Study: Racism Is Unhealthy, Literally

It's well known that stress can lead to many health problems, and now a new study links the mistreatment frequently associated with racism to a protein that's linked to cardio-vascular disease, Alzheimer’s and other illnesses. Host Michel Martin speaks with Tene Lewis of the Yale School of Public Health. Lewis was one of the co-authors of the study.

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MICHEL MARTIN, host:

I'm Michel Martin and this is TELL ME MORE from NPR News.

Coming up, how aid groups are trying to help Haitian children recover from the emotional toll of January's earthquake, that's just ahead.

But first, for many African-Americans the connection between bad health and the stress of racism has long been part of conventional wisdom. But increasingly, it's a matter of science. New research among elderly blacks finds its suffering the mistreatment frequently associated with racism increases a protein that's linked to cardiovascular disease, Alzheimer's and other illnesses.

With us to talk more about this, is Tene Lewis. She is an assistant professor at the Yale School of Public Health. She led the new research and she joins us now. Welcome, thank you for joining us.

Professor TENE LEWIS (Division of Chronic Disease Epidemiology, Social and Behavioral Sciences Program, Yale School of Public Health): Hi, thank you for having me.

MARTIN: What gave you the idea?

Prof. LEWIS: I had been looking at the link between experiences of discrimination and various markers of cardiovascular disease in younger African-American women, and was really interested in thinking more about how these associations might play out in a group of people who had grown up in a time where discrimination was actually legally sanctioned in the U.S. So, really looking at - moving that research from looking at middle-aged women to older people, given that we know that middle-aged women came of age after the U.S. Civil Rights Movement and wanting to get a sense of what the processes might look like for people who came of age before that.

And another issue is, I would say, in the past five to 10 years, we've seen a lot of research looking at discrimination and health, racism and health all sorts of other things. But we really don't know that much about the mechanism. So, this was a nice way of actually looking at one potential mechanism, a biological pathway that might explain some of the findings that people were reporting in other studies.

MARTIN: Well, talk to me about what some of those findings are, because I think that the question a lot of people would have is, how do you know it's racism per se or it's the indignities - it's mistreatments, it's just courtesy - it's these issue as opposed to the social position that racism puts you in?

Prof. LEWIS: One of the things that we do, is we ask people how often do you feel like you're treated with less courtesy? How often do you feel like you receive less respect than other people? How often do you feel like you received poor service than other people in restaurants or stores? And we don't say, and why do you think that is? What we know is that across studies, African-Americans consistently score higher on this scale than whites.

So there's something going on there, where African-Americans feel like they're having this experience more often. So, it's a measure of what we're called stress as opposed to some of what you're talking about, which is some people just don't have access to care and someone turns them away at the door and says you can't come to this hospital, those sorts of blatant things. This is really more subtle, sort of, day to day experiences that people might report having. And we know that, for whatever reason, no matter what people think it's due to, for some reason it's not very good for your health.

MARTIN: What affect does it have on your health?

Prof. LEWIS: Well, we know that people who have more of these experiences are more likely to die sooner than people who report less of these experiences. Some of my work has shown that women, in particular, who report more of these experiences, have more atherosclerosis in their heart. So, more lesions and also to things that you don't what to have that can ultimately lead to heart attacks and strokes and those sorts of things.

Black women, in particular, who report more of those experiences have more plaque in their arteries. And we know from this study, that older African-Americans who report more of these experiences have more of this - have more C-reactive protein, which is a marker of inflammation or illness, if you will, in the body that we know leads to other sorts of diseases.

MARTIN: Why would that be?

Prof. LEWIS: That's the magic question. We know that stress matters. All else being equal, if you have more stress in your life, your immune system is more likely to be compromised, you're more susceptible to viruses and colds and all sorts of other things. And this is another form of stress. And we know that it's more common among African-Americans. We know that in some studies, African-Americans are more vulnerable to it.

So, what we don't know is, is it different from other types of stresses that people experience. So, is it worse than living in a neighborhood with, you know, limited resources. Is it worse than crime, is it worse than having a difficult relationship. Those things we don't know. But we do know that it's a form of stress that's seems to really matter for people's health.

MARTIN: What are the implications of this work?

Prof. LEWIS: Yeah.

MARTIN: And I understand you're, as researcher, your first task is to find out what you think is true. And then other people have to figure out what they're going to do about it. But I'm interested in...

Prof. LEWIS: Mm-hmm.

MARTIN: ...what do you think the implications are about what is to be done about it? I mean, I can think of a range of responses? Should people start focusing on relaxation techniques or something like that...

Prof. LEWIS: Yeah, yeah.

MARTIN: ...at an early age so that people can counteract the...

Prof. LEWIS: Mm-hmm. Mm-hmm.

MARTIN: ...affects here. I mean obviously there are people who are going to say well, you know, more justice, more equality, more, you know...

Prof. LEWIS: Absolutely, absolutely.

MARTIN: ...more fairness.

Prof. LEWIS: So...

MARTIN: ...in society, fine. But in the absence of that, what?

Prof. LEWIS: So, I get asked this question a lot, and it's always the toughest question to deal with. And I think the first thing is - there always societal or institutional things that people think, well, if we can just change things at the broader level. But the real issue is, when people say these things are happening to them, we don't know what's really going on in their day to day lives, and we also don't know that the person who is treating them with less respect and less courtesy is a way that they're doing it. So, that's the other issue.

So, I think, I really believe, the place where we want to really to fix things is at the individual level. So, working with people - and this is, you know, as a researcher - what we're doing is really looking at association. So, are these reports associated with poor health and then the next step is to figure out well, if we come up with ways to help people cope with these types of experiences, then do we see less of an affect on health.

So, for me that would be the next step. And coping can look a lot of different ways. I mean, I think the first thing would be to really figure out - there are some people who have these experiences who don't have poor health. We haven't yet figured out who those people are and what they're doing. So there are, probably are, some things that people are already doing.

And you and I can probably, you know, sit together and come up with well, you know, this happened to me and, you know, instead of allowing myself to get really upset about it or getting worked up, I talked to someone or I really allowed myself to do relaxation techniques or meditate or all sorts of other things. But, I think, for me - I guess the take home message would be we really need to figure out if we're going to work around helping people deal with these experiences. I think we really need to start with figuring out what are people if already doing that works.

MARTIN: Well, what about you? Have you, in doing this work yourself, have you changed the way you do anything? I mean, in the world of scientific research it's not, as I understand it, not always the most hospitable environment...

(Soundbite of laughter)

MARTIN: ...for your - for women...

(Soundbite of laughter)

MARTIN: ...and for people of color.

(Soundbite of laughter)

MARTIN: If I may and so...

Prof. LEWIS: Yeah, you know, and so that - that's - that's a very interesting question. I mean - we - researchers, typically you distance yourself from your science because you want to be as objective as possible. It's always difficult when you're an African-American person doing research on African-Americans and experiences that you know people around you're having, so what I do think matters is context.

And this is, you know, an area, I think, for future research. Is it worse when you're in an environment where you're the only one, versus when you're in an environment whether there others around you who share a common world view, who can offer you support and who can, you know, be a buffer or a sounding board against these sorts of experiences.

Those are things that we - we just don't know. And I honestly can't say that I've thought to myself, gosh, you know, I've been treated with less respect, less courtesy and so on. Because the other thing that's interesting about these experiences, is that although African-Americans are consistently higher than whites, people aren't that high on these scales. So, it's not as if you get these really, really high scores, you gap - some people are high, some people are low, most people are around in the middle.

But it seems as if they're something about these experiences that people can't seem to get around.

MARTIN: Tene Lewis is an assistant professor of epidemiology at the Yale school of Public Health and she was kind enough to join us from the University's studios. I thank you so much for speaking with us.

Prof. LEWIS: Thank you, this has been wonderful.

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