The Stress-related Health Consequences of Skin Color in Black America
by Dr. Darron Smith
Medical school in the mid-1900’s became an authorized domicile where medical students could learn to reject lessons learned previously about blackness as “less than,” and apply medicine in a supposed neutral and value-free way. Yet, institutional discrimination directed at African Americans and other Americans of color continues to blight their life chances. Many white health providers—past and present—do not fully recognize that their own experiences, including understandings of class status as well as race and gender socialization, influence perceptions, interactions and treatment outcomes in the patients they care for, particularly patients of color. The enduring income and wealth-gap that has widened in recent years, particularly since the recession of 2008, as well as the protraction of poverty, social isolation, residential segregation and other social institutions that have been shown to be causative factors for the development of systemic disease secondary to stress and environment.
Disease does not exist in a vacuum. The marginalization and complete disenfranchisement of black Americans who continually experience discrimination in every facet of American life give rise to a perfect storm for disease formation deep within the physiology of the our bodies. The neuro-chemical systems in our body, which begins in our brain, is well equipped to adapt to situational fluctuations of daily stress. The stress response is our biological alarm system that was adaptive for human survival, especially when our ancestors wandered the plains in search of food as hunter-gatherers. Stress for our ancestors were typically acute and situational. The body, however, does not distinguish between stressors—whether it be a physical ailment or emotional turmoil, the body has the same physiological response. Though the initial stress response can still be helpful in today’s times under acute physical threat, often, it is maladaptive given the psychologically stressful lifestyle of the American experience. A secondary, extended stress response is maintained more consistently in the body in response to chronic stressors. The body activates a longer-acting stress hormone—cortisol—which takes several minutes to initiate yet remains high for much longer periods of time.
Though cortisol is necessary for the body in short bouts to decrease inflammation among other functions, it is well documented in the research literature on stress as having a pernicious affect on the body the longer it remains elevated. With exposure to daily stress, such as living with race-based discrimination built into our societal structure, cortisol has a blunting effect on the body’s immunity, leaving it more vulnerable to disease. The end result of all that stress is metabolic imbalance on the body with greater risk toward weight gain especially in the abdomen where more fat around the visceral organs is dangerous. Increases in abdominal girth that can potentially lead to diabetes, high cholesterol, certain cancer, hypertension, depression, anxiety and other forms of life-style related disease—not ironically, health risks in which Americans of color currently occupy in greater numbers than white Americans across the board.
Nowadays threats from charging predators are less likely, but our hard-wired stress response remains intact and responds more commonly to sociologically mediated stressors. African Americans and their descendants have paid an exorbitantly high price for living in an unequal society in a number of reprehensible ways through the practice of forced labor, high incarceration rates, frequent under/unemployment and low educational expectation. And now, significant health care challenges are among the more salient forms of white on black discrimination. In the absence of sweeping governmental reforms that place human rights over property rights, African Americans must take greater ownership in their own health care by becoming better informed on effective ways to reduce stress—to the extent that is possible given the maintenance of systems of domination and oppression—to have an impact upon the quality of black life. Otherwise, these persistently elevated stress levels can be physiologically and mentally bad for health and well-being, particularly with chronic exposure to race-based discrimination, both at the individual and institutional levels of society, that keeps the body’s stress response in a continued state of heightened awareness.
Dr. Darron Smith is an assistant professor in the Department of Physician Assistant Studies at the University of Tennessee Health Science Center.
Follow him on twitter @drdarronsmith.