual people than between larger racial groups". In general, an average of 80% of genetic variation exists within local populations, around 10% is between local populations within the same continent, and approximately 8% of variation occurs between large groups living on different continents. Studies have found evidence of genetic differences between populations, but the distribution of genetic variants within and among human populations is impossible to describe succinctly because of the difficulty of defining a "population", the clinal nature of variation, and heterogeneity across the genome. Thus, the racialization of science and medicine can lead to controversy when the term population and race are used interchangeably.

Evolutionary factors

Currently malaria-endemic countries in the eastern hemisphere
Currently malaria-endemic countries in the western hemisphere

Genes may be under strong selection in response to local diseases. For example, people who are duffy negative tend to have higher resistance to malaria. Most Africans are duffy negative and most non-Africans are duffy positive due to endemic transmission of malaria in Africa. A number of genetic diseases more prevalent in malaria-affected areas may provide some genetic resistance to malaria including sickle cell disease, thalassaemias, glucose-6-phosphate dehydrogenase, and possibly others.

Many theories about the origin of the cystic fibrosis have suggested that it provides a heterozygote advantage by giving resistance to diseases earlier common in Europe.

In earlier research, a common theory was the "common disease-common variant" model. It argues that for common illnesses, the genetic contribution comes from the additive or multiplicative effects of gene variants that each one is common in the population. Each such gene variant is argued to cause only a small risk of disease and no single variant is sufficient or necessary to cause the disease. An individual must have many of these common gene variants in order for the risk of disease to be substantial.

More recent research indicates that the "common disease-rare variant" may be a better explanation for many common diseases. In this model, rare but higher-risk gene variants cause common diseases. This model may be relevant for diseases that reduces fertility. In contrast, for common genes associated with common disease to persist they must either have little effect during the reproductive period of life (like Alzheimer's disease) or provide some advantage in the original environment (like genes causing autoimmune diseases also providing resistance against infections). In either case varying frequencies of genes variants in different populations may be an explanation for health disparities. Genetic variants associated with Alzheimer's disease, deep venous thrombosis, Crohn's disease, and type 2 diabetes appear to adhere to "common disease-common variant" model.

Gene flow

Gene flow and admixture can also have an effect on relationships between race and race-linked disorders. Multiple sclerosis, for example, is typically associated with people of European descent, but due to admixture African Americans have elevated levels of the disorder relative to Africans.

Some diseases and physiological variables vary depending upon their admixture ratios. Examples include measures of insulin functioning and obesity.

Gene interactions

The same gene variant, or group of gene variants, may produce different effects in different populations depending on differences in the gene variants, or groups of gene variants, they interact with. One example is the rate of progression to AIDS and death in HIV–infected patients. In whites and Hispanics, HHC haplotypes were associated with disease retardation, particularly a delayed progression to death, while for African Americans, possession of HHC haplotypes was associated with disease acceleration. In contrast, while the disease-retarding effects of the CCR2-641 allele were found in African Americans, they were not found in whites.

Theoretical approaches in addressing health and race disparities

Interdisciplinary methods have been used to address how race affects health. Factors that influence health include income and social status, education, physical environment, social support networks, genetics, health services, targeted instruction, and gender. These determinants are often cited in public health, anthropology, and other social science disciplines. The WHO categorizes these determinants into three broader topics: the social and economic environment, the physical environment, and the person's individual characteristics and behaviors. Due to the diversity of factors that often attribute to health disparities outcomes, interdisciplinary approaches are often implemented.

The salt sensitivity hypothesis is an example of implementing biocultural evolutionary approaches in order to understand cardiovascular health disparities among African American populations. This theory, founded by Wilson and Grim, stems from the disproportional rates of salt sensitive high blood pressure seen between U.S. African American and White populations and between U.S. African American and West Africans as well. The researchers hypothesized that the patterns were in response to two events. One the trans-Atlantic slave trade, which resulted in massive death totals of Africans who were forced over, those who survived and made to the United States were more likely able to withstand the harsh conditions because they retained salt and water better. The selection continued once they were in the United States. African Americans who were able to withstand hard working conditions had better survival rates due to high water and salt retention. Second, today, because of different environmental conditions and increased salt intake with diets, water and salt retention are disadvantageous, leaving U.S. African Americans at disproportional risks because of their biological descent and culture.

Controversy

There is a controversy regarding race as a method for classifying humans. Different sources argue it is purely social construct or a biological reality reflecting average genetic group differences. New interest in human biological variation has resulted in a resurgence of the use of race in biomedicine.

The main impetus for this development is the possibility of improving the prevention and treatment of certain diseases by predicting hard-to-ascertain factors, such as genetically conditioned health factors, based on more easily ascertained characteristics such as phenotype and racial self-identification. Since medical judgment often involves decision making under uncertain conditions, many doctors consider it useful to take race into account when treating disease because diseases and treatment responses tend to cluster by geographic ancestry. The discovery that more diseases than previously thought correlate with racial identification have further sparked the interest in using race as a proxy for bio-geographical ancestry and genetic buildup.

Race in medicine is used as an approximation for more specific genetic and environmental risk factors. Race is thus partly a surrogate for environmental factors such as differences in socioeconomic status that are known to affect health. It is also an imperfect surrogate for ancestral geographic regions and differences in gene frequencies between different ancestral populations and thus differences in genes that can affect health. This can give an approximation of probability for disease or for preferred treatment, although the approximation is less than perfect.

Taking the example of sickle-cell disease, in an emergency room, knowing the geographic origin of a patient may help a doctor doing an initial diagnosis if a patient presents with symptoms compatible with this disease. This is unreliable evidence with the disease being present in many different groups as noted above with the trait also present in some Mediterranean European populations. Definitive diagnosis comes from examining the blood of the patient. In the US, screening for sickle cell anemia is done on all newborns regardless of race.

The continued use of racial categories has been criticized. Apart from the general controversy regarding race, some argue that the continued use of racial categories in health care and as risk factors could result in increased stereotyping and discrimination in society and health services. Some of those who are critical of race as a biological concept see race as socially meaningful group that is important to study epidemiologically in order to reduce disparities. For example, some racial groups are less likely than others to receive adequate treatment for osteoporosis, even after risk factors have been assessed. Since the 19th century, blacks have been thought to have thicker bones than whites have and to lose bone mass more slowly with age. In a recent study, African Americans were shown to be substantially less likely to receive prescription osteoporosis medications than whites. Men were also significantly less likely to be treated compared with women. This discrepancy may be due to physicians' knowledge that, on average, African Americans are at lower risk for osteoporosis than whites. It may be possible that these physicians generalize this data to high-risk African-Americans, leading them to fail to appropriately assess and manage these individuals' osteoporosis. On the other hand, some of those who are critical of race as a biological concept see race as socially meaningful group that is important to study epidemiologically in order to reduce disparities. Black Americans also have the highest mortality rate related to cardiovascular diseases, at about 30 percent higher than white Americans, even after the American Heart Association (AHA) has attempted to lower all risks.

David Williams (1994) argued, after an examination of articles in the journal Health Services Research during the 1966–90 period, that how race was determined and defined was seldom described. At a minimum, researchers should describe if race was assessed by self-report, proxy report, extraction from records, or direct observation. Race was also often used questionable, such as an indicator of socioeconomic status. Racial genetic explanations may be overemphasized, ignoring the interaction with and the role of the environment.

From concepts of race to ethnogenetic layering

There is general agreement that a goal of health-related genetics should be to move past the weak surrogate relationships of racial health disparity and get to the root causes of health and disease. This includes research which strives to analyze human genetic variation in smaller groups than races across the world.

One such method is called ethnogenetic layering. It works by focusing on geographically identified microethnic groups. For example, in the Mississippi Delta region ethnogenetic layering might include such microethnic groups as the Cajun (as a subset of European Americans), the Creole and Black groups [with African origins in Senegambia, Central Africa and Bight of Benin] (as a subset of African Americans), and Choctaw, Houmas, Chickasaw, Coushatta, Caddo, Atakapa, Karankawa and Chitimacha peoples (as subsets of Native Americans).

Better still may be individual genetic assessment of relevant genes. As genotyping and sequencing have become more accessible and affordable, avenues for determining individual genetic makeup have opened dramatically. Even when such methods become commonly available, race will continue to be important when looking at groups instead of individuals such as in epidemiologic research.

Some doctors and scientists such as geneticist Neil Risch argue that using self-identified race as a proxy for ancestry is necessary to be able to get a sufficiently broad sample of different ancestral populations, and in turn to be able to provide health care that is tailored to the needs of minority groups.

Association studies

One area in which population categories can be important considerations in genetics research is in controlling for confounding between population genetic substructure, environmental exposures, and health outcomes. Association studies can produce spurious results if cases and controls have differing allele frequencies for genes that are not related to the disease being studied, although the magnitude of its problem in genetic association studies is subject to debate. Various techniques detect and account for population substructure, but these methods can be difficult to apply in practice.

Population genetic substructure also can aid genetic association studies. For example, populations that represent recent mixtures of separated ancestral groups can exhibit longer-range linkage disequilibrium between susceptibility alleles and genetic markers than is the case for other populations. Genetic studies can use this disequilibrium to search for disease alleles with fewer markers than would be needed otherwise. Association studies also can take advantage of the contrasting experiences of racial or ethnic groups, including migrant groups, to search for interactions between particular alleles and environmental factors that might influence health.

Race and medical practice

History

Historically, race has been utilized in medicine in various ways, which continue to have enduring impacts today. The imposition of race on pulmonary function and the machinery used to conduct testing is a noteworthy example. Samuel Cartwright was a 19th-century physician and scientist who is known for his work on spirometry and respiratory physiology. Spirometry is a medical test that measures how much air a person can breathe in and out of their lungs, and how quickly they can do so. Cartwright used spirometry to compare Black enslaved people's lung function to white people's. Cartwright, drawing on Thomas Jefferson's beliefs on pulmonary dysfunction, saw a 20% quantitative difference between Black and White people as proof of deficiency that necessitated the enslavement of Black individuals.

These findings of lower lung capacity by race are present in modern medicine through the correction of race in modern spirometry machines and within most textbooks for medical school. When inputting race into the machine, patients either provide their self-identified race or it is determined by the provider. Spirometers in the US utilize population-specific standards or correction factors of 10% to 15% for Black persons and 4% to 6% for Asian people. Thus, equations derived from Black populations will yield a higher percentage of predicted lung function values than those derived from White populations, which may underestimate lung disease severity and delay detection. However, applying an equation developed from White populations to other racial groups may lead to overdiagnosis and limited eligibility for treatment due to the increased perception of risk. Research regarding the efficacy of race-based spirometry found that the race correction was only accurate for Black patients when their African ancestry was above the median between 81 and 100%. As a result, opponents of race correction say it may cause misdiagnosis and perpetuate racial prejudices by encouraging biological race. These race-based clinical decision support tools, such as pulmonary function testing with spirometry, were ended by a report published by the US House of Representatives Ways and Means Committee in October 2021.

In November 2021, the American Academy of Clinical Neuropsychology issued a statement supporting the elimination of race as a variable in demographically based normative test interpretation, proposing instead an approach analogous to precision medicine in which the social, economic, educational, and healthcare-access factors that race functions as a proxy for would be measured and incorporated directly into prediction models. Alternative approaches have been proposed, for example, in the neuropsychological testing world, including the individual comparison standard (ICS) and incorporating social determinants of health (SDoH) instead of race in regression models. The individual comparison standard (ICS) estimates each patient's premorbid neuropsychological skill level from their own data, for example from a single-word reading or vocabulary measure relatively resistant to brain injury, and compares post-onset performance against that individualized baseline rather than against group norms. The social determinants of health model proposes replacing race in regression-based normative equations with direct measures of factors such as quality of education and socioeconomic status.

Sources of racial disparities in care

In a report by the Institute of Medicine called Unequal Treatment, three major source categories are put forth as potential explanations for disparities in health care: patient-level variables, healthcare system-level factors, and care process-level variables.

Patient-level variables

There are many individual factors that could explain the established differences in health care between different racial and ethnic groups. First, attitudes and behaviors of minority patients are different. They are more likely to refuse recommended services, adhere poorly to treatment regimens, and delay seeking care, yet despite this, these behaviors and attitudes are unlikely to explain the differences in health care. In addition to behaviors and attitudes, biological based racial differences have been documented, but these also seem unlikely to explain the majority of observed disparities in care.

Health system-level factors

Health system-level factors include any aspects of health systems that can have different effects on patient outcomes. Some of these factors include different access to services, access to insurance or other means to pay for services, access to adequate language and interpretation services, and geographic availability of different services. Many studies assert that these factors explain portions of the existing disparities in health of racial and ethnic minorities in the United States when compared to their white counterparts.

Care process-level variables

Three major mechanisms are suggested by the Institute of Medicine that may contribute to healthcare disparities from the provider's side: bias (or prejudice) against racial and ethnic minorities; greater clinical uncertainty when interacting with minority patients; and beliefs held by the provider about the behavior or health of minorities. While research in this area is ongoing, some exclusions within clinical trials themselves are also present. A recent systematic review of the literature relating to hearing loss in adults demonstrated that many studies fail to include aspects of racial or ethnic diversity, resulting in studies that do not necessarily represent the US population.

A 2023 scoping review of the literature found that in studies conducted in multiracial or multiethnic populations, the inclusion of race or ethnicity variables lacked thoughtful conceptualization and informative analysis regarding race or ethnicity as indicators of exposure to racialized social disadvantage, the systemic and structural barriers, discrimination, and social exclusion faced by individuals and communities based on their race or ethnicity, leading to disparities in access to resources, opportunities, and health outcomes.

'Medical racism'

An example of "medical racism" (in the words of Robert F. Kennedy Jr.) or "racism" (in the words of US President Bill Clinton) is the Tuskegee Syphilis Study in which, between 1932 and 1972, 400 Black Americans, diagnosed with syphilis, were biomedically experimented on while they were left ignorant of their diagnosis and were not treated with the effective treatments for syphilis existing in that era.

Integrated circuit

From Wikipedia, the free encyclopedia https://en.wikipedia.org/wiki/Integrated_circuit   Integrated circu...