Despite important technological advances that have contributed to an increase in life expectancy, there remain stark racial differences in health outcomes across the United States. According to the Centers for Disease Control and Prevention, rates of Black morbidity and mortality are higher than for most other racial/ethnic groups.
Black Americans have higher rates of low-weight births and substantially higher rates of infant mortality than other racial groups. Black children also experience higher rates of chronic health conditions, such as asthma and obesity, across socioeconomic status. Black adults exhibit the highest rates of hypertension and cancer mortality.
Though life expectancy has risen for all populations in the U.S., both Black men and women still exhibit the lowest life expectancy at 70 and 77 years of age, respectively, compared to 76 and 81 for White American men and women.
Race and Racism
Race is a social construction that has largely served to justify inequitable, often inhumane treatment of some populations by others, such as the forced removal and genocide of indigenous populations, enslaving Africans, and the Jewish Holocaust.
Because racial groups are socially constructed, their meanings have not been fixed over time, may differ across social contexts and geographies, and are often contested. Furthermore, how a person identifies racially may differ from how they are perceived.
Racism is rooted in a belief of white superiority and bestows benefits, unearned rights, rewards, opportunities, advantages, access, and privilege on Europeans and European descendants.
Health inequities among racial minorities are pronounced, persistent, and pervasive. People of color most impacted by racism may internalize destructive psychosocial and behavioral patterns that negatively impact physical, emotional, and mental health as well as spiritual and familial relationships. In addition, the racism experienced by racial minorities may be one cause of these health inequalities. Studies find that individuals who report experiencing racism exhibit worse health than people who do not report it.
While this line of research has been invaluable in shifting the discussion from innate differences in biology or culture to social exposures, most research acknowledges that it has fallen short of providing tangible interventions that focus on the root causes of racism, particularly structural racism.
Structural racism is born of a doctrine of white supremacy created to justify mass oppression for economic and political exploitation and supported by racist policies such as redlining, social segregation, and gerrymandering, to name a few.
In the U.S., this was carried out through centuries of slavery premised on the social construct of race. The consequences of structural racism are still seen through unequal housing, education, living conditions, access to healthy foods, and substandard health care in marginalized communities, especially the Black community.
Racism Is a Public Health Crisis
Those impacted most by racism live shorter and sicker lives. In 2020, many U.S. states, including California, Michigan, Ohio, Nevada, and Wisconsin, declared racism a public health crisis.
This came amid a national reckoning on race in light of racially charged police misconduct and renewed attention to the ways that systems and institutions disadvantage people of color, especially Black Americans, as seen during the COVID-19 pandemic.
What Does the Research Say?
A growing body of research shows that the impact of racism has a far greater impact on health than previously thought. A Johns Hopkins study found that not only can the social impacts of racism be passed down from generation to generation, but people of color can biologically inherit the deleterious effects of white racism.
Epigenetic changes demonstrate how white racism can have durable effects that are not limited to the specific person who is the target of racism but also extend to the cellular level, thereby opening up the possibility that these changes can be passed to the person’s offspring.
Multidisciplinary research suggests that the accumulated impact of these stressors, triggered by racism, contributes to higher rates of mortality and depression. It also posits that the harmful impact of racism on Black Americans can lead to adverse physical health of the individual subjugated to racism and the health of their offspring.
Health Effects Across Generations
Disparities in Black American health remain pervasive and persist between generations, and structural racism allows these disparities to persist. A growing body of research shows that both structural and interpersonal racial discrimination are key mechanisms affecting Black American health.
The biopsychosocial model of racism as a stressor suggests that the persistent stress of experiencing discrimination takes a physical toll on the health of Black Americans and is ultimately manifested in the onset of illness. However, the degree to which the health consequences of racism and discrimination can be passed down is unknown.
This is what the research has found thus far:
- Those impacted by racism have higher cortisol levels, a poor marker of health, impacting the way the body heals itself and fights infections.
- Mothers impacted by racism give birth to infants with lower weight. Since being born small increases risks for developing poor health in adulthood, factors impacting maternal stress hormones in pregnancy could also affect long-term offspring health.
- Higher levels of stress hormones that may result, in part, from experiences of racism may impact a women’s ability to get pregnant.
Impact of Subtle vs. Overt Racism
Overt and subtle racism both have major impacts on the well being of those experiencing racism but in different ways. Overt racism can be deadly. A recent University of Michigan study found that premature deaths at the hands of law enforcement made police violence one of the leading causes of death for young Black men.
Subtle racism is also often felt through racial microaggressions—everyday insults, indignities, and demeaning messages sent to people of color by non-black identifying people of color who are unaware of their hidden messages. The root of microaggressions is unconscious bias.
The impacts of unconscious bias have a drastic impact on the delivery of health care, education, employment, and housing opportunities to Black Americans. A study in the Journal of Multicultural Counseling and Development found that, of counselors who had clients reporting race-based trauma, 89% identified “covert acts of racism” as a contributing factor.
In the early 2000s, Columbia psychology professor Derald Wing Sue expanded the concept of microaggressions to include its effects on other marginalized groups, including other racial and religious minorities, women, and the LGBTQ community.
What Can You Do?
The negative impacts of racism impact us all. While healthcare professionals have an obligation and opportunity to contribute to health equity in concrete ways, so do all Americans. Addressing violence against Black communities starts with anti-racist practices in clinical care and research.
Six recommendations for doing so are:
- Learn, understand, and accept America’s racist roots
- Understand how racism has shaped the disparities narrative
- Define and name racism
- Recognize racism, not just race
- Adopt anti-racist behavior and advocate for anti-racist policies
- Center the margins, using critical self-consciousness to give voice and power to those who are voiceless or disempowered