Raising our Racial Health Consciousness

People who are at the receiving end of racial discrimination are at a greater risk for a variety of diseases, more studies conclude.

Madeline Drexler, a former Boston Globe Magazine medical columnist who holds a visiting appointment at the Harvard School for Public Health, presents a comprehensive and fascinating overview of recent research:

Four years ago, researchers identified a surprising price for being a black woman in America. The study of 334 midlife women, published in the journal Health Psychology, examined links between different kinds of stress and risk factors for heart disease and stroke. Black women who pointed to racism as a source of stress in their lives, the researchers found, developed more plaque in their carotid arteries — an early sign of heart disease — than black women who didn’t. The difference was small but important — making the report the first to link hardening of the arteries to racial discrimination.

The study was just one in a fast-growing field of research documenting how racism literally hurts the body. More than 100 studies — most published since 2000 — now document the effects of racial discrimination on physical health. Some link blood pressure to recollected encounters with bigotry. Others record the cardiovascular reactions of volunteers subjected to racist imagery in a lab. Forthcoming research will even peek into the workings of the brain during exposure to racist provocations.

This relatively new research shines the light on long-standing racial disparities in health:

African-Americans today, despite a half century of economic and social progress since the civil rights movement, face a higher risk than any other racial group of dying from heart disease, diabetes, stroke, and hypertension. In the United States, affluent blacks suffer, on average, more health problems than the poorest whites.

Seeing environmental factors as a cause of these disparities is obviously provocative, but as Drexler reveals, it appears — at least to some degree — undeniable. The consequences are profound:

It could unmask racism as a bona fide public health problem — just as reframing child abuse and marital violence as public health concerns transformed the way we thought about these ubiquitous but often secret sources of suffering. Viewing racial discrimination as a health risk could open the door to understanding how other climates of chronic mistreatment or fear seep into the body — why, for instance, pregnant women in California with Arabic names were suddenly more likely than any other group to deliver low birth-weight babies in the six months after 9/11.

A focus on genetic predispositions to diseases among certain racial or ethnic groups makes them seem like individual problems, regrettable but something that, short of a genetic breakthrough from the medical community, we can do little to change. A broader understanding of the environmental factors, though, makes them a social responsibility.

In that light, public health organizations, many of which already have taken an active role in combatting racial disparities in health, have an added sense of urgency. As an example, Drexler points to the Boston Public Health Commission’s “Disparities Project,” which is approaching this problem from a variety of angles — “partnerships with medical institutions, detailed public reports tracking progress, and community grants to tackle such entrenched problems as street violence and lack of access to fresh produce.”

The research, of course, is not without its critics or its challenges:

One of the biggest problems is that researchers don’t share a concrete, agreed-upon definition of racial discrimination — partly because such prejudice takes myriad forms. They also don’t know if more exposure to racism produces more disease or if, instead, disease sets in only after a threshold has been passed. They don’t know if exposures during certain periods of life are more risky than others. And they don’t know why some victims cope better than others.

In many ways, though, understanding that racism affects health is simply a matter of common sense. Drexler explains:

Jules Harrell, a Howard University professor of psychology, said he was moved this spring by a photo of the Rutgers University women’s college basketball team, sitting together with dignified expressions, after radio talk show host Don Imus had labeled them with a racist epithet.

“The expressions on their faces,” said Harrell. “All I could think was, ‘Good God, I’d hate to see their cortisol levels.'”