Research has shown people of color experience higher levels of physical and chemical stress, which makes us more susceptible to health issues. This combination of troubles puts us at increased risk of contracting coronavirus. Black Health Matters spoke with David Williams, a professor of African and African American studies at Harvard, about how communities of color can fight the pandemic of stress and move forward after COVID-19.
Black Health Matters: Why are we more prone to stress and how does that lead to poorer health?
David Williams: The reasons are many. There’s more air pollution in our communities because we live in closer proximity to factories. Living in areas of higher air pollution are associated with asthma. We have higher levels of financial stress. We postpone seeing the doctor because of finances. We have higher levels of community stress. Friends and relatives are making too many demands on [people of color]. We have higher levels of major life events, like, the death of a loved one or unemployment.
Let’s think of death of a loved one—even before the pandemic. Because of higher rates of death and earlier onset of disease, black children are three times as likely to lose their mother by age 10. Black adults are twice as likely to lose a child by age 30 and a spouse by age 60.
The loss of social ties is often a loss of economic stability. COVID 19 has exacerbated all of these.
BHM: This is a lot.
DW: There’s more. We live with higher levels of discrimination—stopped by police; work discrimination; everyday discrimination; little indignities, like, poorer service in restaurants and stores. This discrimination causes stress. Higher levels of stress is associated with higher rates of high blood pressure, type 2 diabetes, a lot of the health problems that have become risk factors for the pandemic. Discrimination increases all of the co-morbidities that increase risk of COVID-19.
BHM: In 2020 we saw the explosion of two pandemics: coronavirus and racism.
DW: Yes, on top of COVID-19, we’re dealing with the added stress of police killings. That’s another type of traumatic life experience. One study found that every police killing led to elevated levels of stress for the next three months. Another study found that youth who see race-related killings, arrests, beatings online have higher levels of post-traumatic stress disorder and depressive symptoms. COVID plus the George Floyd killing contributed to high levels of stress in the black community.
BHM: A vaccine is the solution for COVID-19. What do we do about racism and stress?
DW: Reduce the risk of racism before it starts. That’s a bigger task. Research shows there are some resources that reduce the levels of negative effects of stress, including social ties, religious involvement.
Research suggests those communities that were engaged in protest, engaged in challenging the federal government, while also maintaining a place in their communities to celebrate their cultural heritage had better mental health.
BHM: We can’t fix this problem alone. What can white folks do to mitigate this?
DW: We need to create environments of psychological safety. It’s where we go out of the way to ensure everyone feels acknowledged and appreciated, treated fairly and with respect, can express their beliefs without being judged unfairly or without fear of hurting their career.
Studies have shown it’s possible to implement interventions that reduce incivility. The kind of rudeness that sometimes exists—treating people discourteously or with disrespect. Interventions teach everyone how to treat everyone with respect. Research shows these interventions are successful, increase trust in management, reduce employee burnout.
BHM: What does research show about the biology of stress?
DW: We know there are four main pathways by which stress impacts health in general. When individuals experience stress, they have negative emotions. For some people these negative emotions can lead to mental disorders. They can lead to higher levels of hypertension, depression.
Coping with negative emotional states that cause stress can lead people to engage in risky behaviors. They smoke more, drink more. They have poorer quality sleep or lower quality sleep.
This can lead to declines in the use of and access to the medical care system. Lack of engagement is particularly true for discrimination. When you have been treated badly by social institutions, the health care system is just one more social institution. This leads to less likelihood of following doctors instructions or getting appropriate screenings.
BHM: So lack of access to health care is a significant stressor?
DW: Absolutely correct that, in general, lacking access to health care can be a significant stress for families of color. I am embarrassed that I live in a country that does not guarantee what every other industrialized country offers their citizens: the right to medical care.
Some people can get into care, but incur a huge bill. Being unable to pay medical bills is the number one cause of people declaring bankruptcy in America. Communities of color have higher levels of mistrust of the health care system—it’s well founded based on historical instances. Tuskegee may be most striking, but it’s only one. We’ve been sterilized without permission, medicated without permission.
Research shows it’s not just that communities are disadvantaged because of lack of access. Even given access, communities of color receive poorer standards of care. Less quality of care, less intensity of care. Across every measure—from diagnosis to treatments—Blacks get poorer quality care. During COVID, Blacks with symptoms tried multiple times to get tested and couldn’t and ended up dying.
Racial disparities in health care are not the only disparities. Many people, irrespective of their race in rural poor communities, have problems of access and quality of care. Do we need to find ways to care for our rural communities of care across races? Yes, we do.
COVID is causing unemployment on a very large scale. Universities and hospitals may have major challenges, especially in poor communities, urban and rural. We’re looking at even worse access to and quality of care in the future.
BHM: Talk to us about biological racism in the American educational system.
DW: A relatively recent study asked medical students and residents about different beliefs about Blacks, and some of them had to do with Blacks’ ability to tolerate pain and not feeling pain. Some had to do with the thickness of skin. What was shocking was the level of misinformation, the degree of myths that existed, even among health care professional. Pain is one for which there has been research on.
Another study that looked at Latinos at UCLA Medical Center. It looked at long-bone fractures. Fifty-six percent of Latinos with long-bone fractures didn’t get any pain mediation compared to 26 percent of whites. Emory University repeated the study in Atlanta with Black patients and had the same results. Part of that is linked to implicit bias and the specific stereotype that minorities can tolerate pain.
This pattern of receiving poorer care, this was most frequently documented in the treatment of heart disease. It’s not just about pain. Blacks are given inferior care across so many domains of medical care.
BHM: Are there models of interventions that are ideal to help communities deal with stress?
DW: Providing emotional support is a universal indicator of reducing stress. This can take place within the context of the family, community organizations, the workplace and religious communities. During the pandemic we’re told to socially distance, which means physically distance, not socially. Reaching out to folks at home who can’t get out emotional support is really powerful.
Physical exercise is very powerful in reducing stress. A 30- to 45-minute bout of exercise can be as effective as antidepressant medicines at reducing symptoms of mild depression. Getting quality sleep is important at reducing stress.
Finding ways to make sure people feel valued and cared for. This reduces not just the levels of stress, but also the impact of stress.
BHM: You mentioned earlier that pollution exposure can lead to greater risk of COVID-19. Talk about policies that lead to environmental racism.
DW: The historic most powerful policy is residential segregation by race. Residential segregation developed in the late 19th century and kept the white community from contact with the newly freed slave. It was perfected in the early 20th century and has been locked in place since the 1940s, and it hasn’t really changed. The fundamental structure of residential segregation leads to living in areas of higher air pollution and other toxic substances, but also to living in communities that lack opportunity. When segregation moves into an area, you don’t have high quality schools and you have lack of access to jobs, quality of housing, city services not there. Across the United States, when you rate communities by access to opportunities for children, two-thirds of African Americans and 60 percent of Hispanic kids live in low-opportunity neighborhoods. Two-thirds of whites and Asians live in high-opportunity neighborhoods.
In 99 percent of communities across America, a Black boy in a low-opportunity neighborhood who starts at the same level of income as a white boy, by the time he reaches adulthood, his opportunities will be less.
We are kidding ourselves if we think we’re going to address racism without a Marshall plan to devote opportunities at a neighborhood level.
BHM: What should our leaders do?
DW: We need to target at the communities with greatest need. We look at income. But even looking at the income data, when we look at the economic reserves—for every dollar of wealth white households have, African American households have 10 pennies. We need to pay more attention to wealth, in terms of allocating assistance and emergency assistance. Long term, we have to step back and ask what are we doing to create long-term communities of opportunity? What are we doing to ensure schools give every child a fighting chance at success? How do we provide incentives so we can have businesses and jobs in those communities? When we have all Americans enjoying the best health they can, it strengthens our economy. It’s in the best interest of everyone to ensure this.