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May 02, 2005

Racism, stress, and health

Interesting item in the Washington Post about about the impact of discrimination on the cardiovascular health of black women. The study featured in the article is noteworthy because it points to a specific mechanism by which the psychosocial stress of discrimination may directly harm the cardiovascular system. The authors of the study aren't trying to minimize the more familiar effects of racism on health, via poverty, lack of access to health care, and other risks associated with race. But their results might help explain the health disparities between black and white women that persist even after controlling income, education, and health behaviors.
Study Links Discrimination, Blacks' Health

Studies have linked discrimination to higher rates of depression, and a small number have found associations with risk factors for physical disease, such as high blood pressure. The new study is the largest, most detailed to date to examine the relationship between discrimination and the early stages of a physical ailment.

Lewis and her colleagues studied 181 black women ages 45 to 58 in Chicago and Pittsburgh who are participating in a large, ongoing project, called the Study of Women's Health Across the Nation (SWAN), that is examining a host of health issues among middle-age women.

As part of the SWAN project, every year between 1996 and 2001 the women answered a questionnaire designed to measure encounters with subtle racial discrimination. The questionnaire asked each woman if, in her "day-to-day life," she had had one of 10 experiences, including: "You are treated with less courtesy than other people"; "You receive poorer service than other people at restaurants or stores"; and "People ignore you or act as if you are not there."

"We're not talking overt incidents. It's not racism in the form of being chased down the street because you have brown skin or being called a name," Lewis said. "We're talking about subtleties -- everyday insults that build up over time."

The women's scores over the years were averaged on a four-point scale, and in 2001 the participants underwent an examination known as a CT scan to measure coronary artery calcification -- buildup of calcium inside arteries that supply blood to the heart. It is considered an early stage of heart disease -- the nation's leading cause of death.

The more discrimination the women reported, the more likely they were to have calcification, the researchers found. After accounting for age, geographic location and education, the researchers found that for every unit of increase in perceived discrimination, the odds of having calcification nearly tripled. The chances of having calcification remained 2 1/2 times higher even after the researchers took into consideration such factors as high blood pressure, cholesterol, smoking, age and body weight.

"It's a strong association," Lewis said in a telephone interview before her presentation. [WaPo]
I was wondering whether some of the cardiovascular risks of obesity might be attributable to a lifetime of similar slights, such as obese people routinely experience in our society.


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That's interesting. But why would calcification of the arteries be the effect?

I witnessed a very blatant example of this type of discrimination this weekend. (For the purposes of the story you need to know that I am white.)

I was out shopping, and a saleswoman was helping me. Or I should say "helping," because I was doing just fine and wanted to be left alone to read the info on the boxes and figure out whether they had what I wanted to buy. Meanwhile, there was a young black woman trying to get the attention of the saleswoman, who didn't seem to notice her existence. Finally, I shook off the saleswoman, but instead of turning around and finally getting to the other woman's question, she allowed herself to be intercepted by another (white) customer. At this point I was practically boiling over, and I was trying to find the right words to intervene ("This woman was here first" would have done, but somehow I didn't think of that until later) when the black woman tapped the saleswoman on the shoulder and finally got her attention so she could politely ask her question. She seemed pretty collected, and not even very angry. The thing about it that strikes me now was that this was obviously something she had to deal with all the time.

Is it possible that diet differences between the races and not racism are entirely responsible for these differences?

I am also very skeptical about the claims that "income, education, and health behaviors" are properly controlled. With many of these studies, "controlling" for education results in the comparision of a "C" student with an education degree from a crappy college with a Harvard Math grad. After all, they are both "college grads."

Have you seen Sapolsky’s review article in Science (“The Influence of Social Hierarchy on Primate Health,” 29 April, p. 648-52)?

Having observed the literal "pecking order" in action, ie barnyard fowl, the study conclusions come as no surprise (and I'd guess that the Primate study mentioned above will bear out a connection, as well). As an urban bus driver (8 year's worth), my observations of public interactions at ground level revealed behaviors that were not uniform; but, as the ages of those observed became greater, so did the display of attitudes that registered as a sort of resignation become more universally evident, among African-Americans. In contrast, such attitudes were almost entirely absent from the relatively large numbers of Eritrean, Ethiopian, Sudanese, etc immigrant populations (who were mostly in their 20s- 50s). This same context included a number of Asian immigrants and Asian-Americans, as well, who generally behaved as astutely unobtrusive as possible- like tourists might, in a strange place. It occurred to me that all the different groups had their own cultural enclaves within which they could be comfortable (and feel secure- &/or even superior- in the face of the cultural milieu around them), except for the African- Americans, for whom the dominant white culture remains a paradigm.
(There was some unifying cross-cultural symbolic behavior, however. Whenever plainclothes cops got on the bus, all conversations simply stopped; and it remained quiet until they had left. It didn't matter who had been talking to whom...) ^..^

"It's a strong association,"

I have to doubt it. This tiny study? How big is that 2.5-fold effect relative to what they can reliably claim to be a difference--i.e. a standard deviation or two.

Is there any possible way that subtle racism can lead to being overweight? Perhaps racism leads to depression and then depression leads to being overweight?

Blacks don't suffer from higher rates of depression. Ironically, their happiness rate is probably higher than that of the general population.

From what I know, Jews & Asians, who are disproportionately successful, have higher depression & suicide rates than the general population. They feel more stress than blacks.

Just because you live with something that might cause one person stress doesn't mean that another person, in the same circumstance, will feel the same way about it.

We need change in health system and insuring better delivery of services.

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