Does Systematic Racism Undermine Health?

In recent years, health statistics have consistently shown that African Americans are far more prone to a wide range of medical problems than most other ethnic groups. Not only do they have a 30 percent greater risk of dying from cardiovascular disease, but they twice as likely to develop diabetes and also have a much lower life expectancy than average. And despite efforts to reverse these trends, the problem appears to be getting worse.

Efforts at explaining these differences often focused on low income, unemployment, and living in high-crime areas, as well as lifestyle choices including higher rates of smoking, less exercise, and poor diet. Still, high rates of disease and disability have also been reported in middle and upper-class African Americans who live relatively advantaged lives.

Since conventional risk factors aren't explaining these differences, more recent research has focused on the "weathering hypothesis" first developed by University of Michigan professor Arline Geronimus and her colleagues. According to this hypothesis, the poorer health outcome seen in African Americans is a cumulative effect of the social, economic, and political exclusion they often experience.

This can include the emotional impact of the daily slights, systematic discrimination, and other risks faced by African Americans on a daily basis. Research evidence supporting the weathering hypothesis suggests that these kind of stressors can trigger biological changes, including stress-related problems that can increase the risk of disease. One model which has shown promise in explaining why social adversity can affect health is the predictive adaptive response (PAR) model. According to this model, childhood and early adolescence are critical periods during which people learn to prepare for the future by developing cognitive and emotional skills.

Due to adverse environmental conditions such as abusive home environments or systematic discrimination, young people often become more distrustful and vigilant due to the perceived threats around them. This also means becoming more sensitized to different life stressors as well as a hypersensitive immune system. As they grow older, this early adversity often means an elevated inflammatory response that can enhance the effect of adult stressors. This also makes them more vulnerable to stress-related health problems.

A recent study published in the journal Developmental Psychology provides a sobering test of the PAR model using data through longitudinal research following a large sample of African American participants over two decades. A team of researchers led by Ronald L. Simon of the University of Georgia based their study on data taken from the Family and Community Health Study (FACHS). Intended as a longitudinal study examining almost nine hundred African American families living in Georgia and Iowa, the FACHS was designed to study these families over a series of successive waves beginning in 1997-1998 when each family studied had a child in fifth grade. Later waves occurred when the child was 12–13, 14–15, 18–19, 21–22, and 24–25, respectively. The most recent wave was in 2014-2015 when the target children in the study were around the age of 28.

For the first wave, 889 fifth-graders were assessed along with their primary caregiver (most usually a mother). Along with collecting data on family income, caregiver education, family structure (whether single-parent or two-parent), and the characteristics of the neighbourhood in which the families lived.

At each wave, participants completed items from the Schedule of Racist Events measuring the frequency to which they had been exposed to discrimination based on race. Examples include: being the victim of racial slurs, being hassled by the police, disrespectful treatment by sales clerks, false accusations by authority figures, and exclusion from social activities because of being African American. The neighbourhoods in which each participant family lived were also examined to determine whether they were living in relatively segregated areas with reduced exposure to other racial groups.

The study also collected data on health risk factors such as whether or not they had health insurance, extent of tobacco and alcohol use by caregivers, and other potential health factors deemed relevant. Finally, the 479 participants of the seventh wave were re-interviewed and then had blood samples taken to determine cytokine levels as a measure of immune functioning and potential problems linked to stress and inflammation.

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As expected, the study results showed a significant relationship between exposure to segregation and racism at all age levels and cytokine levels later in life. Even when other factors such as level of education or income levels were taken into account, no real difference was found suggesting that higher income or social class doesn't really protect against the effects of discrimination.

Interestingly enough however, exposure to discrimination and segregation for adults didn't have as great an impact on cytokine levels as exposure to it when younger. Also, the results were identical whether looking at discrimination alone (which was based on self-report) or whether participants grew up in segregated communities.

As Simons and his co-authors pointed out in their conclusions, these results provide strong support for the predictive adaptive response model by showing that early exposure to adverse conditions (in this case, discrimination and segregation) fosters hypervigilance and increased inflammation through the adult lifetime. Furthermore, people exposed to this kind of adversity when younger will be more sensitized to potentially racist events, including being more likely to view ambiguous experiences as being racially motivated.

It also means increased inflammation which impacts on physical health and vulnerability to a wide range of medical conditions. Also, given that the effects of this kind of stress are cumulative, it means that this vulnerability will only increase with time.

While previous studies have failed to show any link between inflammation and discrimination, they have usually focused exclusively on adult exposure which, as has been shown by this study, may not have as great an impact as exposure when younger. Though more research is needed, this study shows that childhood adversity alters the immune system to be more responsive to similar threats in future.

While this kind of exposure can make people more resilient, it can also amplify the effects of adult exposure leading to greater health problems as a result. These results also show that traditional solutions, which involve providing African Americans with better economic opportunities, aren't enough in themselves to eliminate the effect that systematic discrimination and segregation can have.

As studies such as this one demonstrate, it's important to recognize the impact that systematic racism can have on long-term health While cognitive behavioural stress management programs and supportive counseling can help reduce inflammation and help people better face life adversities, these are short-term solutions at best. Though actual solutions to the problems posed by racial disparity remain elusive, it's more essential than ever that they be found.