In­sult, then In­jury

Re­searchers are find­ing links be­tween racial dis­crim­i­na­tion and long-term health

The Walrus - - CONTENTS - By Mo­jola Omole

Re­searchers are find­ing links be­tween racial dis­crim­i­na­tion and long-term health

For decades, it has been one of the most vex­ing ques­tions fac­ing re­searchers: Why do white peo­ple have such a health ad­van­tage over racial­ized groups in North Amer­ica? In 1985, a United States gov­ern­ment task force showed that African Amer­i­cans not only suf­fered more se­ri­ous med­i­cal prob­lems but black men were also dy­ing an av­er­age of six years ear­lier than their white coun­ter­parts. Since the re­port’s re­lease, dozens of stud­ies have re­vealed sim­i­lar dis­par­i­ties in­volv­ing other mi­nori­ties, in­clud­ing Indige­nous peo­ple, Asian peo­ple, and His­panic peo­ple. In the US, breast cancer rates among Korean and South­east Asian women have been in­creas­ing faster than among any other group, and His­panic peo­ple die at higher rates from chronic liver dis­ease. While race-based health in­for­ma­tion isn’t col­lected or made avail­able in Canada in a sys­tem­atic way, we do know, ac­cord­ing to a 2016 sur­vey, that im­mi­grant black women have higher odds of hy­per­ten­sion than im­mi­grant white women.

These dis­par­i­ties have pushed sci­en­tists to look at racism as a rea­son for the dra­matic dif­fer­ences in health out­comes. A 2017 meta-anal­y­sis of six­teen stud­ies that mea­sured the phys­i­o­log­i­cal ef­fects of dis­crim­i­na­tion found “com­pelling” ev­i­dence of a “com­plex” as­so­ci­a­tion be­tween racism and an in­crease in cor­ti­sol out­put, the hor­mone re­leased in re­sponse to stress. Dur­ing a sep­a­rate US study, the results of which were pub­lished in 2012, re­searchers asked Latina col­lege stu­dents to de­liver a three­minute speech to a white woman they were part­nered with. If the Latina stu­dents, who were hooked to sen­sors, were told that their part­ner was racist, they had higher blood pres­sure and a faster heart rate dur­ing the speech. That kind of stress re­sponse has been as­so­ci­ated with obe­sity, a weak­ened im­mune sys­tem, and an in­creased risk of heart at­tacks. Dis­crim­i­na­tion, as one US re­searcher has hy­poth­e­sized, is a “so­cial toxin” that may be sick­en­ing and, ul­ti­mately, killing peo­ple.

Two re­cent stud­ies, how­ever, show that the sci­ence is far from set­tled. They sug­gest that not all racist en­coun­ters take a toll on our bod­ies — in fact, some might even help us live longer. Be­cause these results run counter to es­tab­lished med­i­cal wis­dom, their pub­li­ca­tion has raised a new set of ques­tions, in­clud­ing whether sci­ence even has the proper tech­niques to study, and mea­sure, the phys­i­cal ef­fects of racial dis­crim­i­na­tion. As the me­dia fo­cuses on the so­cial and po­lit­i­cal cost of resur­gent white-su­prem­a­cist and Nazi groups, doc­tors are em­broiled in their own de­bate: Is it pos­si­ble to prove that racism is bad for our health?

We tend to think that sci­ence is a de­ci­sive prac­tice, that once a study has been conducted, the results will give a con­clu­sive an­swer. But stud­ies are ex­per­i­ments; some­times, sci­en­tists don’t get it right: they may not have tested for the right vari­ables, cho­sen the right con­trol groups, or even asked the right ques­tions. The is­sue of health dis­par­i­ties is a good ex­am­ple of how dif­fi­cult it can be to ap­ply sta­tis­ti­cal think­ing to a large-scale so­ci­o­log­i­cal prob­lem. While ge­net­ics could par­tially ac­count for dis­par­i­ties with cer­tain dis­eases — such as breast cancer — it can’t ex­plain why the dif­fer­ences re­main so per­sis­tent across racial and eth­nic groups. It now ap­pears that one ob­sta­cle to unpacking the con­nec­tion be­tween dis­crim­i­na­tion and poor health is that re­searchers ap­proach the lived and so­cial ex­pe­ri­ence of race in dif­fer­ent ways.

Last April, the Amer­i­can Jour­nal of Epi­demi­ol­ogy pub­lished a study that looked at the racism ex­pe­ri­enced by mul­ti­ple eth­nic groups over a ten-year pe­riod. Could such in­ci­dents, the study won­dered, ex­plain why African Amer­i­cans, Chi­nese peo­ple, and His­panic peo­ple run a higher risk of de­vel­op­ing type-two di­a­beties than white peo­ple? Un­sur­pris­ingly, overt dis­crim­i­na­tion, such as be­ing de­nied a pro­mo­tion be­cause of race, was linked to a greater in­ci­dence of the dis­ease. But the study un­cov­ered some­thing else: more sub­tly un­fair treat­ment, such as be­ing given poor ser­vice, seemed to have no im­pact.

The di­a­betes study was run by Kara Whitaker, then a post-doc­toral fel­low at the Univer­sity of Min­nesota. Be­cause her results break with ex­ist­ing con­clu­sions about racism and health, Whitaker be­lieves

Dis­crim­i­na­tion is a “so­cial toxin” that may be sick­en­ing and, ul­ti­mately, killing peo­ple.

her method­ol­ogy, which in­cluded two sel­f­re­ported sur­veys at the start of the study , wasn’t nu­anced enough to cap­ture the ef­fects of un­der­stated racist en­coun­ters: sub­jects may have in­ter­nal­ized or nor­mal­ized such ex­pe­ri­ences, which forced Whitaker’s team to fo­cus on the overt in­ci­dents. “Ma­jor dis­crim­i­na­tion—such as be­ing ha­rassed by po­lice, be­ing fired from a job — sticks out in your head, but peo­ple tend to un­der-re­port sub­tle forms,” she says.

Shannon Dun­lay, a car­di­ol­o­gist at the Mayo Clinic in Min­nesota, found results that seemed to dif­fer even more sig­nif­i­cantly from other stud­ies. For over a decade, she fol­lowed 5,085 African Amer­i­can adults — a group with a sig­nif­i­cantly higher risk of de­vel­op­ing car­dio­vas­cu­lar dis­ease than white peo­ple — to bet­ter un­der­stand whether the racism they per­ceived played a role in any hos­pi­tal­iza­tion for stroke, heart fail­ure, or heart at­tacks. Pub­lished last May, Dun­lay’s study ended up find­ing no such link. More un­ex­pect­edly, par­tic­i­pants who had the great­est ex­po­sure to in­dig­ni­ties seemed to have, on av­er­age, a lower risk of death.

These coun­ter­in­tu­itive find­ings re­mind us that that peo­ple may cope with daily dis­crim­i­na­tion, be it overt or sub­tle , by med­i­tat­ing, play­ing sports, or working out—all ac­tiv­i­ties that have been shown to act against some of the long-term ef­fects of stress. As with Whitaker’s, Dun­lay’s study — which in­volved a ques­tion­naire and reg­u­lar check-ins by phone or in per­son—high­lights the lim­i­ta­tions of hav­ing par­tic­i­pants self-re­port mis­treat­ment and of ask­ing them to fo­cus on iso­lated in­ci­dents. Yet re­searchers know that mem­bers of racial­ized com­mu­ni­ties ex­pe­ri­ence racism on a reg­u­lar ba­sis and also know that they fall prey to more health prob­lems — but can one be proved to cause the other? What would it take to de­ter­mine, un­equiv­o­cally, that the re­la­tion­ship is more than cor­re­la­tion?

Zaneta Thayer, a bi­o­log­i­cal an­thro­pol­o­gist at Dart­mouth Col­lege, stud­ies how health in­equal­ity af­fects Indige­nous peo­ple in New Zealand and the US. She thinks that stud­ies shouldn’t sim­ply ex­am­ine the di­rect ef­fects of dis­crim­i­na­tion on spe­cific dis­eases. “One of the most com­monly stud­ied ways that dis­crim­i­na­tion causes dis­ease is through our be­hav­iours,” says Thayer. “In these stud­ies, to con­trol for ir­reg­u­lar­i­ties, we of­ten elim­i­nate be­hav­iours such as smok­ing. In turn, we elim­i­nate a cru­cial mech­a­nism that can link dis­crim­i­na­tion with dis­ease.”

In other words, one way that racism might cause dis­ease is by push­ing mem­bers of vul­ner­a­ble pop­u­la­tions to cope with the stress of dis­crim­i­na­tion by pick­ing up un­healthy habits — such as smok­ing or drink­ing — that lead to ill­ness. Adapt­ing stud­ies to re­flect this re­al­ity would al­low re­searchers to widen the net, al­low­ing for fac­tors that could track racism’s ef­fects through a chain of events, in­stead of sim­ply phys­i­o­log­i­cal changes.

While more com­pre­hen­sive, this ap­proach still doesn’t take into ac­count in­sti­tu­tional fac­tors, such as ac­cess to med­i­cal care, that may pose more di­rect threats to an in­di­vid­ual’s health. For ex­am­ple, not only are African Amer­i­cans less likely to have health in­sur­ance than white Amer­i­cans but, ac­cord­ing to a 2012 study, racial bi­ases cause some US primary-care doc­tors to avoid in­volv­ing black pa­tients in med­i­cal de­ci­sions. We also know that African Amer­i­can women are three to four times more likely than white women to die from preg­nancy- and de­liv­ery-re­lated causes. Be­cause this dis­par­ity ap­pears to tran­scend ed­u­ca­tion and in­come lev­els, re­searchers have traced it to vari­a­tions in the way care is de­liv­ered to black women ver­sus white women.

Re­search into the links be­tween op­pres­sive struc­tures and health is still in its in­fancy. But Onye Nnorom, the as­so­ciate pro­gram di­rec­tor of the Univer­sity of Toronto’s Dalla Lana School of Pub­lic Health and a fam­ily doc­tor, be­lieves that we shouldn’t wait un­til we have all the an­swers be­fore tak­ing ac­tion. Gov­ern­ment ef­forts to ad­dress sys­temic dis­crim­i­na­tion are likely to have the great­est im­pact, be­cause they will dis­rupt path­ways that lead to poor health. “It’s much eas­ier to wag our fin­gers at bla­tant racism like the Char­lottesville march in­stead of try­ing to fix child wel­fare, ed­u­ca­tion, and crim­i­nal jus­tice,” says Nnorom. “These are fac­tors we can change.”

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