Systemic racism and its uniquely stressful impact on the health of Black Americans: Where to next? • Major goals / Agenda • Historical aspects of racism for Black Americans? o Key definitions ❖ Historical trauma ❖ Racism • What is stress? • How does racism stress impact Black Americans? • How does (COVID-19) stress impact Black Americans? • Open discussion forum: What do you think works to reduce or avoid the stress of systemic racism? In the outbreak? • Recap session: Putting it all together Marcellus M. Merritt, Ph.D. Associate Professor of Psychology University of Wisconsin Milwaukee Garland Hall 216, P.O. Box 413 Milwaukee, WI 53201 (414) 229-6145 office [email protected]
67
Embed
Systemic racism and its uniquely stressful impact on the health of Black Americans… · 2020. 7. 24. · MAJOR GOALS OF WORKSHOP (Better) recognize the historical aspects of systemic
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Systemic racism and its uniquely
stressful impact on the health of Black
Americans: Where to next?
• Major goals / Agenda
• Historical aspects of racism for Black Americans?
o Key definitions
❖ Historical trauma
❖ Racism
• What is stress?
• How does racism stress impact Black Americans?
• How does (COVID-19) stress impact Black Americans?
• Open discussion forum: What do you think works to reduce or avoid the stress of systemic racism? In the outbreak?
• The Meriam Report is a guide to the “historically traumatic events” that have influenced the health of Native Americans
• As said by Evans-Campbell (2008), historical trauma is defined as “a collective complex trauma inflicted on a group of people, who share a specific group identity or affiliation-ethnicity, nationality, and religious”…
• Europeans introduced contagious diseases, alcohol, tobacco, sugar, firearms and other risk factors for disease into the slave trade. (p. 175)
• These items were used to pacify slaves & sustain American slavery
• Tragically, African slaves’ use of these substances promoted their premature risk for disease and death…and have symbolized key barriers to the health of African-Americans to this very day
• “In short, the disruption of African culture to serve the economic needs of Europeans caused profound and negative changes in the health of Africans in Africa and in the New World.” (p. 176)
• The list of health risks for slaves is a long painful one; for instance:
– Infectious and parasitic diseases linked with inadequate housing accommodations and inadequate clothing (e g., no shoes provided)
– Nutritional deficiencies resulting from contaminated water and poorly prepared and limited food options (e g., scraps of fat pork and corn meal)
– Respiratory and digestive ailments linked with excess exposure to extreme weather conditions
• Reconstruction and Jim Crow (1863-1965) represent the periods where Blacks were considered “free” but not full American citizens (e g., not able to vote or attend highly privileged and predominately White schools/colleges).
• Segregation (separate but unequal) was legally enforced in most public places
• Blacks were excluded from access to mainstream medical settings and had to go to segregated hospitals which were usually poor economically and limited in resources
• When Blacks did interact with the White medical system, they found overt and disrespectful treatment that further limited their access to treatment
• The post-Civil Rights era (1965 to present) has seen remedies to these inequalities (legally and socially)
• Racially segregated hospitals are a thing of the past, at least legally
• Along with this trend, has been some improvements in various health indicators for racial/ethnic minorities, although many of the disparities in health remain
• However, racial/ethnic minorities are stilldiscriminated against in terms of access or referrals for state-of-the-art treatments (e g., new drugs, surgical procedures) and some worsening disparities are a product of larger societal trends (e g., diabetes and obesity among Black and Native American children)
• These dynamics among other events (e.g., outing of the Tuskegee Syphilis Study) fueled mistrust of the medical care system and created wider disparities in access to and use of health care services among members of racial/ethnic minority groups.
POST “OBAMA” /“GEORGE FLOYD”
AND BLACK LIVES MATTER (2016 -?)
Age of persisting discrimination in
an apparently “post-racial” world,
albeit subtle in most cases.
Violations seen as irrelevant
departures from a new norm.
INTRO TO RACISM: GENERAL POINTS AND
ARGUMENTS
Jane Elliot in her “brown eye/blue eye” study argued that humans experience negative social outcomes because of the larger social worth of superficial features. However, for members of racial and ethnic minority groups these arbitrary factors have permanence and strong psychological meaning
◦ (e.g., “Living while Black” - based on accumulated personal experiences and socialization http://www.npr.org/templates/story/story.php?storyId=111388878
*As with the term “race”, the definition of “racism” is varied, contradictory, and slippery
◦ Racism (as defined by Clark p. 150): “beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation.”
◦ It usually includes facets of unequal power, oppression, or dominant vs. deprived group status
OUTLINE Comments –1) Graded In class EXAM #2 returned on Tuesday/ Take Home Exam #2 due Tuesday May 1.2) The corrected and updated class and reading schedule (see handout).3) Research papers were due by 11:59pm on Tuesday by hard copy or by submission to D2L - late papers will be penalized five points per day
Recap Lecture on Introduction to concept of racism and link to health (5)◦ Determinants of health model (Ch. 7) as a framework◦ Definition and “logic” (plus key terms)◦ Videos: “Imus issue”, Doll studies, “The Calgary experience”
Discussion groups- discuss meaning of racism and stereotypes in terms of Imus comments and Calgary video (Is this racism? How would you respond to it?) (8)
Continue with coverage of different aspects of racism (42)◦ Psychological (cognitive, emotional, racial identity) (15)◦ Behavioral (example of experience with housing discrimination; “Kill Bill!”) (20)◦ Social (5)
Impact of modern racism – the invisibility syndrome (from Franklin, 2001) (5)
Preview Tuesday 5/1 lecture (Cover racism and health)◦ Homework for Tuesday: Read Blascovich, 2001 & Merritt, 2006 papers. Submit five DQ’s for each reading by Tuesday 5/1.
ABC News - Sept. 21, 2006 — Studies of resumes have found that
people with black-sounding names are less likely to get callbacks.
"20/20" put 22 pairs of names to the test, posting identical
resumes except for the names at the top.
The resumes with the white-sounding names were actually
downloaded 17 percent more often by job recruiters than the
resumes with black-sounding names.
What are some of those names? Here's a list from the book
"Freakonomics," by Steven D. Levitt and Stephen J. Dubner,
showing the top 20 whitest- and blackest-sounding girl and boy
names.
20 "Whitest" Girl
Names
Molly
Amy
Claire
Emily
Katie
Madeline
Katelyn
Emma
Abigail
Carly
Jenna
Heather
Katherine
Caitlin
Kaitlin
Holly
Allison
Kaitlyn
Hannah
Kathryn
20 "Blackest"
Girl Names
Imani
Ebony
Shanice
Aaliyah
Precious
Nia
Deja
Diamond
Asia
Aliyah
Jada
Tierra
Tiara
Kiara
Jazmine
Jasmin
Jazmin
Jasmine
Alexus
Raven
20 "Whitest" Boy
Names
Jake
Connor
Tanner
Wyatt
Cody
Dustin
Luke
Jack
Scott
Logan
Cole
Lucas
Bradley
Jacob
Garrett
Dylan
Maxwell
Hunter
Brett
Colin
20 "Blackest"
Boy Names
DeShawn
DeAndre
Marquis
Darnell
Terrell
Malik
Trevon
Tyrone
Willie
Dominique
Demetrius
Reginald
Jamal
Maurice
Jalen
Darius
Xavier
Terrance
Andre
Darryl
HAVE YOU EXPERIENCED ANYTHING
SIMILAR TO THIS (THAT YOU CAN
DIVULGE)?
3 TYPES OF MICROAGGRESSIONS
Microassaults: Conscious and intentional
actions or slurs.
Like using racial epithets, or purposely serving a
white person before a person of color in a bank.
Microinsults: Verbal and nonverbal messages
that subtly convey rudeness and insensitivity
and demean a person's racial identity.
Like a professor who asks a student of color how
she got into college, implying she may have gotten
in by way of affirmative action or quota system.
Microinvalidations: Messages that subtly
exclude or negate or the thoughts, feelings or
experiential reality of a person of color.
For instance, non-Asians often ask Asian-Americans
where they were born, sending the message that
they are perpetual foreigners in their own land.
Why can microaggressions be distressing for
the targets?
APPLICATION: WHAT IS STRESS?
In your chat box, type in 2-3 relevant events or things
that you find stressful in your daily life (e.g., paying
bills or work conflicts).
Then, go back and rank order those events or things
in terms of their perceived psychological and
physical health impacts.
WHAT IS STRESS(OR)?
Def. The psychological, behavioral,
and physiological aspects of being
in a situation that is perceived as
harmful to one’s well-being or ideal
comfort level (quoting the great
philosopher Marcellus M. Merritt, circa 2007)
Psychological (includes social)
◦ Thinking about an impending speech
(e g., feelings of anxiety)
Behavioral
◦ Giving a speech before an auditorium
full of people (e g., stammering)
Physiological (biological)
◦ Elevated physiological response during
the speech (e.g., increased blood
pressure and racing heart)
Stimulus = Stressor ResponseTraumatic event, Life event, Daily hassle Person factors
THINGS THAT MAKE STRESS HARD
TO STUDY / UNDERSTAND
complex
multidimensional
pervasive
frequent
unpredictable
intense
undesirable
uncontrollable
ambiguous
unconscious
“healthy”
treatable
SYSTEMIC RACISM AND ITS UNIQUELY
STRESSFUL IMPACT ON THE HEALTH
OF BLACK AMERICANS:
WHERE TO NEXT?
How systemic racism may affect health
disparities for Black Americans
SYSTEMIC
RACISM
(“usual”)
STRESS
BLACK
AMERICAN
HEALTH
COPING
RESOURCES
-
-
-
-
-
-
HOW DOES RACISM STRESS IMPACT
THE HEALTH OF BLACK
AMERICANS?
AFRICAN AMERICAN STRESS
EXPERIENCE?
First, what do we know about how
African Americans experience
stress?
Williams’ (2018) national survey of
racial disparities in stress
experience (Black vs. White)
More stressors
Stressors are seen as more intense
and prolonged
Thus, higher stress is more likely to
predict premature illness and death
So, race is a go-between for the
link between stress and disease
THE WEATHERING HYPOTHESIS
AND PREGNANCY OUTCOMES
• Recent studies show that as African American women age they are more likely to have low birth weight infants than White women of similar ages.
• The weathering hypothesis (Geronimus, 1992) in this context argues that the health status of African American women starts to prematurely decline in young adulthood.
– elevated blood pressure, early signs of vascular disease (e.g., stroke), depressive symptomology, impaired hormonal response, less exercise
• The key mechanisms for this weathering are chronic exposure to psychosocial and economic stress and sustained active coping with demanding stressors.
– family conflicts or responsibilities, limited socioeconomic opportunities, harassment or discrimination at work (Dominguez, et al., 2008), dating conflicts, academic stress, inadequate social support mechanisms, neighborhood stress (“role overload”).
• Premature aging and related health risks can have adverse effects on pregnancy outcomes (e.g., low birth weight).
CAN ANYONE THINK HOW
WEATHERING HAS UNDULY
AFFECTED YOUR AGING PROCESS?
HEALTH (PHYSIOLOGICAL)
EFFECTS OF RACISM
• Recent studies show that discrimination works like
other mental stressors (Dion et al., 1992; Krieger & Sidney
1996; Thompson, 1991; Williams et al., 2000) and is a major
contributor to mental distress for people of color.
– Indeed, one study of minority group members by Kessler et al. (1999)
ranks it with major negative life events such as the death of a loved
one, divorce and job loss.
• As shown in Clark (2002, see the next slide), exposure
to and perceptions of racism can lead to objective
health risks.
CLARK MODEL: RACISM TO HEALTH
Summary: It is NOT SIMPLY exposure
but also how one appraises and copes
with stressors (and the moderating
role of related biological, social and
behavioral factors) that molds health.
"Race has always been my biggest burden. Having to live as minority in America. Even now it continues to feel like an extra weight tied around me" (Ashe & Rampersad, 1995, p. 306).
LaVeist, TA (2006). Minority Populations
and Health: An introduction to health
disparities in the United States.
HEALTH EFFECTS OF RACISM
• Recent studies show that discrimination works like
other mental stressors (Dion et al., 1992; Krieger & Sidney
1996; Thompson, 1991; Williams et al., 2000) and is a major
contributor to mental distress for people of color.
– Indeed, one study of minority group members by Kessler et al. (1999)
ranks it with major negative life events such as the death of a loved
one, divorce and job loss.
• As shown in Clark (2002, see the next slide), exposure
to and perceptions of racism can lead to the following
objective health risks:
– Physiological reactivity (e.g., blood pressure reactivity to racist
statements and less nighttime BP dipping, Tomfohr et al, 2010)
– Health behaviors (e.g., For African American and Black Caribbean
respondents in the National Survey of American Life Study (NSAL),
every 1 unit rise in everyday discrimination positively predicted (DSM-
IV) alcohol and drug use disorders (Hunte & Barry, 2012)
– Mental health (e.g., African American and Black Caribbean
respondents in the NSALwho were high on “Chronic Discrimination”
(vs. those who were high on Low Discrimination, Disrespect and
Condescension, or General Discrimination) were much more likely to
meet DSM-IV criteria for generalized anxiety disorder and major
depressive disorder, Clark et al., 2015)
– Biomedical health status (e.g., higher mortality rates in segregated
areas and census tracts where there are higher mean scores on
disrespect of African Americans; Kennedy, 1997) (See next slide)
Hypotheses (originally linear in nature)
• The specific aims were to determine if:
(1) exposure to an overtly racist (vs. “non-racist”) stressor is
linked with increased blood pressure (BP) reactivity to active
speech, anger recall and ensuing rest periods and
(2) if perceived racism (PR) is linked to BP reactivity to racist
stressors
Sample
▪ 58 Black healthy and employed men (aged 23-47)
Procedure
▪ Collect blood pressure (BP) and heart rate (HR) during:
➢ a one-minute neutral reading task
➢ a ten-minute active speech task with racist or “non-racist” content in an audiotaped shopping scenario (five-minute speech preparation and five-minute presentation)
➢ a five-minute anger recall task
How subtle racism can increase riskMerritt, M. M., Bennett, G. G., Williams, R. B., Edwards, C. L., & Sollers, J. J. (2006).
Perceived racism and cardiovascular reactivity and recovery to personally-relevant
Period x Stressor effects on diastolic BP responses
Non-racist RacistF(7, 476) = 2.21; p < .07
Play Audio Racism Question
Dia
stoli
c B
loo
d P
ress
ure
(m
mH
g)
How much racism did you see in the shopping scenario?
0 = None 1 = A little bit
2 = A moderate amount 3 = A great deal
4 = An extreme amount
0
5
10
15
20
25
0* 1 2 3 4
Freq
uency
*Levels: 0= none; 1= a little bit; 2= a moderate amount;
3= a great deal; 4= an extreme amount
Frequency of perceived racism (PR) in shopping scenario
by stressor condition Racist Non-racist
• NRC- no PR (n= 15)
• NRC- hi PR (n= 8) – “a great
deal” or more
• Blatantly Racist Condition only
(BRC, n=36)
Period by Stressor by Perceived Racism
effects on diastolic BP levelsNRC-no PRF(7, 47) = 2.08; p < .05
Play Audio Racism Question
NRC-hi PR
BRC
Base Read Rest1 Prep Present Rest2 Anger RecallRest3
74
78
82
86
90
94
98
102
106
110
Dia
sto
lic
BP
mea
n l
evel
(m
mH
g)
* *
Summary & Conclusions
◼ Contrary to prediction, we found that the “non-racist” (NRC; compared to racist) stressor was linked with larger increases in diastolic BP during anger recall
◼ However, when we examined perceived racism (PR) scores, those in the NRC group who reported more PR showed notably larger BP responses after the presentation and anger recall tasks
◼ That the increased BP was only seen after the presentation suggests a rumination effect of the “non-racist” condition here (e.g., stereotype threat or attributional ambiguity; Blascovich et al., 2001) – subjects were trying fill in the attributional blanks
◼ The residual arousal for delayed recovery is usually not good for responses to later stressors
◼ MECHANISMS??? (anger coping, past exposure)
MUJAHID (2010). NEIGHBORHOOD STRESSORS AND
RACE/ETHNIC DIFFERENCES IN HYPERTENSION
PREVALENCE (THE MULTI-ETHNIC STUDY OF
ATHEROSCLEROSIS). IN AMERICAN JOURNAL OF HYPERTENSION.
Studied whether individual-
and neighborhood-level
chronic stressors add to
hypertension (HTN)
disparities.
Participants (45-84 years)
living in Baltimore, New York,
and North Carolina.
HTN assessed as systolic or
diastolic blood pressure
≥140 or 90 mm Hg, or taking
antihypertensive
medications.
Individual-level chronic stress
assessed by self-reported
chronic burden and
perceived major and
everyday discrimination.
An index of neighborhood
(census tract) chronic
stressors (i.e., physical
disorder, violence) created
using results from a
telephone survey.
The prevalence of HTN was
59.5% in African Americans
(AAs), 43.9% in Hispanics,
and 42.0% in whites.
TAKE HOME: Neighborhood
chronic stressors may add to
race/ethnic disparities in
HTN prevalence in the U. S.
IS PERCEIVED RACISM
IN THE GENES? [GREGOSKI,
ET AL. 2013]
Everyday discrimination scores are
linked with higher ambulatory blood
pressure (BP) and reduced nighttime
dipping, and the endothelin-1 (ET-
1)/Lys198Asn polymorphism is linked
with higher resting BP and elevated
BP reactivity for African Americans
versus White Americans.
However, the joint effects of these
factors on BP control are unknown.
The everyday discrimination scale
done by 352 (175 African American)
young adult normotensives, after that
24-hour ambulatory BP monitoring.
Among African American ET-1 T-allele
carriers, increases in everyday
discrimination predicted lesser
nighttime dipping.
Fig. 2 a, b Nightly dipping based on
ethnicity, Lys198Asn T-allele carrier
status by everyday discrimination. EA
White Americans, AA African Americans,
LowEDS (a left) everyday discrimination
below median, HighEDS (b right)
everyday discrimination on/above
median. Lower scores indicate
less dipping.
HOW DOES STRESS OF COVID-19
IMPACT AFRICAN AMERICANS?
In recent months, strong evidence has
arisen that COVID-19 is deadlier for
people who are:
elderly
those with chronic health ailments
those whose living or working situations
make social distancing tougher
These issues mean that the disease
has chiefly hurt many minority (non-
White) communities badly, in large part
by interrupting long-standing traditions.
Of note is the unique stress linked with
the pandemic for African Americans.
UNIQUE STRESS OF COVID-19 FOR
AFRICAN AMERICANS
Disparities in preexisting medical
conditions exacerbate health
effects of COVID-19 diagnosis
Lack of access to quality health
care and health information leads
to inadequate prevention efforts
Poor living conditions (e.g., over-
crowding or structural deficits)
means more exposure
Low job status and lack of work-at-
home resources means higher
exposure in public or work settings
SYSTEMIC RACISM AND ITS UNIQUELY
STRESSFUL IMPACT ON THE HEALTH
OF BLACK AMERICANS:
WHERE TO NEXT?
How high-effort coping with daily stress
affects health disparities for Black
Americans
SYSTEMIC
RACISM
(‘usual’)
STRESS
BLACK
AMERICAN
HEALTH
COPING
RESOURCES
-John Henryism
active coping?
-
-
-
-
PERCEIVED LACK OF CONTROL MAY
IMPACT THE RACISM AND STRESS
LINK FOR BLACK AMERICANS
❑ Black Americans work hard to provide for themselves,
their families, live in harmony with their own beliefs and
social expectations and expect fair treatment, support,
and gratitude in return for this hard work.
❑ This effort at controlling one's milieu by way of hard
work and behaving in step with society's expectations has
been termed as "John Henryism“ (James, 1984).
❑ John Henryism is formally defined as the value of hard
work and determination in the face of extreme and great
odds (e.g., racial exclusion; James et al., 1983).
❑ Facing many instances of racism can create a feeling of
not being valued or being viewed as a person of little or
no worth for both Black men and women.
❑ This sense of invisibility can promote feelings and
beliefs, as Black Americans, that we cannot control
whether our talents, abilities, character, and right to
safety are acknowledged by others in society.
HEALTH DISPARITIES:
JOHN HENRYISM?
The origin of health disparities is likely an interaction of social, psychological, and biological factors
The historical struggles of newly freed African Americans to realize the American Dream and the vast institutional racism and social barriers against successful outcomes
Some followed a coping style akin to the Protestant work ethic to deal with these barriers (“self-reliance”)
The legend of John Henry typifies this orientation among some African Americans
Ballad of John Henry's Hammer http://www.youtube.com/watch?v=xxReOxRwS-g