Racism and its Role in the Health Crisis
April 7th is observed as World Health Day. The following statement was taken from the World Health Organization website:
On World Health Day, 7 April 2021, we will be inviting you to join a new campaign to build a fairer, healthier world. We’ll be posting more details here shortly, but here’s why we’re doing this:
Our world is an unequal one.World Health Organization
As COVID-19 has highlighted, some people are able to live healthier lives and have better access to health services than others – entirely due to the conditions in which they are born, grow, live, work and age.
Racism as an Epidemic
As a coach and helping professional, I bear witness to the wide and deep reach that this pandemic, not unlike any other pandemic, has on people. It has been a source of financial ruin, a spotlight on disparity, and the taker of lives. Today, I ask that you consider what I feel is the greatest health risk factor for marginalized groups in America today–racism.
I am not going to turn my little blog post into a white paper, though I could. Suffice it to say that several studies(hundreds to be sure), and increasing in complexity and number, have all teased out the many socioeconomic factors that create barriers and less than desirable health outcomes for BIPOC (Black, Indigenous, and People of Color). The verdict of the recent review by PubMed? Racism is at the heart of it all.
You may be wondering how exactly. Consider this. Racism is the foundation of every structure in this country, particularly public work structures like education, the justice system, wealth and resource systems, and the healthcare system. If BIPOC have been and continue to be marginalized, they are not accessing resources at the same rate or depth as whites. It all makes sense. I am not speaking about one offs–I am speaking in general terms. I am aware that there are folks that have transcended some of these systems successfully. But that is where racism steps in.
We have seen that despite education, influence, or affluence racism still persists. BIPOC are still treated as valets at fancy venues, harassed by neighbors in nice neighborhoods, followed by campus police where they are tenured professors, and experience hate crimes at the hands of the police and citizens.
It is the stress that racism causes that is being linked to the dis-eases that plague BIPOC. Hypertension, caused by elevated blood pressure, is one of them, along with mental health issues and dis-eases that result in weakened immune systems borne of the chronic stress such as heart and kidney disorders. Additionally, Blacks in particular, but other ethnicities, also suffer from higher occurrences of Type 2 diabetes and higher rates of infant mortality.
For further example, black children are about twice as likely as white children to develop asthma, health statistics suggest. And racial and ethnic gaps in infant mortality have persisted for as long as researchers have been collecting data. People with diabetes who are members of racial and ethnic minorities are more likely to have complications like kidney failure, or to require amputations. These disparities persist when all other variables have been accounted for. The fact that racism–the missing factor–is now being talked about as a preliminary cause can help illuminate the voices of people who have been rendered invisible.
The Body on Stress and COVID-19
Stress. Stress is known to actually alter the composition and function of a body. Particularly when a body is being bombarded long-term with the chemicals produced as a result of that stress. There is nothing as long-term as your race.
As stress hormones like cortisol circulate in the body, they turn fat into sugar that the body can use to fight or flee. Unused sugars are often then re-stored as fat in the midsection; this makes them accessible for future stress responses but can damage the kidneys, heart, and other organs. Because cortisol is made from cholesterol, many people who are chronically stressed crave fatty foods as a way to replenish their levels, Juster says, which can then lead to other health problems. And the elevated blood pressure and heart rate that prepare a person for conflict can also lead to hypertension and an enlarged heart.
NOTE: Both of these heart conditions—as well as the diabetes that’s linked to chronic stress—can put people at a higher risk of serious illness from COVID-19. And now we can better understand what the real co-morbidity issue was as the number of deaths for Blacks, which were the highest of any ethnic group, and the disproportionate numbers for Latinx stacked up.
In laymen’s terms, the chronic flooding of the circulatory system–whether it is frequent short bursts or longer periods without proper recovery–with stress hormones creates an overtaxed, overexcited immune system, which is less effective at recognizing a real foe and is prone to attacking the body instead.
In the short-term, stress hormones inhibit damaging inflammatory reactions. But over time the body becomes cortisol resistant, instead promoting the production of proteins from the immune system called “pro-inflammatory cytokines.” People with especially high allostatic load (for example, people from chronically underserved communities who experience severe trauma and racism), can be prone to producing too many of these pro-inflammatory cytokines, which can begin attacking other cells or tissues that aren’t a threat—the “cytokine storms” that have come to characterize some of the most severe COVID-19 cases.https://www.pbs.org/wgbh/nova/article/racism-stress-covid-allostatic-load/
Stress hormones affect the ability to think clearly, preserve memory, and exacerbate other mental conditions. The damage can cross the placenta barrier and affect fetuses when carried by a mother under this type of stress. This widespread damage from chronic stress also leads to a broad premature aging of cells, which have had to divide more often in order to repair damaged tissue. Each one of our cells is built to divide a limited number of times, explains Arline Geronimus, a professor of public health at the University of Michigan. And each time it divides, the caps at the ends of its chromosomes (called telomeres) shorten a little. Once a cell reaches the end of its telomeres, it can no longer divide. This process happens in every body as we age—but not at the same rate. People with chronic stress “have, in effect, an older biological age than other people at their same chronological age,” she says.
Developmental psychologist Virginia Huynh brings this dynamic back to the pandemic, pointing out that “Black people were already at a higher risk for health problems because of racism” and that structural and workplace inequalities have intensified during this time. “It makes sense they’re disproportionately affected by COVID-19,” she says.
Racism at the Cellular Level
“Just being in this society, as a Black person or a brown person means the recognition that you are potentially at risk for some sort of negative encounter,” Parker Dominguez says, “whether it’s with the police or elsewhere. Your level of threat perception in the environment is higher.” That threat perception leads to hypervigilance, which leads to heightened allostatic load.
It’s that “pervasive, persistent” experience of stress that is damaging to the health of Black Americans and other marginalized communities, and permeates every facet of life. A BIPOC person, and Blacks more so , are always on edge–waiting to see when they will have to run or fight.
The research of Virginia Huynh indicates that young people don’t need to be on the receiving end of racist behavior to be affected physiologically, nor does the behavior need to be overt or extreme for it to do damage. In one study, Huynh and her colleagues collected saliva from 300 teenagers over the course of a day to measure cortisol levels. Teenagers who reported experiencing discrimination had higher levels of cortisol that did not decline normally over the course of the day—suggesting that they were not only experiencing more stress but that they weren’t recovering from it fully. In a second study, a cohort of college students experienced increased levels of cortisol after simply witnessing or overhearing a racist comment, indicating that even vicarious discrimination can create a physiological response.
Huynh emphasizes that these daily experiences of discrimination are often less overt and more insidious, the offhand comments or small interactions sometimes known as microaggressions. “Years of being followed around in a grocery store or liquor market—subtle everyday slight insults—convey to people of color and marginalized communities that they don’t belong, don’t fit in,” she says. When it comes to allostatic load, “it’s often cumulative, a lifetime of experiences that affect multiple regulatory systems.”
In this way, subjectivity and individual perception can deeply affect health, she says. The stress of microaggressions reverberates painfully, regardless of original intent. “There’s often a number of explanations [for a microaggression], but ultimately the impact is that you felt it was offensive, racist, or discriminatory,” she says. “If you’re vigilant against someone being rude to you, and trying to figure out if it’s because of your race or gender, then your body is constantly feeling like it needs to prepare.”
Health in the Face of Racism
BIPOC alone should not carry and absolutely cannot carry the burden of coping with racism. Everyone needs to address structural disadvantage, socioeconomic deprivation, and institutionalized racism to reduce discrimination.
However, there is evidence to suggest that certain factors can help people cope with the negative effects of racism, both physically and mentally.
Fostering a strong sense of racial identity is one evidenced-based way to stave off the effects of racism. Studies have found a link between those with a positive self-image and decreased stress due to racism. Helping children and adolescents develop a strong and positive self-image can go a long way in mitigating the long-term affects of racism, which can transcend generations. To this end, Hunyh points to research showing that kids who feel a stronger sense of ethnic identity—whose parents have talked to them about what it means to be Black or Mexican or taught them Indigenous traditions—have lower allostatic load. Parker Dominguez points to California’s Black Infant Health Program, a program that provides social support and connection to resources during pregnancy to women across 20 regions of California and has made significant strides in closing gaps in pregnancy outcomes.
Engaging in critical dialogues about racist experiences, instead of bottling them up, have been proven to help a person process feelings of stress, anger, and frustration.
Having a strong support system to talk to for support, advice, and comfort can help people cope with racial discrimination. It can encourage a sense of security and identity and reduce negative thoughts and feelings, and even depression. Research on resilience shows that social support, a sense of meaning, and feelings of control are “extremely beneficial in lowering allostatic load,” Juster says.
In this current climate, where conversations and movement on serious matters are taking place, I felt like speaking on this topic. I see the effects of long-term, or chronic stress, and I can an relate to the heightened sense of stress that I feel navigating American society as a Black woman. I can only empathize with those who have the additional intersection of being BIPOC and LGBTQIA or BIPOC and Fat, and so on. Stress kills and knowing how the stress of racism affects the body it is not a far-cry to say that even when a person is not murdered, that racism kills. This is the single most threatening variable in health care to BIPOC.
I would dare say that BIPOC the world over are experiencing the same kinds of chronic stress-induced conditions.
I stand with the organizations and individuals from all walks of life that are bravely showing up to end systemic racism. I will keep being a listener and an activist. I know that fighting racism will literally save lives.