Is Race Really Linked To Hypertension?

The high rates of blood pressure among African-Americans have confounded doctors and scientists for years. Host Michel Martin speaks with Clarence Gravlee, an anthropologist at the University of Florida, who believes that bigotry against blacks is a primary factor driving up blood-pressure rates and genes don't play as big a role as many think.

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MICHEL MARTIN, host:

Now to a story about health and race. The persistence and staggering rate of high blood pressure among African-Americans remains a riddle that has eluded doctors and researchers alike.

More than 40 percent of African-Americans suffer from the disease, according to the American Heart Association. Now, a lot of people believe that genetics is the explanation for the high rate of hypertension and cite African ancestry as the cause. But blood pressure rates among Africans are low. So what's the answer?

University of Florida anthropologist Clarence Gravlee thinks racism and social discrimination could be principal causes for this extraordinary incidence of hypertension among African-Americans. To explain further, he's with us now. Thank you so much for joining us.

Professor CLARENCE GRAVLEE (University of Florida): Thanks, Michel. Thanks for having me.

MARTIN: Now, the idea that there is some link between race and health conditions. But what is it that your research is attempting to discover that has not been previously known?

Prof. GRAVLEE: What I'd say we're trying to do is two things: First, we're trying to ground an understanding of how people experience race and racism. And we're also trying to bring together the social and the biological sciences. So in my current work, I'm collaborating with a geneticist to try to examine the full complexity of hypertension, studying both social and genetic factors.

MARTIN: And what does that mean? I mean, what do you think the social factors are?

Prof. GRAVLEE: Well, they're wide-ranging. You know, I should begin by saying that one of the striking things about research in this area is that the assumption that genes are part of the answer is pervasive, but hardly anyone tests that assumption directly. And if they do so, they often ignore some of the many social factors that could influence blood pressure.

So we know that there are basic and obvious factors like diet and physical activity that matter. But we also know that poverty is a associated with hypertension, also the type of neighborhood where you live, the availability of fresh produce, the amount of crime, the amount of stress that people experience in their day-to-day lives. There's more and more evidence now that these factors are important to solving the puzzle of hypertension.

MARTIN: Talk to me about what - your study in Puerto Rico.

Prof. GRAVLEE: The goal of that study was to try to understand a puzzle that stretched back to the 1960s, and that has to do with a relationship between skin color and blood pressure within populations of African ancestry. One of the intriguing pieces of this puzzle is that if you look within populations of African ancestry, not just in the U.S., but also in the Caribbean and parts of Latin America, we see an association between darker skin color and higher average blood pressure. And the same pattern had been observed in Puerto Rico and in parts of South America.

The original study, which was published in the Journal of the American Medical Association back in 1970, used skin color as a proxy for understanding African ancestry. So the assumption was that darker-skinned people had more African genes, and that that African ancestry was related to risk of hypertension. But some critics pointed out that the social and cultural meaning of skin color might be part of the answer - that is, darker-skinned people are more likely to be poor. They're more likely to experience discrimination in their everyday lives, and that the sorts of social stressers associated with those factors might help to explain the puzzle.

MARTIN: It sounds, in a way, like you're shifting the balance, here. I think that you're saying that the traditional understanding has been that the role that race plays has been strictly genetic, that for whatever reason, if you are of a certain genetic makeup, you have certain vulnerabilities. It sounds to me like your hypothesis is that perhaps it's the social conditions associated with race play more of a role than people would believe.

If that's the case, then, shouldn't it be that as you achieve more affluence, more social mobility, that some of these health conditions disappear? And do they?

Prof. GRAVLEE: Well, in part, that is true. In part, it is the case that as people achieve greater levels of education and income, their lives do improve. And for almost any health outcome that we examine, if you take into account differences in education and income and occupation, racial inequities in health narrow, if they don't disappear altogether. But in many cases, there remained some persistent association between race and health. And that attests to the enduring significance of racism, that racism affects people's lives in ways that aren't fully captured by education or by income or by occupation.

MARTIN: What are some of the challenges in doing this work?

Prof. GRAVLEE: I would say that one of the key challenges - especially for a white researcher like me - is to come to terms with the historical legacy of relationships between researchers and especially African-American communities. There's - as you know - a long history of exploitation and abuse of African-Americans and of African-American communities. And so one of the things that we have had to grapple with is what our responsibilities are as researchers coming into a community, asking people to participate with us, and how can we involve people in the process as partners rather than as subjects in the research.

MARTIN: So when do you expect to report your findings?

Prof. GRAVLEE: Well, for the work that's ongoing now in Tallahassee, Florida, we expect to begin reporting findings in the next year.

MARTIN: And how do you think this will change our thinking about health if your findings hold up? What if it is, you know, social factors that are really beyond your control? How do you really reduce the stress of racism?

Prof. GRAVLEE: Well, I think that one of the big implications - not only of my work, but of lots of researchers who are working in this area - is that we have to think about health beyond health care. We know that health is, in fact, influenced by one's access to quality health care, and we know that things like diet and physical activity - we know that those things are - matter. But we also know that the social environment matters. We know that that the quality of neighborhoods and the availability of jobs and schools, that all of these other social factors also impinge on health. The implication of that for me is that it means that we can identify policy levers that will improve the quality of life and improve the health of people.

So we need to be thinking broadly that health policy isn't just about health care policy, but it's also about transportation policy and jobs policy and education policy, that when we improve the quality of communities, we're also improving the health of people.

MARTIN: And finally, though, Professor Gravlee, there's a lot of - this is kind of beyond your subject area. But there's been a lot of discussion in the last couple of years since Barack Obama's election as president that we are now in a post-racial era. And while many people sort of dispute that characterization for, you know, all kinds of reasons, it would suggest that there really is a lack of patience right now for conversations that have to do with race, that people feel that we really are beyond it. And to people who have that perspective, you know, what would you say?

Prof. GRAVLEE: What I would say is that, you know, the work that we're doing in Tallahassee now, in the first couple of years of the project, what we have been attempting to do is to understand how African-Americans in this community experience race, and how they experience racism. And we have documented the many ways that racism continues to impact people's lives. And this cuts across boundaries of social class. It's not just something that affects poor African-Americans. And it's not just about individual attitudes. It's also about the extent to which the core institutions in our society are organized around principles of race. And so we have a lot of work to do to achieve equity in the basic organization of society.

MARTIN: Clarence Gravlee is an anthropologist at the University of Florida. He joined us from the campus in Gainesville, Florida. I thank you so much for speaking with us, and we await your findings.

Prof. GRAVLEE: Well, thank you for having me.

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