Racism and Health Disparities

In a report just released from the NIH, as many as 1 in 100 black men and women develop heart failure before the age of 50, which is 20 times the rate in whites in the same age group.  In public health terms, these racial differences in health are referred to as “health the human heartdisparities,” and the newly released report from the NIH raises questions about why there are such stark disparities across racial groups (Creative Commons License photo credit: derek*b).

According to the NIH, this sharp rise in heart failure is directly related to the increased levels of hypertension (aka, high blood pressure) for blacks.    There’s a growing body of scientific literature which points to the experience of racism as a major factor in elevated blood pressure, one of the leading risk factors for early heart failure.   David Williams was a pioneer in this field with his 2001 article, “Racism, discrimination and hypertension: evidence and needed research,” (Ethn Dis. 2001 Fall;11(4):800-16).  That piece spawned a bunch of others, including an excellent piece by Wyatt and colleagues entitled, “Racism and cardiovascular disease in African Americans,” (Am J Med Sci. 2003 Jun;325(6):315-31), which posits that there are three levels of racism that affect the cardiovascular disease (CVD) of African Americans, namely:

First, institutional racism can lead to limited opportunities for socioeconomic mobility, differential access to goods and resources, and poor living conditions that can adversely affect cardiovascular health. Second, perceived/personally mediated racism acts as a stressor and can induce psychophysiological reactions that negatively affect cardiovascular health. Third, in race-conscious societies, such as the United States, the negative self-evaluations of accepting negative cultural stereotypes as true (internalized racism) can have deleterious effects on cardiovascular health.

And, in a recent cross-sectional study that included African American men  (n = 393) and women (n = 717), researchers at the University of North Carolina Chapel Hill found that the likelihood of hypertension significantly increased with higher levels of perceived stress following racism from non-African-Americans.

While many people contend that racism is no longer a relevant or life-threatening issue,  this kind of evidence persuades me that addressing racism is more crucial than ever.

AMA Apologizes, Yet Racism in Medicine Continues

In the last few days, there has been a telling confluence of events related to racism in medicine. In the story that’s getting the most coverage from major news outlets and a few blogs, the American Medical Association (AMA) has issued an apology for more than a century of discriminatory policies toward black physicians, including those that effectively restricted membership in the AMA to whites only. The way the AMA did this in the 1890s was to restrict access so that the only physicians eligible for membership were those doctors who already belonged to a state or local medical society. The state and local medical societies were almost all racially restrictive, meaning only open to white membership. The AMA never took any action to challenge the racist practices of the state and local societies. So, the AMA could say they had a “race blind” policy, when in fact, they were complicit in the same racist exclusionary practices that ended in the same result: African-Americans were not allowed to become members in the AMA.

That’s the way they did it. The reason? Decrease competition for patients, and the revenue that patients represent. If you have any doubts about this, read Paul Starr’s compelling The Social Transformation of American Medicine (1982). And, an excellent companion to that book is Harriet Washington’s recent Medical Apartheid (2007).

And, the result? Quite simply, the racial discrimination by the AMA is part of:

“a litany of discriminatory practices that have had a devastating effect on the health of African-Americans,”

according to Dr. Nelson L. Adams, president of the National Medical Association (NMA). The NMA is an African-American physician group founded in 1895 when black physicians were excluded from the AMA. In his written statement, Dr. Adams goes on to commend the AMA for their “courageous step” and encourages us all to “seize this opportunity to move forward to correct these injustices.” It’s a noble move on Dr. Adams’ part, unfortunately, these injustices are do not exist exclusively in the distant past.

UPDATED (5:20pmEST): For example, in New Jersey just two days ago, three EMS workers were fired by the University of Medicine and Dentistry of New Jersey over a racist incident. The university’s president said that the three were terminated after cell phone camera images surfaced of paramedic trainees at University Hospital in Newark garbed in white sheets resembling Ku Klux Klan robes (photo from here).  On a local news report in the area, they interviewed a person on the street and got their reaction to this, and it reminded me of some of the accounts in Living with Racism (Feagin and Sykes, 1993).  The man, who was black (and yes that’s relevant to this story), said something along the lines of: “If this is what they got caught doing, you know that there’s other stuff going on that they didn’t get caught doing!” This is the kind of everyday racism that black people live with in this country (and elsewhere).  The harm here is not only in this incident, it’s also in the wondering about “what else” is happening in the back stage of white people’s behavior.   And, for their part, white people engage in this sort of behavior and then call black people “paranoid.”     What’s interesting too, here, is the language.  How is this ‘hazing” – a ritual following which someone is inducted into a group, club or state of being?  I don’t think that applies here.  The lead-in to the local news report I heard also referred to this incident as “horrifying for the memories it evokes of another time.”  It seems to me that such an analysis misses the harm of such acts in the present.    Of course, this kind of ongoing racism has serious health consequences for in the present tense; and, indeed, the white EMS workers in this incident are working and making emergency calls in a predominantly black and Latino neighborhood.  So much for our putatively “post-racial” society.

Racism as the Root Cause of Infant Mortality

FIrst, apologies for being away from posting, but the ISP at my apartment has been intermittent of late (indeed, I’m typing this post really quickly and saving often, in the hopes that the ISP doesn’t crash again before I can click “publish”). I’m also finishing up the last details on the book and, it being summer, getting out papers for peer-review (three so far, the goal is two more), all of which can distract from the much more compelling blog-related tasks. So, with all those excuses firmly in place, I return to blogging here.

Second, I discovered a fairly cool new tool, “Slideshare,” wherein you can view, download, and share slideshows created by others, and upload your own. Exceedingly groovy, in my opinion, although a tier below most of the presentations at TED Talks, which are quite simply addictive.

And, finally, on to the actual substance of this post, racism as the root cause of infant mortality. Infant mortality is one of those “index measures,” that demographers and public health officials use to measure quality of life. High rates of infant mortality indicate that people in the general health and well being of a group of people, whether the ‘group’ is a city neighborhood, developing country, or a racial/ethnic group. Most of the time that scholars and researchers talk about infant mortality it’s in terms of large, structures of inequality as contributing factors, such as poverty. More recently, however, researchers have begun to pay attention to racism as a root cause of high rates of infant mortality, independent of poverty, educational levels, living conditions, or even maternal health behaviors. The following slideshow from Barbara Ferrer, PhD, MPH, M.Ed., the Executive Director of the Boston Public Health Commission, makes a convincing case for racism as a root cause of infant mortality: