Medical studies increasingly show that racial bias, whether overt or subtle and unintentional, can lead to chronic stress problems among victims -- and stress can literally alter how our brains work and how we respond to germs, according to Paula Braveman, director of the Center on Social Disparities in Health at the University of California, San Francisco.
Americans and their doctors tend to focus on what individuals can do to be healthier, but there's evidence they should look at broader societal factors like racism, Braverman told listeners in remarks at a Washington meeting of the Robert Wood Johnson Foundation Commission to Build a Healthier America on Wednesday.
Blacks and Hispanics statistically have more health complications at earlier ages, as well as shorter life expectancies, than their Caucasian counterparts. Researchers in recent years have offered a variety of biological and social explanations for the disparity, but few until now have focused on a simple fact: Blacks and Hispanics are also more likely to experience racism in their day-to-day lives, which can build up stress.
That discrimination isn't always overt, but it's powerful. Hispanics and blacks are charged more than whites for homes in Chicago, for example, which can push minority buyers into poorer neighborhoods -- a further cause of stress.
A January study in the American Medical Association's journal JAMA Surgery concluded that the more segregated a racial community is, the higher its incidence of lung cancer is. It also found that minority patients registered lower satisfaction in doctors who showed signs of unintentional racial biases. "It is the lack of access, the deprivation, but also the intangible sociocultural aspects of it," the study's lead author said.
Doctors saw similar health consequences in children whose parents have been deported, according to Dr. Karen Hacker, senior medical director of public and community health at Cambridge Health Alliance and executive director of the Institute for Community Health. Children who live in constant fear that their parents will be kicked out of the country experience chronic stress, Hacker said.
That can bring on anxiety, depression and cardiovascular health issues. (Heart disease is the second-leading cause of death in Hispanic women.)
The issue is all the more critical today, as the federal government debates social spending and the Obama healthcare reforms are set to kick in. The U.S. spends more per person on healthcare than any other nation, but much of that is spent addressing symptoms and not potential underlying behavioral conditions, including racism.
Americans have to see income and education policies as health-related matters, Braveman said. That includes addressing racism and discrimination, and a renewed push for urban planning that gets grocery stores, schools, parks and green space into historically minority neighborhoods that have felt marginalized.
A tall order? Absolutely. But racial health disparities will continue unless the country makes some dramatic changes, Braveman added.
"We know enough to act," she said.