“I am glad COVID has ‘laid bare’ structural racism and inequalities in health care and health for some folks. Welcome. We are happy to have you join us in the fight of our lives.”
-Dr. Robin Stevens, Associate Professor of Communications, University of Southern California
By Glenn Ellis
Throughout modern U.S. medical history, official reports and statistics have documented, and confirmed, the disproportionate burden of health carried by the Black community. Now, COVID-19 has not only brought incredible attention to myriad of chronic diseases and social determinants that lead to those health
outcomes but has made clear and indisputable how systemic racism works.
For all of us in the United States, the phrase “health disparities” or “health inequities” has never been made clearer than what are seeing with the impact of the COVID-19 pandemic on Black communities. For what is arguably the first time in this nation’s history, the entire country is witnessing exactly what has been historically denied the Blacks in health care. For generations, health disparities were thrust on us as though it was something “biologically wrong” with us.
Many of us, and the rest of America, believed that we were supposed to have higher rates of high blood pressure; diabetes; obesity; asthma; and many other chronic diseases. That led to societal acceptance of the rate with which we die so prematurely; without any true medical or public health intervention.
High blood pressure is one of those “Black” diseases that is not only a chronic condition itself, but also is linked to heart attacks and strokes. For Blacks, the risk of being diagnosed with diabetes is 77 percent higher than for whites. A similar gap, with poor outcomes in equity, follows with all other chronic conditions.
It was an acceptable fact that mistrust in Blacks is something we are born with that gets triggered by a memory or experience of an event or incident that we should “get over it, that was a long time ago!” Blacks, and mistrust were thought to be as inseparable as hand in glove. It was accepted as “fact” by many of us, and the entire health care system. Finally, because of COVID-19, all of America is feeling (and seeing) our pain.
For Blacks, the good news is that there is an underlying factor in these inequities that is seldom, if ever, mentioned in the scientific and medical reports that we get consistently in the media that “normalize” the notion of Blacks having higher rates of chronic diseases.
Turns out, we are the victims of an absence of a piece of vital information when it comes to understanding why we are “cursed” with so many chronic diseases that seem to affect generation after generation! Studies have shown that a term, first coined in 1993, called allostatic load is a huge factor in the unequal prevalence of chronic diseases between whites and Blacks in this country. Allostatic load is “the wear and tear on the body” which accumulates as an individual is exposed to repeated or chronic stress.
Your brain interprets and responds to environmental challenges that we all face in our lives. It manifests as anxiety disorders, depressive illness, hostile and aggressive states, substance abuse, and post-traumatic stress disorder (PTSD). There is growing evidence that depression and hostility are both associated with chronic diseases. This plays out as a product of the risk factors associated with early childhood experiences of abuse and neglect, which in turn increases their allostatic load later in life and lead many people into social isolation, hostility, depression, and subsequently to higher rates of chronic conditions than others.
Those individuals with a history of childhood abuse suffer greater early death and sickness from a range of chronic diseases. We find the same principle in those elderly who have had a lifetime of economic hardship ending up experiencing a more rapid decline of physical and mental functioning
All of this previously unknown information is a clarion call for Blacks to be vigilant in chronic disease management and pay close attention to diet, lifestyle, and primary healthcare. We all know that “when America catches a cold, Black people get pneumonia.” Whether it’s COIVD-19; chronic diseases, HIV/AIDS, or any of the other health issues that wreak havoc on us, we’ve got to realize that only we can save ourselves, and live healthy, productive lives.
Chronic diseases represent 75 percent of all health care costs in the United States and are 60 percent of all Americans have at least one chronic disease, representing 70 percent of all deaths. By 2030 that the total number of Americans will exceed 170 million.
Chronic diseases are linked strongly to the effects of structural racism on Blacks, but we don’t have the luxury of waiting for the system to change. We are not capable, on our own, of eliminating structural racism in our society; particularly in healthcare and medicine. What we can do is take care of ourselves as best of our abilities. Diet; lifestyle; stress management; and physical activity are things that help us all people protect their health, particularly from chronic diseases. It is even more important to be behaviors that Blacks have to pay even closer attention. There is much more to be done, as great disparities in this country in wealth, income, and education continue to plague our community.
Glenn Ellis, MPH is a Visiting Scholar at The National Bioethics Center at Tuskegee University and a Harvard Medical School Research Bioethics Fellow. He is author of Which Doctor? and Information is the Best Medicine. For more good health information visit: www.glennellis.com.