Rosalind Ramsey-Goldman, MD, DrPH, a Public Voices Fellow of the OpEd Project, is the Solovy Arthritis Research Professor of Medicine (Rheumatology) at Northwestern University Feinberg School of Medicine.
Like a raging wildfire, everything we know about health outcomes linked to racism tells us to brace ourselves for the lingering effects of the coronavirus on marginalized communities. We can count on “weathering” to challenge African Americans who are dealing with disproportionate impacts from the coronavirus.
Science already proves racism wears down its victims, but we can do something about that if we just will.
Weathering occurs from repeated exposure to social and economic adversity, and political marginalization. If imagining the lifelong impact of structural neglect and daily microaggressions is challenging, then think about what we’ve witnessed lately: the racial inequalities in policing have produced disproportionate life-or-death outcomes for certain communities much like COVID-19 has affected the Black community with unequal precision.
What does weathering look like?
The stress inherent in a race-conscious society stigmatizes and disadvantages Black individuals, causing deterioration in body functions and faster aging compared with older white individuals. Abnormal test results, such as higher levels of blood pressure, blood sugar, and weight are associated with faster aging and its consequences, including earlier onset of heart attacks, strokes, and diabetes. Consider that African Americans are 60 percent more likely than white people to be diagnosed with diabetes. Black women are more likely to have a stroke then white women, and Black men are 60 percent more likely to die from a stroke than white men.
Weathering may contribute to the increased risk of a chronic disease that increases the risk of acute disease such as asthma and its complications. Children are at risk, too. In Black children, exposure to racism during late childhood was linked to stronger inflammatory responses in adulthood that could negatively affect body functions as these individuals continued to age.
Now, blood pressure, blood sugar, and weight are potentially modifiable risk factors to minimize and prevent chronic disease. And it’s true that healthcare providers can support communities by prescribing medications and counseling on lifestyle changes, such as eating healthy foods and getting exercise. We know that is not enough in communities lacking walkable areas, easy access to healthy foods, and adequate housing amid a lack of coordinated effort by institutions to factor all of this into the big picture of health.
Documenting the impact of racial discrimination at the neighborhood level can give us better information for better approaches to healthcare and civic policies. We can start by collecting data that measures exposure to stress. In addition to studying body functions, the survey tool, “Schedule of Racist Events,” measures exposure to racism by asking questions about experiencing racial slurs, being hassled by police, or being disrespected in retail stores. Framing racism rather than race as a risk factor for disease would allow a more effective strategy to address health inequities.
But first, we must gain trust.
Multiple stakeholders from the private and public sectors must address their own implicit biases (we all have them) and invest in Black communities beyond achieving business or research goals. Researchers must acknowledge and respond to historical and current issues related to racial discrimination in healthcare and in clinical trials enrollment.
Right now, the National Medical Association, which represents Black doctors, is independently vetting the safety of COVID-19 vaccines because they know the Black community doesn’t trust medicine: “We’re really doing this to be a source of trusted information for our physicians and our community,” said Dr. Leon McDougle, NMA president.
The Tuskegee syphilis experiment and other well-documented instances of medical abuse and lack of informed consent aimed at the Black community have created a wall of skepticism. We have an opportunity—and the tools—to build up trust and create better health outcomes if we just take it. v