Living in a constant state of vigilance leads to chronic stress for many Black Americans and accounts for striking health inequalities in the US, a Harvard professor says.
David R Williams Photo: TEDMED
Structural inequality, the threat of daily indignities and brutal inter-personal racism leave African Americans open to a multitude of stress-related illnesses, Dr David R Williams tells Kim Hill.
Listen to the full interview with Professor Williams here
Although African Americans make up 13 percent of the US population, they account for 40 percent of the prison population.
In 2019, the unemployment rate of African Americans was 6.1 percent - over 1.6 times the national average of 3.7 percent.
In 2018, for every dollar of household income that white households received in the United States, Black households received 59 cents.
This Black-white income gap is identical to what it was in 1978, the Professor of Public Health at Harvard's TH Chan School of Public Health says.
“These are large differences in [the extent to which] income and education predicts health in virtually every country… But what we find in data for the United States is... race still matters."
Black Americans have higher rates of chronic illness than white Americans and numerous studies point to a strong racial dimension in poor health statistics. This has been well documented over the last 20 years, Williams says.
Ambulatory blood pressure tests, which measured blood pressure at random intervals day and night in healthy young people, were the most telling.
“These studies were done in multiple cities in the United States and the same pattern was found in earlier studies down in different places. The subjects were healthy young Blacks and whites with no high blood pressure and there was no racial difference in blood pressure during the day.
“But at night when they were asleep, Blacks had higher levels of blood pressure than whites… When we go to sleep our blood pressure goes down, but the pressure that declined in whites was larger than that of Blacks, so Blacks were maintaining higher levels of blood pressure even while they are sleeping.”
It is now clear that when a person experiences discrimination during the day - both overt and in the form ‘micro-aggressions’ - there will be a lack of blood pressure decline during the night, Williams says.
The unrelenting stress of living in excluded and criminalised communities means the physiological systems of Black Americans never get a break.
Days spent in a hyperadrenalised state - which is a natural response to a stressful or dangerous environment - lead to a vigilant “one eye open” type of sleep in which the body cannot fully relax and replenish itself.
Everyday discrimination, economic stress, poor service due to race, and other day-to-day indignities - as well as the threat of police brutality, racial profiling and an unfair criminal justice system - have created for Black Americans a “cultural predisposition to protect yourself where you cannot fully relax”, Williams says.
As a successful professional originally from the West Indies, Williams says he isn’t immune to this stress himself, nor are the people he socialises with.
“If I am driving down the road and I see a police car behind me, my blood pressure goes up. I feel more stressed.
“I become more tense because I have been pulled over by the police for no reason. I was pulled over by the police when I was younger and when the police said we were speeding. It was a car with five Black men. We were going to school in Michigan and driving from a Thanksgiving weekend in New York City, but we were driving through a small white community…
“They pulled us over and said we were speeding, which we weren’t. And normally the police ask for the driver’s license of the driver, but these police officers demanded the driver’s license of everybody in the car.”
“These little day-to-day indignities all add up with the big things and create a level of ongoing chronic stress.”
American studies which link poor health outcomes to systemic racism and discrimination are universal and are not contestable, Williams says.
“There are over 200 published studies from multiple studies across the world documenting that higher levels of everyday discrimination leads to worse physical and mental health.”
The disproportionately high Covid-19 death and infection rate among Black Americans is also due to systemic inequality and discrimination, he says.
“The systemic structural racism and discrimination that leads to unequal income… that didn’t just happen, that is embedded in the ways the institutions function and the systemic institutional racism that creates these qualities and leaves these disadvantaged populations of colour, that don’t have the resources, to work at jobs where they are at higher risk and in areas where there are higher levels of crowding.
“Racism is not only the interpersonal dimension, but the racism also creates these inequities in access to opportunity within society, that puts these populations at higher risk.”
Claims that racial genetics and biology can account for these figures have always been flawed, he says.
“The role of genetics and biology has been the historic claim that medicine has made for racial and ethnic differences in health ... that any differences observed were obviously linked to some innate biological characteristics.
“Yes, there is genetic variation across human populations but our arbitrarily-created racial categories do not capture biological distinctiveness for the factors that predict health.
“Genetics are important for who your grandparents are, it matters profoundly for your health as an individual, but genetics is not a powerful predictor of group differences in health.”
Dubious, too, are claims that 'Black culture' plays a role in health outcomes, according to Dr Williams.
Theories that willfully ignore social and economic context and power differentials within society can be used to victim-blame a marginalised community.
“Culture does not emerge out of a vacuum. Culture is a response to the realities and constraints of the social environment. Culture reflects how people adapt to what they have been served and what they have been given.
“For example, in dealing with the distress of discrimination, people have developed certain cultural responses to dealing with that stress… but you just can’t think of it in the abstract and separate it from the context that it emerges and the triggers of those cultural responses in the first place.”
Photo: Ehimetalor Akhere Unuabona / Unsplash
The Black Lives Matter movement, further fuelled by the killing of George Floyd by the Minnesota Police Department in May, has further highlighted America’s race problem.
Such police killings remind every Black citizen that they are at risk of random death at the State’s hand, he says.
“Every time a person is shot dead, there’s a feeling ‘it could be me'."
Although current protests and tensions add to the stress of Black communities, they also offer hope, Williams adds.
“It is raising awareness levels [which] hasn’t happened in decades in the United States and I think it’s been so comforting to see the turn-out of young people of all races saying ‘this is unacceptable, we have to do better as a society’.”
Dr David R Williams is Professor of Public Health and Professor of African and African American Studies and Sociology at Harvard's TH Chan School of Public Health.