George Floyd’s death on 25 May, outside a shop in Minneapolis, Minnesota, focused the world’s attention on racial disparities, not just in the US but around the globe. With governments, organisations, schools and individuals prompted to assess racism’s many forms, a conversation about the impact of racism on health is reigniting.
Across nearly every metric of cardiovascular health, US African Americans fare worse than non-Hispanic whites. Taking just one measure – high blood pressure (HBP) – the Centers for Disease Control and Prevention in the US claim that 42 per cent of black people suffer from HBP in the country, compared to 28.8 per cent of white people. Racial discrepancies in key health measures exist even after studies control for socioeconomic factors. In fact, at every level of education and income, black people in the US have a lower life expectancy at age 25 than do white people and Hispanics.
Social aspects of racism, such as segregation and discrimination, could play a significant role. A 2017 review of 17 studies found that experiences of racial segregation was positively associated with later-stage diagnosis, higher death rates and shorter survival for both breast and lung cancer in black people. Now, researchers with the Jackson Heart Study – a community-based investigation of environmental and genetic factors associated with cardiovascular disease among African Americans – are investigating the effect of discrimination on incidences of HBP in the tri-county areas of Jackson, Mississippi. ‘Our study used the lifetime discrimination scale, which included questions about experiencing unfair treatment at school/training, getting a job, at work, getting housing, money, resources or medical care,’ says Allana Forde, a researcher at Drexel University.
The study showed that African Americans with high scores for ‘lifetime discrimination’ were more likely to develop HBP. The association persisted even after researchers adjusted for known HBP risk factors, such as smoking, obesity and limited exercise. There could be a physiological link. Those that reported a greater degree of stress from lifetime experiences of discrimination were also more likely to develop HBP. ‘Discrimination may act as a chronic stressor and predispose an individual to poor health,’ says Forde. ‘Discrimination can activate the sympathetic nervous system and hypothalamic-pituitary adrenal axis [the body’s central stress response system] through the “stress pathway”.
‘Our findings emphasise the unfair treatment experienced by African Americans and highlight the importance of addressing discrimination in efforts to reduce health disparities,’ says Forde .