- Racism deeply affects the physical and mental health of Black people in a number of ways.
- Many conditions and illnesses disproportionally affect Black people, including heart disease, stroke, diabetes, several types of cancer, and COVID-19.
- Research has shown that healthcare providers treat Black patients differently than white patients, recommending lifesaving procedures to white patients more often while being less likely to administer pain relief in emergency rooms to nonwhite patients.
After 5 days of protests against police brutality in Columbus, Ohio, the city council organized a virtual meeting and introduced a resolution to classify racism as a public health crisis.
Joining that meeting was Ohio State University (OSU) President Michael V. Drake, who gave his “unqualified support” to the resolution.
“The burden of being Black in America is not only exploding in our bodies, it’s spilling into the streets. If we don’t begin treating this as a health crisis, our communities will never heal,” said Drake, who then committed the university’s staff and resources toward addressing the issue.
Dr. Nwando Olayiwola, chair of the department of family medicine at The Ohio State University Wexner Medical Center, admires how Drake called racism a health crisis.
“There are many institutions across the nation that are still not comfortable actually saying that, so I think calling it by its name is hugely important as a first [step]” to addressing it, Olayiwola said.
In the medical community, there’s a growing body of research confirming that racism, in addition to being a societal ill, is indeed a public health crisis, one that has been hard to ignore with the arrival of COVID-19.
The pandemic has revealed stark disparities among racial lines in health outcomes. Death rates for Black and Hispanic/Latino people are significantly higher in every age category, according to data from the Centers for Disease Control and Prevention (CDC).
The disparity is especially apparent in younger brackets. Death rates of Black and Hispanic/Latino people ages 45 to 54 are at least six times higher than rates for white people.
While geography may play some part in these disparities, there are deeper forces at work.
Stress and ‘social toxins’ affect physical health
A study released in February from Auburn University found that racist encounters caused sustained stress among a group of African Americans, which in turn led to cellular aging.
David Chae, ScD, who helmed the research team, called racism “a social toxin” that “becomes embedded at the cellular level.”
This would help explain why, for example, Black men continue to have shorter life expectancies than white men (72.2 years vs. 76.6 years, respectively, in 2011, according to the CDC).
Stress stemming from biased encounters is far from the only factor that leads to shorter life spans.
Racism is a “multisystem agitator,” said Wizdom Powell, director of the Health Disparities Institute and associate professor of psychiatry at UConn Health.
Its “many tentacles” are wrapped around the policies, practices, and procedures that govern (and harm) Black lives, she says.
“There is more than enough evidence to affirm that racism in all of its myriad forms has significant detrimental impacts or implications for the health of Black Americans,” Powell said.
Racism’s harm to health is both physical and mental. Experiencing an act like racial profiling or a microaggression can lead to a higher risk of depression, anxiety, and trauma for a Black person.
A 2019 study from UCLA and University of Southern California scientists showed that the “toxic effect” of stress caused by racism can trigger an immune system response that increases chronic inflammation in Black people, which in turn causes a host of health problems like heart disease and metastatic cancer.
Across the board, institutional racism negatively impacts social determinants of health
The redlining of neighborhoods across the country had led to ongoing segregation and poorer quality environments and education for many communities of color.
Numerous studies equate higher education with less stress and longer life spans. Wealth is also tied to better health, leaving a bleak outlook for those with few opportunities for employment and upward mobility.
Long histories of discrimination sow distrust in institutions among people of color. And this spills over into the healthcare system.
“If you experience a lot of racism in your everyday life, you’re more likely to believe, and rationally so, that you could experience the same racism while trying to get your healthcare needs met,” Powell said.
This perception is earned. Research has shown that healthcare providers treat Black patients differently than white patients.
A 2010 study found that physicians are more likely to recommend a cardiac procedure to white patients presenting with the same symptoms as Black patients. Nonwhite patients also receive less pain relief in emergency rooms, according to a 2019 report that listed implicit bias as a factor.
“Racism isn’t just a figment of people’s imagination or an attitudinal challenge,” Powell said. “It’s actually one that’s rooted in an unfortunate reality, and that’s that Black folk don’t always get equal treatment and equal quality care.”
America has a long history of ‘medical malice’ toward Black people
The United States has a long history of “medical malice,” says Powell, most infamously the Tuskegee experiment conducted by the U.S. Public Health Service in which Black men — unbeknownst to them — were observed for untreated syphilis for decades.
Horrific abuses, from slavery to present day, fill books like “Medical Apartheid” by Harriet A. Washington and “Bones in the Basement” by Robert Blakely and Judith M. Harrington.
Powell worries even today about how “well-intentioned” providers in the current pandemic may be making decisions based on implicit bias, such as where to allocate a ventilator or other lifesaving medical resources.
While there’s no study to back up this concern, Olayiwola attests that not all providers are as committed as OSU’s president to the belief that racism is a health crisis.
“I wish I could say that that these physicians feel that’s a problem, but I’m confident that that’s not true,” Olayiwola said.
Recently, OSU’s department of family medicine, which she chairs, hosted an open dialogue where several doctors expressed that they remained unconvinced of this connection.
The need for a complete system change
Because racism is a deep-seated issue that touches every institution, it requires “a complete system change,” one that transforms “spaces where people live, work, play, pray, get educated, and get healthcare,” Powell said.
“I always talk about racism as a virus,” Powell said, noting parallels between the work of containing an outbreak and stamping out bias at every level.
For an institution, the first step is calling racism a health crisis, as OSU has done. Then comes a plan of action for addressing it.
To this end, an institution can conduct an internal review of its practices in employment, promotion, and, in OSU’s case, its selection of students and curriculum.
While all medical students undergo implicit bias training, for example, Olayiwola believes far more can be done to teach about racism in medical education, “just as we would embryology and understanding the genesis of a human being.”
“You’re doing a self-examination on an X-ray, if you will, of your own performance, and mitigating or eliminating any of the disparities that you find,” Olayiwola said.
After an internal review comes the external work of investing in communities. OSU infused economic vibrancy in communities of color by building health facilities, increasing employment opportunities, and launching education programs.
And even more importantly, it has the “recognition that we can do better, no matter how well we think we’re doing,” Olayiwola said.
Of course, improvement or reform may not always be the answer.
“Reform suggests that there is something meritorious in the design in the first place. And in many instances, that’s the case. But there are circumstances and systems where that call for something more radical,” Powell said.
In the wake of the killing of George Floyd, protestors are demanding a dismantling of the police, which institutionally began as a slave patrol in the United States.
“I am hard-pressed to imagine, or try to reimagine, how we could rebuild that,” Powell said.
Reimagining healthcare that works for everyone
Healthcare has its own advocates for a rebuilding.
But there are also areas for reform to ensure greater access to care for Black people and all vulnerable people, including increasing access to care regardless of employment status and other hurdles that disproportionately affect people of color.
On a local level, communities can reallocate budgets to spend less money on law enforcement and more on resources for mental health.
In an ideal world, a counselor, not a cop, can be called to help a child after an angry outburst. Police are ill-equipped to deal with people dealing with mental health issues, and prisons are no substitute for treatment centers.
Schools can also be resource centers to help young people cope with trauma, be it intergenerational or rooted in the pandemic, police shootings, and protests that have shook the nation.
In Los Angeles, students are marching to demand the removal of police — who patrol the public schools — in favor of funding college counselors, mental health services, nurses, and more programs.
This could be just the beginning of the conversation in creating an anti-racist school environment.
Community groups are key to making positive change
Community groups are key in this fight.
The Center for African American Health provides a wide range of essential resources in the Denver area. It connects individuals and families with general services like food and clothing, parental support, employment, and transportation, as well as education programs in parenting, aging, health insurance literacy, and nutrition.
These groups need committed leaders, volunteers, and resources. When Deidre Johnson joined as CEO and executive director nearly 5 years ago, she expanded the organization’s scope to become a family resource center.
“The goal was, how can we start earlier in the life span so that we’re not managing diseases but starting to prevent them altogether?” Johnson said. “Having changed our model, we really are working to help people have better access to all the social determinants.”
Local groups also have the ability to convey the Black community’s needs to positions of political power.
A social movement maintained by the center, BeHeard Mile High, surveys Black Denver-area residents on issues related to health that are shared with policymakers.
Recently, the group was able to collect more than 500 responses about COVID-19 from Black residents after the state failed to collect many responses from Black people on its own — invaluable data that spotlighted the crisis in this community and will help address it.
“You’ve got to be flexible,” Johnson advised other groups looking to serve communities of color.
COVID-19, for example, spurred the center to “pivot” suddenly in its services. It began distributing personal protective equipment as well as funds to help people pay food and rent.
“We were the only ones that were doing it for the African American community in Denver,” Johnson said with incredulity. “I’m glad that we were there. We’re still raising more, but we got way more requests than we had the ability to handle.”
10 ways you can help fight systemic racism every day
1. Don’t believe the myth of the ‘complexity’ of racism
“This is not a problem that cannot be solved,” Powell said. “Race is a sociological invention. The circumstances and experiences linked to race are very real, and the structural barriers produced by race are real. The violence against community in the name of race are real, but race itself is fictitious.”
2. Don’t ‘overtax’ people of color with questions about how to help
Be active in seeking out information and resources that others have already prepared.
3. Leverage your privilege
Think about how you can use a platform to create an ant-racist culture. This could be at work or even at the dinner table, where conversations with children and family members can turn into an opportunity to learn from this moment and grow.
4. Don’t drown in guilt
This “gets in the way of a lot of substantial action,” Powell said. “As a psychologist, I can tell you it’s normal and appropriate in some instances, but too much of that will paralyze you.”
5. Donate to organizations that support Black communities and causes
Donating even a small amount to organizations that are supporting Black communities and advocating for social justice, like the Center for African American Health, can make a big difference.
Beyond donating, contact an organization to see what volunteer support is needed.
“Reach out, but don’t reach out with assumption that you know what’s needed. Just reach out and ask how you can be of service,” Johnson advised.
6. Support the rise of people of color to positions of power
This could mean voting for them, engaging in mentorship opportunities, or giving up a seat at the table.
7. Remember that this is a fight that every person shares, regardless of race
“My liberation is bound up in yours. If I’m not free, you’re not free,” Powell said. “If there’s a racial injustice I’m experiencing, then we’re all living in a racially unjust world.”
8. Relax — especially if you’re a person of color
“Breathe, baby, breathe. I would say to everyone, because this is heavy,” Powell said.
9. Find your ‘protest practice’
Not everyone will be able to attend in-person protests and demonstrations, especially in the middle of a pandemic.
“There’s many paths to the revolution,” Powell said. Hers is scholarship; for others, it might be writing, giving, or having those tough conversations.
10. Give love to the kids
“We owe it to them to ensure that, while we’re fighting the unnecessary fights, that we are pouring love back into our children and reminding them they matter, that their lives matter, their words matter, their existence matter,” Powell said.
“In many ways, without them, the future of our nation will be compromised. So we have to hold space for our children as we are holding space for our own pain, anger, and grief,” she said.