Sickle Cell Anemia: The Natural and Social Lottery

By: Anita Cheng

Sickle cell anemia is probably one of the most commonly studied genetic diseases in all biology courses. Individuals with this disease have an abnormal type of hemoglobin that causes red blood cells to adopt a crescent shape rather than the normal donut shape. Because of this abnormality, these cells have difficulty traversing through the circulatory system and subsequently damage vasculature (painfully) in the body. Although sickle cell anemia is an autosomal recessive disorder and takes two abnormal genes to manifest into the physical disease, it occurs in about one in five hundred African American births because the sickle cell trait occurs in one in twelve African Americans. Treatment for sickle cell anemia include antibiotics for newborns to prevent infection, education for parents on how to manage the disease, over-the-counter pain relievers, eye checkups, regular physical checkups with a primary care physician, blood transfusion, and possibly gene therapy. While it has already been established that natural lottery determines who gets sickle cell anemia, the social lottery determines who gets quality treatment. It merits our attention that the prevalence of this disease is so high among African Americans.

The writing prompt for last week’s readings asked whether we should respond differently to a disease based on whether it was caused by action of personal choice rather than natural or social lottery. Because our discussion surrounded the impact of (poor) personal choice on health, I wanted to draw attention to the natural and social lotteries of health outcomes. While I rarely pondered on the relationship between management of genetic diseases and poor socioeconomic status, this article challenged me to do so with sickle cell anemia. Despite the fact that there is no absolute cure for sickle cell anemia, technological advances in medicine has made it easier to manage this disease – if you have the right resources. This is where the social lottery comes in. Take Davina Daniels, an African American single mother from Queens who is the subject of the article. Since her exact socioeconomic status is not disclosed, let us picture her living in North St. Louis City with two small children. How will her access to quality treatment be affected? Even if she has Medicaid, which does cover treatment for sickle cell anemia, what if she cannot afford to take off work early for regular checkups with her physician because it takes two hours to travel to the hospital by public transportation? What if she cannot find anyone to take care of her children during her doctor visits? What if she cannot afford over-the-counter pain relievers and she must give up a few days of wages because the pain is too unbearable? What if Daniels dropped out of high school and has limited health literacy skills? How does that affect her ability to understand her condition and how to manage it well?

As public health students, how do we respond to the detrimental effects the natural and social lotteries impose upon sickle cell anemia patients? Even if we cannot change the genetic makeup of the entire African American population to decrease the chance of children born with sickle cell anemia, methods to equalize the opportunity for all to sustain a sense of well-being, with sickle cell anemia or not, exist. To further challenge the reader and connect this topic with the upcoming week’s discussion, how do the three levels of racism further complicate the issue?

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