Imagine that you’re in the middle of racist encounter. It might be someone following you in a store. You could be watching a video that captures someone who looks like you experiencing violence. You witness it and you know something bad is going down. Your mind isn’t simply reacting, your heart is, too.
What’s happening is “sympathetic overactivity,” explained Kevin Ahmaad Jenkins, a postdoctoral fellow at the University of Pennsylvania who researches health disparities. When you can feel your heart beat intensely inside of your chest, or maybe sense a funny taste in your mouth, your body is recognizing that it’s facing an “unmitigated social threat.”
“Your body is saying, ‘OK, heart rate needs to increase. We need to get the blood pressure up. We need to make sure that our muscles contract so we’re ready for anything,’ ” Jenkins explained.
“I want you to feel it as I’m saying it. Your vessels get smaller,” Jenkins continued, comparing the vessels to a hose that tenses as water flows through. “Your endocrine system fires off, which means your kidneys are moving at a faster pace. Then you have glucose levels going up. Everything I just explained happens in a healthy body.”
These physical responses are among many reasons the stress of racism concerns health experts. The racial reckoning that is happening across the country has raised awareness and discussions about preventable deaths caused by the coronavirus pandemic, and police violence. But experts say the tolls of racism pervade the U.S. health system and pose myriad health risks. And they impact Black Americans, many of whom are already facing other health crises, such as high blood pressure or diabetes, or other trauma with hidden impacts.
You might tremble, Jenkins offered for comparison, while having an argument with someone you love. But that experience may be easily resolved. With racism, Jenkins said, there’s a sense that it’s a problem that’s not going anywhere.
Black people can be experiencing a lot of different forms of racism at the same, whether it’s from an interaction or systemic. “The nation just told me the same thing that my job just told me,” Jenkins said, as an example. “it’s everywhere you go.”
Black people who have experienced anti-Blackness may have shorter life expectancies, said Clyde Yancy, chief of the cardiology division at Northwestern University’s Feinberg School of Medicine. Yancy cited a 2014 American Journal of Preventive Medicine study, which revealed that experiencing bias accelerates aging for Black men.
“We have talked about stress for a long time as a fairly abstract issue,” Yancy said. “One can no longer think about stress as just this moment of anxiety or tension. There are biological consequences with repeated exposure to stress. This is yet another way in which these things intermingle and interconnect.”
It can be damaging. Experts point to the term “weathering,” which refers to the ways prolonged exposure to stressors ultimately lead to health declines. In other words, the cumulative effects of the racism a Black person faces regularly wears down the body.
“On top of the chronic stressors and the chronic impacts on health for Black Americans, or for Black [people more broadly], now we have these acute episodes, particularly the issues around police violence,” said Patrice Harris, an Atlanta-based psychiatrist who completed her tenure as the American Medical Association president last month. “I want to just note here that you don’t have to directly experience the police violence. It is stressful; it is traumatic even witnessing police violence.”
To grasp the ways that racism can hurt someone’s health, it takes considering “the multiple dimensions from which racism occurs,” said Yancy. There’s the stress, but there’s also evidence that where people live impacts their access to health care, a clean environment, and healthy food. Also, that people of color do not receive equal care from clinicians, and that doctors often don’t represent the communities they serve.
“I don’t want to suggest that there is an overt effort of racism that permeates medicine, but rather to articulate that over time, the place where people live reflects a disinvestment in their communities. Over time, the decision-making process reflects the absence of certain voices in the education, and the leadership, even in the generation of evidence,” Yancy said. “And then, up until recently, just the ability to access care based on having health insurance was a big challenge. And even now, what’s very interesting, is that we have less of a problem with uninsurance and more of a problem with under insurance.”
Experts say that racism can lead to depression, anxiety, headaches, back pain, high blood pressure, cardiovascular disease, and diabetes, among other conditions. It can also make preexisting conditions worse.
“We have to remember to bake in the idea that so many of us are living with chronic disease,” Jenkins explained. “So even the impact of stress in a healthy body looks totally different than people that are walking around with vascular-based diseases such as heart disease or diabetes or chronic kidney disease or respiratory diseases such as asthma.”
For individuals experiencing or witnessing racism, it’s important, experts say, to develop wellness plans, monitor their own heart health closely, and exercise. Protesting and religious experiences, Jenkins said, can make people dealing with the stress of racism feel better.
Still, experts say, the necessary reforms go beyond people who’ve felt racism, and well beyond health-care centers; to address the racism, public policy and lawmakers would also need to address racial disparities in housing conditions, food insecurity, and transportation access — even sleep, Jenkins argues. Rest, he said, is “the ultimate sign of privilege, equity, and justice in this country,” and many people are losing sleep.
“We have got to reset our expectations and remember — this is more of an economic issue. This is more of an issue that goes well above the social,” Jenkins said. “And what we all got to do is lean into this moment.”
Work to address the heath disparities Harris said, has to be more than talk.