Disparities between the health of whites vs. that of minorities in the United States are wide and pervasive, and have been for decades. Some of the largest and most persistent health gaps are between whites and blacks. Black Americans experience significantly higher rates of cardiovascular disease, HIV, certain cancers, diabetes, asthma, and infant and maternal mortality than white Americans do. On average, white Americans live three years longer than black Americans; in high-poverty communities, life expectancy gaps can be as wide as 40 years.
A major contributor to these health disparities is racism in various forms.
Results from a recent American Psychological Association online poll of 3,361 adults found that more than three-quarters of black adults reported experiencing racially based daily discrimination—such as disrespectful treatment, receiving poorer service, or being threatened or harassed—and nearly two in five black men said police have unfairly stopped, searched, questioned, physically threatened, or abused them.
"A large and growing body of evidence indicates that experiences of racial discrimination ... can lead to adverse changes in health," according to David R. Williams, a professor of public health, sociology, and African-American studies at Harvard University. He cites research that has associated chronic racial discrimination in adulthood with an increased risk of blood pressure problems, coronary artery disease, cognitive impairment, poor sleep, high visceral fat, early mortality, chronic inflammation, and giving birth to lower birth weight babies. Chronic inflammation is when the body is in a prolonged state of "high alert," which can cause lasting damage to the heart, brain, and other organs.
Chronic discrimination can cause chronic stress, which has been shown to disrupt almost all of the body's processes, leading to an increase in the risk of heart disease, anxiety, depression, and digestive, sleep, and cognitive problems. Higher rates of chronic stress are observed in minority populations across all socioeconomic levels.
Now, by studying the effects of discrimination in childhood, researchers are painting an even more specific picture of the toll that racial discrimination can exact on the body and how long those effects can last.
EXPERIENCING RACIAL DISCRIMINATION IN CHILDHOOD IS ESPECIALLY DAMAGING
Northwestern University researchers recently discovered that discrimination during adolescence can produce long-lasting negative health effects by altering the body's natural cortisol rhythms. As the body's primary stress hormone, cortisol levels follow a daily rhythm: peaking in the morning and declining throughout the day. Dysfunctional cortisol levels are linked to fatigue, cardiovascular disease, and early mortality, as well as poor mental health and other cognitive problems. Previous research shows that young adult minorities who perceive more discrimination experience disrupted cortisol cycles, but until now we didn't know how long this disruption could last. Using data collected over a 20-year period, the Northwestern researchers found that, the more discrimination experienced throughout adolescence and early adulthood, the more dysfunctional cortisol rhythms became by age 32.
Surprisingly, the results showed that, while feelings of discrimination can upset the cortisol levels of both blacks and whites, the negative effects of discrimination on cortisol are stronger in blacks than whites. According to lead author Emma Adam, the team observed "a flattening of cortisol levels for both blacks and whites, but blacks also had an overall drop in levels. The surprise was that this was particularly true for discrimination that happened during adolescence."
Williams points out that perceived unfair treatment for any reason is associated with adverse health in people of all races, but wonders "whether the occasional experiences of discrimination by whites are truly equivalent with the insidious and systematic experiences reported by stigmatized minority populations."
Cortisol levels are a useful singular measure the body's reaction to stress, but allostatic load—the measure of the widespread wear and tear the body experiences in response to interruptions in its natural cycles—is considered to more accurately represent the multiple systems affected by chronic stress. "Coping with cumulative stressors elicits a cascade of biological responses that may be functional in the short term, but over time 'weather' or damage the systems that regulate the body's stress response," researchers from the Center for Family Research at the University of Georgia explain.
Using data from 331 youths, a study by the University of Georgia researchers determined that perceived racial discrimination among older teenagers was associated with heightened allostatic load symptoms at age 20—even after controlling for socioeconomic status, perceived life stress, depressive symptoms, and unhealthy behaviors. They also found that high levels of perceived discrimination in adolescence were related to depressive symptoms and heightened perceived stress in adulthood.
The damaging health effects of racism may even begin before childhood, starting in the womb, where fetuses can vicariously experience their pregnant mothers' stress. Chronic stress during pregnancy has been linked to an increase in the risk of premature delivery and low birth weight, and of the baby having reduced grey matter volume in areas of the brain involved in learning, memory, attention, and emotional regulation. Low birth weight and premature birth are among the leading causes of infant death. Thirteen percent of black babies are born at a low birth weight, which is twice the rate of white babies. And black babies are four times more likely than white babies to die from complications related to low birth weight.
Actually, it might go back even further, to your mother's own childhood. A very small study looked specifically at how racism in a woman's childhood might even affect the health of her future children. Thirty-nine pregnant black women reported their lifetime exposure to racism, experienced either directly or indirectly (by friends or family). Women who experienced more racism in childhood—both direct and indirect—had increased blood pressure during pregnancy and gave birth to lower birth weight babies. Other studies have associated experiencing stress in childhood with an increased risk for premature delivery.
A systematic review of 121 studies examining the relationship between reported racism and children's health found associations between racial discrimination and negative mental health—such as depression and anxiety—and positive mental health—such as high self esteem and resilience. It's not as simple as saying that experiencing racial discrimination could lead to a child becoming more resilient; it could be that minority children are taught to be more resilient because of the high potential for racial discrimination.
HOW YOU VIEW YOUR OWN RACE CAN CHANGE HOW DISCRIMINATION AFFECTS YOUR BODY
For teens, a positive racial identity may reduce some of the ill effects of discrimination. A study of 160 black teens found that racial discrimination, racial identity, and the interaction of the two forecast future cytokine levels, a measure of chronic inflammation in the body. Teens exposed to high levels of racial discrimination had elevated cytokine levels three years later, except in cases where the teens had positive racial identities. "High levels of interpersonal racial discrimination and the development of a positive racial identity operate jointly to determine low-grade inflammation levels that have been found to forecast chronic diseases of aging, such as coronary disease and stroke," the authors noted.
But other research has uncovered an opposite association between strong racial identity and health. Tony N. Brown, associate chair of sociology and associate director of the Center for Research on Health Disparities at Vanderbilt University, has come to the stark conclusion that "if you dig being black, then you are digging your grave." Unlike the study of teens that found a positive racial identity protective, Brown's study—based on data from the Nashville Stress and Health Study—found that adults with a strong sense of racial identity actually had increased allostatic load symptoms. In fact, having a strong racial/ethnic identity had the same effect on allostatic load as exposure to chronic stress.
Brown's theory on why: "Rumination. Blacks with high levels of racial identity are connected to and impacted by the racism-related acts and attitudes that hurt others (i.e., vicarious victimization). For example, people—who actually like me—keep sending me stories about Michael Brown, the unarmed youth killed in Ferguson, Missouri. What those people may not realize is that the stories hurt me. I keep thinking about them. I don't want to know how many unarmed black men were shot in New York. I don't want to know that a Ferguson police officer was placed on administrative leave for saying he was comfortable killing people. I don't want to know that blacks are rioting, and being arrested for protesting. ... Yet, I feel obligated to know these things because I have high levels of racial identity. I hypothesize that, on a subconscious level, I am experiencing physiological reactivity, and that my mind is hurting my body."
Researchers attempted to explain how a strong racial identity could be protective for some and detrimental to others in a March 2015 article in Social Psychology Quarterly. Using data from the National Survey of American Life, they found that those who identified more with their racial group and evaluated it more positively had greater self-esteem and fewer depressive symptoms. When someone viewed their racial group negatively (internalized racism), however, a strong racial identity was related to higher depressive symptoms.
It should be noted that the limitations of self-reported experiences of racial discrimination, as well as the best methods to measure discrimination, and how to account for intersectionalities are ongoing issues in this field.
Williams believes researchers must make a more concerted effort to uncover methods that will eliminate the pathogenic effects of racism on health and to identify strategies that will combat negative stereotypes, racial prejudice, and discrimination.
Children aren't born racist—but they do notice differences, according to Kristina R. Olson, assistant professor of psychology at the University of Washington. She cites studies showing that minority parents often discuss race with their children, while white parents don't. By avoiding such conversations, children may come to their own unsettling conclusions about race. Olson advises that "one clear thing parents can do is to not just talk about race and challenge children's assumptions, but model through their own behavior, the importance of interracial interactions and relationships."
For adults, once there, racial stereotypes may be difficult, but not impossible to erase. "Implicit biases are deeply engrained habits that can be replaced by learning multiple new prejudice-reducing strategies, including stereotype replacement, perspective taking, and increasing opportunities for interracial contact." Williams notes. "Society-wide reductions in prejudice, stereotypes, and discrimination will require large-scale adoption and implementation to alter deeply embedded cultural beliefs about race."