What’s the correlation?

Most people know that racism is not a good thing. Typically, it involves discriminating against individuals or groups of people because of their skin color. This can have a profound impact on many parts of life, such as education and socioeconomic status. One major area is the effect it has on health. Many don’t realize the extent of the influence. What exactly is the relationship between the two? What can be done to improve it?

Racism & HealthRacism is when an individual or group is viewed or treated differently because of their race or ethnicity. In the past year, it’s become abundantly clear that it’s still prevalent in our society. Part of the problem is that it has been ingrained for so long that many don’t realize the extent it exists. This systemic racism has a significant impact. Studies show that racism, both intentional and unintentional, negatively affects the health and well-being of individuals and communities. It also limits the opportunity of many people to contribute and participate fully in the future and growth of our nation.

Racism shapes a person’s health in many ways, both physical and mental. However, it’s twice as likely to affect mental health, causing depression, stress, emotional distress, anxiety, post-traumatic stress disorder (PTSD), and suicidal thoughts. It undermines good mental health characteristics, such as resilience, hope, and motivation. Compared to white people, Black people face higher levels of mental health conditions. Other people of color also experience increased racial discrimination rates, resulting in elevated levels of depression and anxiety. Another example is alcohol dependence. Native and Indigenous Americans have the highest rates out of any marginalized group. On the contrary, Asian Americans are under-diagnosed with the disorder, which may occur because they’re “viewed” as prosperous and self-reliant. Besides increased alcohol use, discrimination is linked to higher rates of smoking, drug use, and unhealthy eating habits.

When it comes to physical health, the effects can be long lasting. One of the biggest concerns of racism is that it’s associated with higher stress levels, elevating blood pressure and weakening the immune system. Over the long-term, this raises the risk of developing long-term health conditions, like heart disease, skin rashes, insomnia, and gastrointestinal problems. According to the Centers for Disease Control and Prevention (CDC), Black people are more likely to have hypertension than any other racial or ethnic group. Both Black and Latino people are more likely to have a chronic illness than white people of the same age. In a study released in 2015, the US Department of Health and Human Services (HHS) found abundant examples of health inequity for people of color. Black individuals have lower life expectancies than white ones. On average, a Black person’s lifespan is six years less than a white person. The study also found that 42.4% of Black males had high blood pressure compared to 30.2% of white males. For females, the numbers were 44% for Black females and 28% for white females. Black and Latino people also get vaccinated at lower rates than white people. For instance, a study from 2014 indicated only 60% of Black and Latino people aged 65 or over got the yearly flu vaccination, compared to 70% of white and Asian people in the same age group. While Black women are far less likely to have breast cancer, they’re 40% more likely to die from it. Even after taking into account for age, gender, marital status, region of residence, employment status, and insurance coverage, Black individuals have worse health outcomes than whites in nearly every category. An increasing amount of evidence shows that the chronicity of racism, not just the severity of exposure, is associated with higher mortality rates.

One area affected by racism that is especially concerning is children. Unfortunately, it starts before they’re even born. Racial disparities in healthcare make it challenging for people of color to get pregnant mothers and their newborns the medical care they need. Mothers who experience racism are more likely to have babies with a low birth weight, which can cause health problems for infants later in life. Another thing that is higher among people of color is infant mortality, which is the proportion of babies who die below the age of one compared to those that live. Data from the HHS shows that infant mortality decreased between 1999–2013 on average in the US. However, there were still disparities between racial groups. In 2013, infant mortality, which is measures the number of deaths per 1,000 births, was 11 for Black babies, 8 for indigenous, 5 for both white and Latino, and 4 for Asian or Pacific Islander. The statistics also demonstrate that Black women are 3–4 times more likely to die from pregnancy-related causes than white women.

The impacts of racism on children continues as they grow. It can be in the form of overt bullying or the less obvious of social exclusion and economic disadvantage. Just like their parents, children of color are more likely to be discriminated against when seeking care for medical issues. According to Frontiers in Pediatrics, doctors in emergency departments are less likely to classify Black and Latino children as requiring emergency care, order testing, and admit them to the hospital compared to white or Asian children. While the researchers didn’t look at the cause of these differences, they say it can’t be explained by social, economic, or clinical factors. The American Academy of Pediatrics (AAP) is so concerned about how racism affects young people’s well-being that it released a policy statement on it in 2019. Part of the statement declares that if racism isn’t addressed, it “will continue to undermine health equity of all children, adolescents, emerging adults, and their families.” The AAP goes on to say that even if children aren’t directly subjected to racism, they can still be significantly affected by witnessing it. As with adults, intense and persistent stress can negatively impact the body. For children, stress can shape how the brain develops, escalates negative emotions, and alters learning and memory.

To understand the depth of racial health disparities, we need to look at previous government attempts to care for marginalized minority populations. One well-known example was conducted by the US Public Health Service from 1932 to 1972. It was called The Tuskegee Study of Untreated Syphilis in the African American because it was done in collaboration with Tuskegee University, a historically Black college in Alabama. The study enrolled 600 impoverished Black men, who were sharecroppers from Macon County, Alabama. The purpose was to observe the progression of untreated syphilis. In return, the individuals received free healthcare. While this might seem like a good idea, when penicillin became the standard treatment for syphilis by 1947, researchers didn’t provide the treatment to the men so they could continue their observation. Untreated syphilis results in blindness, insanity, or other severe complications. By the study’s end in 1972, 28 men had died from syphilis, 100 more had succumbed to complications, 40 spouses contracted the disease, and 19 children had been born with congenital syphilis. It wasn’t until 1997 that the US government addressed what happened. President Bill Clinton issued a formal apology to the victims, saying, “What was done cannot be undone. But we can end the silence. We can stop turning our heads away…what the US government did was shameful, and I am sorry…it is in remembering the past that we can build a better present and a better future.” While studies like the Tuskegee are no longer done, there are still racial disparities in healthcare. It’s not uncommon for there to be limited access to trauma centers in predominantly Black communities, which indicates racial bias may prevent individuals from receiving emergency care. A 2020 study proves that racism continues to play a role in healthcare. It looked at data from 2005 – 2016 and found that medical professionals were 10% less likely to admit Black patients to the hospital than white patients and Black people were 1.26 times more likely to die in the emergency department or hospital.

Most doctors aren’t racist and are committed to treating all patients equally. However, subconscious prejudices, or implicit bias, does affect the way patients are treated. The main issue is the healthcare system is inherently racist, which can lead to neglect, disbelieve, or actively discriminate against patients. A 2016 study examined racial bias and pain management. It found a link between undertreating pain in Black patients. The researchers say that racial bias causes medical professionals to use separate thresholds for pain for various racial groups. Often, this is done inadvertently because of the belief that pain is expressed differently depending on a person’s race. Another example is the COVID-19 pandemic. A May 2020 study estimated that Black people were 3.57 times more likely to die from COVID-19 than white people. Similarly, Latinos were nearly twice as likely to die compared to whites. Using just these two studies, it’s easy to see how the prevalence of inequality leads to higher risks of illness and, in some cases, lower standards of care for people of color. Another interesting finding of the COVID-19 report was that healthcare workers from marginalized groups felt they couldn’t voice their concerns about the lack of personal protective equipment and testing. An area that is also being looked at is patients who exhibit racist behaviors toward medical personnel who are people of color since this makes it challenging to provide care to them.

In response to the increase in hate speech, anti-immigrant policies, and recent political rhetoric surrounding race, a large group of physicians issued a letter trying to reassure patients. In the letter, the doctors emphasized their commitment to health being a human right, providing evidence-based care, dismantling structural racism, and ending race-based violence. The American Medical Association (AMA) also has taken action to recognize racism as a public health threat because it exacerbates health inequities among historically marginalized communities. They feel that without systemic and structural-level change, health inequities will continue to exist, and the overall health of the nation will suffer. To further promote anti-racist practices, the AMA is encouraging undergraduate/graduate medical education and continuing medical education programs to recognize the harmful effects of racism and mitigate them through curriculum changes. The AMA also “recommend that clinicians and researchers focus on genetics and biology, the experience of racism, and social determinants of health—and not race—when describing risk factors for disease.” The AMA is planning on collaborating with the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, National Board of Medical Examiners, National Board of Osteopathic Medical Examiners, Accreditation Council for Graduate Medical Education, and other groups to identify and focus on changing any teachings, assessments, and practices that reinforce institutional and structural racism.

It will take time to make long-term changes because racism has been ingrained in our society’s social, political, and economic structures for centuries. Structural racism is the societal approach to housing, education, employment, healthcare, and criminal justice resulting in unequal access to these. Numerous studies show that low socioeconomic status and a lack of economic development are the number one cause of poor health and a shorter life expectancy. The American Psychological Association (APA) states socioeconomic status can directly affect both physical and mental health. According to a 2017 analysis of 1.7 million people, low socioeconomic status is as bad for a person’s health as smoking, drinking alcohol excessively, or eating an unhealthy diet. Individuals who experience economic difficulties are more likely to need medical procedures/hospitalizations that could be avoided and have chronic conditions that go untreated. Economic disparities make it more challenging for some people to get health insurance, which without it, people don’t seek medical care unless it’s an emergency. In 2014, it was estimated that close to 20% of Black adults and 35% of Latino adults couldn’t access health insurance compared to 10% of white and Asian adults. A 2012 study discovered that predominantly Black zip codes were 67% more likely to have a shortage of primary care doctors. Another concern is education, specifically high school graduation, because it’s a leading indicator of healthy adult behaviors and health status. When you consider that over 50 million students attend public elementary and high schools every fall, and over half of them live in poverty, the concerns surrounding health are significant. Also, only two-thirds of Black and less than three-quarters of Latino students will graduate on time. This isn’t surprising since these children are more likely to live in low-income households, lack access to quality education, and be involved in the juvenile justice system. In addition, racism and unconscious bias lead people, like healthcare providers, teachers, and law officers, to treat children of color differently. Many of these children internalize these beliefs, leading to negative, self-limiting beliefs about themselves and others.

It’s all of our responsibility to address structural disadvantage, socioeconomic deprivation, and institutionalized racism. We need to recognize, name, and understand these attitudes and actions. Also, we must be open to identifying and controlling our own implicit biases. The goal should be to eliminate discrimination, learn from it, and educate others while practicing acceptance, tolerance, respect, open-mindedness, and peace for each other. All of these need to be incorporated into education and institutional policy. For individuals who experience racism, there are certain things you can do to help you cope with the adverse effects. Talking about experiences with others can help you process any feelings of stress, anger, and frustration. It can help to have a network of people that can provide support, advice, and comfort. For children, talking about racism helps them to better understand what it is and how it impacts them. In addition, the AAP recommends that young people who report dealing with racism have routine assessment for mental health conditions, like PTSD, anxiety, grief, and depression. It’s also vital to have a strong sense of racial identity because individuals who do are less likely to be physically or mentally distressed by racism.

Racism is a topic that makes people feel uncomfortable, which makes it a difficult issue to take on, but it must be addressed. If we don’t, the health disparities will continue and that will threaten our nation’s health. Declaring racism as an urgent public health threat is a step in the right direction, but tackling racism requires a multi-pronged approach. We must make sure healthcare institutions, educational systems, and all other components of our society change practices to be more welcoming to people of different races, cultures, and ethnicities. Educators, law enforcement officers, and healthcare providers should receive anti-bias training. Laws need to be enacted that address structural racism by supporting fair housing and reducing the criminalization of minority youth. By working together, we can end racism and all of the health concerns it causes!