Although evidence is just emerging, and therefore largely criticized, an article from the William and Medlock NEJM suggested that the increasing racial hostility and community level prejudice towards marginalized groups will adversely affect health. This will only increase the already present health disparities of the nation and is therefore an important issue to address and quickly find a solution for.
A study on the perceived racial discrimination on health status and health behavior showed that there is an inverse relationship between perception of discrimination and health. This was mainly due to higher internalization and externalization reactions. Internalization was related to self-reported health status, whereas externalization included changes in substance use problems. This study showed that both substance use and physical health are affected negatively by discrimination (Gibbons, 2014).
A study on Racism and Health showed that health can be negatively impacted by a variety of racial issues.
Any discrimination, even of the physician adversely affects the healthcare a patient receives. In fact, the study showed that “institutional and cultural forms” of racism “have been and continue to be major contributors to initiating and sustaining racial inequalities in a broad range of societal and institutional policies…” (Williams, 2014).
Although the above study showed how patients might receive less than optimal healthcare due to discrimination by institutions and healthcare providers, health disparities are not just based on race.
Race is also complicated by social economic status. What I mean by that is this, social economic status is sometimes lower among certain races, and therefore might have less access to health care. According to a study on race, socioeconomic status and health, poverty varies by race, moreover, child poverty rates “for all racial groups, are higher than the overall poverty rates and child poverty is also strongly patterned by race”. Furthermore, poverty levels of blacks and Hispanics were two to three times higher than those of whites (Williams, 2012).
However, even after controlling for SES, “racial disparities in health often remain”. Likewise, there are also racial differences in disease even among high SES groups.
Certain diseases such as diabetes and high blood pressure were almost twice as high in black physicians than white physicians. From class lecture in my health policy class, Life expectancy is also affected by race, as well as SES and income.
According to a study on race, SES and health, racial discrimination has gained a lot of interest for a possible stressor that may adversely affect health.
Some of the health issues that have been found to be associated with racial discrimination include fibromas, diabetes, higher risk of drug abuse and coronary artery disease (William, 2012).
Stereotypes have also been found to adversely affect health disparities between races. Any stigmas of inferiority, which have been found to affect academic performance, have also been associated with high blood pressure.
Stigmas such as “blacks performing more poorly on exams than whites, women who were told they performed worse than men, white men told they perform worse than Asians,” etc. In addition, internalized stigma has been associated with higher risk of being overweight, as well as more abdominal obesity in black women in the Caribbean and more cardiovascular outcomes in black women in Africa (William, 2012).
Another study showed how the patients themselves change their behaviors and increase their risk of illness. A study on racial discrimination and HIV-related risk behaviors in Southeast Lousiana showed that those who experienced racial discrimination had higher levels of risky sexual behaviors.
This put them at higher risk of sexually transmitted infections (STIs) and increased “vulnerability to HIV” (Kaplan, 2016). According to Scherwitz, there is a relationship between hostility and health behaviors, which may contribute to bad health such as tobacco smoking and marijuana (Scherwitz, 1992).
One study found that even if exposed to hostile or racist interactions,
as long as there are healthy, high quality relationships in the patients’ life, their health is not as negatively affected since they are not exposed to the physiological changes that normally would occur in the person exposed to high interpersonal conflict (Guyll, 2011). However, just as with any other disease, psychological state is also important to a person’s health and wellbeing. In fact, a study has found a connection between anger, hostility and aggressiveness and many health risks (Staicu, 2010).
I don’t agree that racial hostility alone is a major cause of health disparities. I do however strongly believe that how people react to hostility has a huge effect on the body. This effect can be physiological, psychological and therefore physical.
As a doctor and based on what I know from medicine, the body reacts to stress in many ways. Many times having a good support system at home or at school, even in the community increases your chances of thriving. This has even been shown to work in babies in the neonatal intensive care units (NICU), where sometimes placing two babies in the same incubator, their health stats begin to rise. It is unclear the reason why this occurs, but I think humanity strives through support. Loneliness, marginalization and isolation often times lead to symptoms of depression. This alone can wreck havoc on your body and adversely affect your health.
I have conducted a lot of research on stress and its effects on the body. Interstingly enough, the research I have done for my health blog and youtube channel have somehow coincided with what I have needed to know in my masters of public health. In this case, I have learned all the reasons why certain exercises that decrease stress can have such positive gains on health. It is not just that exercise is beneficial because well, its exercise.
It is because things like yoga and meditation interact with how your body manages and responds to stress; mainly the stress hormone, cortisol. Anything that decreases persistently higher levels of cortisol will have huge benefits on health.
I strongly believe that it is our physiological response to stress, and in this care racial hostility or marginalization that brings with it all the adverse effects previous studies have shown to be associated with just racial hostility.
A study by Richman in 2009 found that racial stressors were associated with higher cortisol levels and a blunted stress response, especially among African American women. The findings also suggested that race-related stress may have a “sustained impact on physiological stress response” and that it is “such alterations in physiological processes and adrenocortical responses in particular can have a negative impact on long-term health outcomes”. Furthermore, other studies have shown that higher levels cortisol increase the risk of infectious diseases, depression ([Mason, 1991] & [Brown, 1999]). Even more important is that recent traumatic racial stressors have a strong impact on stress related responses and prolonged stressors may alter coping responses to moderate the effects of the stressors (Richman, 2009).
Although the above study was limited to African Americans and it is therefore a limitation of the study, I agree that any stressor can increase levels of cortisol. Prolonged stress about a certain situation will cause prolonged increases in cortisol which will then leave the person vulnerable to diseases such as infections, weight gain, osteoporosis, diabetes, sleep disturbances, cardiovascular disease as well as depression (Whitworth, 2005). Therefore it is my belief that although race and socioeconomic status may have a role on health, the main issue is how a person responds to it. If racial hostility causes the person to be stressed, and cortisol levels remain high due to the person’s inability to cope or lack of high quality relationships, then they are at increased risk of health issues. I have always believed that health is a complicated thing. So many things must work together to give a person good health. Any disturbance in their life, stress whether it is racial or economic, will of course adversely affect their health. It is because of this that yes, I agree that racial hostility will no doubt adversely affect health and therefore widen the health disparities. However, I don’t believe it is from racial hostility alone. It is more about how the person, who is experiencing racial hostility, reacts to the hostility. Do they have high quality relationships? Do they have adequate support from their physicians? Is there anyone who they can speak to and lean on? Do they feel safe? Stress itself is what worsens a person’s health. If the person is experiencing increased stress and is unable to cope adequately, then their health will plummet. Therefore, based on all this, I believe that if a patient does not have a good support system, high quality relationships and good coping mechanisms, then racial hostility will definitely worsen their health.