A new publication by Rebecca Jackson discusses the racial history of a the Apgar Score – a score assigned to infants one minute after birth.
Whenever we encounter healthcare, we encounter measurement – even from the moment we are born. A new paper by Rebecca Jackson published in History and Philosophy of the Life Sciences, The Apgar Score and race: Why healthy babies are supposed to be ‘pink’, discusses the racial history of a score (from 0-10) assigned to infants one minute after birth. This number is based at least partly on an assessment of skin tone (the “Appearance” of the infant).
In this paper, Rebecca explains the following: (1) Why the “Appearance” item of the Apgar Score is not as worrying as it initially appears (although the term “pink” for healthy babies is white-centric, inaccurate, and far overdue for change), (2) why the more concerning aspect of the Score is its misinterpretation as a retroactive diagnosis of asphyxiation (and prognosis for neurological damage) for individual infants, and (3) why racial inequities in medicine pose a problem for two frameworks in philosophy of measurement when applied to patient outcome measures. Ultimately, she argues that the case of the Apgar Score shows us that we need a historically- and socially-informed philosophy of measurement if we want to be able to understand and guide the development and revision of patient outcome measures.
This paper exemplifies the interdisciplinary work of the Measurement Lab, which studies how measurement relates to, challenges, reflects or reinforces existing biases and health inequalities. By examining the social, cultural, political and historical forces that shape the meaning and function of measurement in medicine, health and health sciences, this lab asks questions such as: How can the measures necessary for medical practice capture the lived experiences of individuals? Do population level measures hold at the individual level? It explores how these forces guide how we think about what is ‘normal’ and ‘pathological’, what is ‘divergent’ or ‘typical’, and how measurement can render some people and their health experiences visible or keep them invisible.
If these kinds of topics interest you, and you find that when it comes to health measures, you struggle to see where epistemology ends and ethics begins, please feel free to join the Measurement Heretics reading group (which meets once a month on the 3rd Tuesday at 15:30-17:00). Please see the Measurement Lab Events page for the list of reading group events.
Find out more:
Rebecca’s paper is available to read freely under Wellcome’s open access policy at the following link;
Jackson R. L. (2025). The Apgar score and race: why healthy babies are supposed to be “pink”. History and philosophy of the life sciences, 47(4), 45. https://doi.org/10.1007/s40656-025-00693-3
