The recent shootings in Atlanta highlighted a surge of anti-Asian violence in the United States throughout the pandemic. Disease stigma and racism have together shaped pandemic response and policy for centuries.

And so to better understand this history, on the podcast Social Distance, co-hosts James Hamblin and Maeve Higgins speak with Alexandre White, a sociologist and medical historian at Johns Hopkins University. He shares his views on how a legacy of prejudice tied to disease should lead us to reexamine how we respond when outbreaks occur.

What follows is a transcript of the episode, edited and condensed for clarity:

James Hamblin: How did you get into this line of research?

Alexandre White: I became very interested in the ways in which epidemic moments seem to key off of, or become more severe as a result of, existing social, economic, and political inequalities. I found this most clearly when I was conducting research on HIV/AIDS and tuberculosis infections in South Africa. And I was really struck by the ways in which histories of apartheid and ongoing racial inequities would shape who got sick, who got better, and—ultimately—why. And I became very interested in looking at international epidemic responses and the ways in which economic ideologies, political ideologies, histories, and legacies of colonialism and racism shape international epidemic response.

In the early days of my research, I was exploring an earlier case of racially segregated responses to an epidemic of bubonic plague in Cape Town in 1901. And I was doing this research at the same time we were living through the West African Ebola epidemic. We were seeing highly policed, militarized quarantining of poorer neighborhoods in Monrovia, with violence ensuing. And I was like: There must be something connecting these two phenomena in some way. And as I continued my research, I started to see [that] the way in which we as a globe have responded to the threat of infectious disease spread—the threat of epidemics and pandemics—is to, in so many ways, double down on the rooted and continuing social imbalances as a way of not only ascribing difference to populations but also as a way of providing differential care. And we see the ways in which this has very disparate outcomes in who lives and who dies from epidemic disease.

There’s a wonderful quote by Roderick McGrew from his study on cholera that says: “Epidemics do not create abnormal situations, but rather sharpen existing behavior which ‘betray deeply rooted and continuing social imbalances.’” What I was seeing was an example of what sociologists would call the “social determinants of health.” We could see, especially in the legacies of apartheid, the ways in which racial segregation, unequal access to housing resources, [and] political violence really shape how people live and, unfortunately, also the diseases they get and ultimately how they die. And as we’ve seen in the United States, especially over the last year, racism in a variety of different ways, whether it’s political violence or whether it’s the effects of structural racism leaving you vulnerable to contagion and infectious disease, it quite literally kills.