Racism and Chronic Illness

Source: Katie Willard Virant

“[W]e are each other’s harvest: We are each other’s business: we are each other’s magnitude and bond.” –Gwendolyn Brooks.

The personal is political, and the political is personal. In my work as a psychotherapist, I see every day how the larger political and cultural environment shapes people’s lives. We who live with chronic illness are influenced dramatically by societal views of our illness, policies that grant and deny us access to resources, and economic investments in treatments and cures. Similarly, we individuals affect the larger environment when we advocate for visibility, respect, and belonging. Policies change because people insist that they must.

Racism Makes People Sick

A recent research study describes a causal pathway connecting racial discrimination, inflammation, and chronic illness (Simons et al., 2020). The authors of this study, based at the University of Georgia, collected and measured longitudinal data from middle-aged African American women. They found that exposure to racial discrimination was linked to a physiological inflammatory response. This inflammatory response was linked, in turn, to chronic illnesses.

The study authors used instruments that assessed the frequency of various discriminatory events, including disrespectful treatment in various arenas, false accusations, racial slurs, harassment by the police, exclusion, and stereotyping. The data revealed that exposure to racial discrimination led to an elevated inflammatory response, measured in study participants’ blood tests. The authors conclude that “social environments that pose a persistent threat of hostility, denigration, and disrespect promote chronically high levels of inflammation ... In the USA, this is particularly the case for Black Americans (Simon et al., 2020).”

This latest study corroborates prior research out of USC and UCLA finding that racist experiences can increase inflammation in African Americans, thereby raising the risk of chronic illness (Gersema, 2019). Authors of the USC/UCLA study explain that racism is a chronic stress that triggers chronically elevated inflammation. Chronic inflammation ages the body, causes organ damage, and is a major driver of chronic disease. Thus, racism—which promotes inflammation—is a risk factor for chronic disease. (Thames, 2019).

Socioeconomic Status, Racism, and Chronic Illness

In both the University of Georgia and USC/UCLA studies, researchers were able to control for factors such as socioeconomic status, thus isolating the experience of racial discrimination as a chronic stressor that makes people more vulnerable to illness. It’s well-established, though, that socioeconomic status is also linked to chronic illness (Simons, et al., 2020), and it’s worth underscoring this point in light of the fact that the poverty rate for African Americans is 20.8%, while the poverty rate for White Americans is 8.1% (Talk Poverty, 2020).

People with a higher socioeconomic status can afford consistent and competent medical care. They can live in safe housing that is not overcrowded. They can purchase nutritious foods from grocery stores near their homes. They are employed in jobs that support their families and offer a reasonable life/work balance. They have reliable transportation that enables them to travel to work, food shopping, and medical care. Their social connections are with people who also have these resources, such that the social environment is predictable and nurturing.

For people without these resources, scarcity rules the day. People with low socioeconomic status live lives of heightened stress, uncertainty, and danger. As African Americans are disproportionately represented among people living in poverty, many African Americans add low socioeconomic status to racial discrimination as factors increasing vulnerability to illness. And, of course, it is not a coincidence that poverty and race are linked, as racial discrimination is a powerful driver of exclusion from resources (United Nations, 2013).

Racism: A Public Health Issue

Health organizations such as the American Academy of Pediatrics and the National Association of Chronic Disease Directors recognize racism as a public health crisis (Engel-Smith & Newsome, 2020; NACCD, 2020). Dr. Anthony Fauci of the National Institutes of Health recently stated that the disproportionate effects of COVID-19 on the African American community is “unacceptable” (Aubrey, 2020).

While it’s well established now that cigarettes are a public health issue, it’s not that long ago that smoking was commonplace. People smoked in offices, in cars, in restaurants, in houses, in buses. Then we learned that smoking cigarettes caused illness and death. At first people didn’t pay much attention. Even people who didn’t themselves smoke and hated being around second-hand smoke knew better than to expect smokers to stop smoking in public spaces. But over time, non-smokers became increasingly adamant that they had the right to be free of this health risk. People insisted and policy changed. Attitudes, laws, and experiences surrounding cigarette smoking are very different than they were just a few decades ago.

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African Americans have been fighting for a long time to be free of discrimination. What’s happening now in our country is the latest chapter in a long history of anti-racism work. The air we breathe needs to be healthy for everyone. Discrimination is making African Americans sick, just as second-hand smoke affects non-smokers. “Why are you writing a policy brief?” I can imagine some of my readers asking. “Stay in your lane.” My lane is health—physical and mental well-being. My lane is wanting air that everyone can breathe, an environment where the color of one’s skin is not a risk factor for illness, a country where all of us can thrive.