The Physical Pains of Discrimination

The intersection between race and social psychology has been examined in several posts on The Situationist, including by Jon Hanson and Michael McCann in “Black History is Now” and “Hoyas, Hos, & Gangstas,” by Jerry Kang in “Implicit Bias and Strawmen,” and by the Staff in “The Situation in New Olreans.” In today’s Boston Globe, science writer Madeline Drexler studies a different dimension to this intersection: how being discriminated against because of one’s race increases one’s chances for physical ailments, and how forthcoming studies on the human brain may further illuminate that connection. Below we have excerpted portions of Drexler’s piece.

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Four years ago, researchers identified a surprising price for being a black woman in America. The study of 334 midlife women, published in the journal Health Psychology, examined links between different kinds of stress and risk factors for heart disease and stroke. Black women who pointed to racism as a source of stress in their lives, the researchers found, developed more plaque in their carotid arteries — an early sign of heart disease — than black women who didn’t. The difference was small but important — making the report the first to link hardening of the arteries to racial discrimination.

The study was just one in a fast-growing field of research documenting how racism literally hurts the body. More than 100 studies — most published since 2000 — now document the effects of racial discrimination on physical health. Some link blood pressure to recollected encounters with bigotry. Others record the cardiovascular reactions of volunteers subjected to racist imagery in a lab. Forthcoming research will even peek into the workings of the brain during exposure to racist provocations.

Scientists caution that the research is preliminary, and some of it is quite controversial, but they say the findings could profoundly change the way we look at both racism and health. It could unmask racism as a bona fide public health problem — just as reframing child abuse and marital violence as public health concerns transformed the way we thought about these ubiquitous but often secret sources of suffering. Viewing racial discrimination as a health risk could open the door to understanding how other climates of chronic mistreatment or fear seep into the body — why, for instance, pregnant women in California with Arabic names were suddenly more likely than any other group to deliver low birth-weight babies in the six months after 9/11.

Most striking, researchers note, is how consistent the findings have been across a wide range of studies. The task now, they say, is to discover why.

“We don’t know all the internal processes,” said James Jackson, director of the Institute for Social Research at the University of Michigan. “But we can observe an effect, and we need to find out what’s going on.”

The burgeoning research comes at a time when lawmakers and government officials are increasingly focused on the problem of racial disparities in health. African-Americans today, despite a half century of economic and social progress since the civil rights movement, face a higher risk than any other racial group of dying from heart disease, diabetes, stroke, and hypertension. In the United States, affluent blacks suffer, on average, more health problems than the poorest whites. Spurred by statistics like these, dozens of states and cities have been passing legislation intended to eliminate racial and ethnic disparities in health.

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For decades, experts have agreed that racial disparities in health spring from pervasive social and institutional forces. The scientific literature has linked higher rates of death and disease in American blacks to such “social determinants” as residential segregation, environmental waste, joblessness, unsafe housing, targeted marketing of alcohol and cigarettes, and other inequities.

But the new work draws on a different vein of research. In the early 1980s, Duke University social psychologist Sherman James, introduced his now-classic “John Henryism” hypothesis. The name comes from the legendary 19th-century “steel-driving” railroad worker who competed against a mechanical steam drill and won — only to drop dead from what today would probably be diagnosed as a massive stroke or heart attack. In James’s work, people who churn out prodigious physical and mental effort to cope with chronic life stresses are said to score high on John Henryism. James showed that blacks with high John Henryism but low socioeconomic position pay a physical price, with higher rates of blood pressure and hypertension.

Racism, other research suggests, acts as a classic chronic stressor, setting off the same physiological train wreck as job strain or marital conflict: higher blood pressure, elevated heart rate, increases in the stress hormone cortisol, suppressed immunity. Chronic stress is also known to encourage unhealthy behaviors, such as smoking and eating too much, that themselves raise the risk of disease.

In the 1990s, Harvard School of Public Health social epidemiologist Nancy Krieger pushed the hypothesis further. She confirmed that experiences of race-based discrimination were associated with higher blood pressure, and that an internalized response — not talking to others about the experience or not taking action against the inequity — raised blood pressure even more. A controversial finding at the time, it has since been replicated by other investigators: The suppressed inner turmoil after a racist encounter can set off a cascade of ill effects.

Jules Harrell, a Howard University professor of psychology, said he was moved this spring by a photo of the Rutgers University women’s college basketball team, sitting together with dignified expressions, after radio talk show host Don Imus had labeled them with a racist epithet.

“The expressions on their faces,” said Harrell. “All I could think was, ‘Good God, I’d hate to see their cortisol levels.’ ”

Collectively, these studies of the racism-health link have tied experiences of discrimination to poorer self-reported health, smoking, low-birth-weight deliveries, depressive symptoms, and especially to cardiovascular effects. In the mid-1980s scientists began to take advantage of the controlled conditions of the laboratory. When African-American volunteers are hooked up to blood-pressure monitors, for example, and then exposed to a racially provocative vignette on tape or TV — such as a white store clerk calling a black customer a racist epithet — the volunteers’ blood pressures rise, their heart rates jump, and they take longer than normal to recover from both reactions. Perhaps, scientists reasoned, the effort of a lifetime of bracing for such threats prolongs the effect.

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To read the rest of the piece, click here.