The Apgar score and race: why healthy babies are supposed to be “pink”

Outlining the Apgar Score's use throughout the latter half of the twentieth century, I propose that the historical abuse of this score for newborn wellness does not only come from the obviously white-centered assessment criteria for "color" established in the 1950s. The more concerning aspect of the Score is its potential interpretation as measuring one unitary construct which captures both the past asphyxiated condition and future health risks of individual infants (a problem that has been noted for decades in professional guidance documents). My novel contribution is to use the history of the Apgar Score's use and misuse to demonstrate why racial inequities in medicine pose a problem for two frameworks in philosophy of measurement when applied to patient outcome measures. I ultimately argue that the case of the Apgar Score shows how both dominant frameworks in philosophy of measurement, that of coordination (within the representational theory of measurement) and that of psychometric validity, fail to help us fully comprehend the challenge of clinical measuring with indices. Both frameworks expect that, at some point, the process of coordination or validation of an instrument will end. An expanded and historically-informed framework is warranted for understanding how patient outcome measures are validated (and re-validated) over time, which can include the social and institutional forces which render an index relevant, biased, or questionable for different aims.