There's a Great Health Divide in this country that separates the races, and African Americans of all ages and backgrounds continue to find themselves on the wrong side. According to the Agency for Healthcare Research and Quality, African Americans are twice as likely as whites to develop type 2 diabetes. They're more likely to suffer from asthma and to die from it: Although they make up about 12.7 percent of the population, they account for 26 percent of all asthma deaths. And, according to the Centers for Disease Control and Prevention, the death rate from cancer is 25 percent higher for African Americans than for whites.

In fact, the overall life expectancy for African Americans falls five years short of whites'. From birth until old age, they have higher death rates. And whether they live in the inner city or the upscale suburbs, they are more likely than their white neighbors to die from heart disease, the number one killer in the United States.

African Americans often face daunting obstacles that keep them from closing the health gap. Poverty and inadequate medical care all conspire to threaten health and shorten lives. But there's one other burden that seems to weigh down far too many African Americans no matter how much they earn or where they live: stress.

Simply put, it's stressful to be black in this country, says Arline Geronimus, PhD, a professor of health behavior and health education at the University of Michigan. It's a chronic, lingering stress -- exactly the sort of strain that can set the stage for heart disease and other stress-related illnesses. She believes that understanding the sources and consequences of race-related stress could go a long way toward explaining -- and maybe even narrowing -- the racial divide in health.

Simply put, the stress of living and working in a "race-conscious" society slowly wears down black people from all walks of life, according to Geronimus. In her view, stress eventually erodes health, a gradual process that she calls "weathering."

Geronimus is the first to admit that the health divide between blacks and whites is too complicated and too vast to be captured by one word. For example, the term "stress" doesn't come close to describing the tragic consequences of poverty, which plagues many black communities. Poverty is associated with increased neighborhood violence, inferior health care, sedentary lifestyles, and poor diets -- a potentially deadly combination. A 1990 study published in the New England Journal of Medicine found that black men living in the impoverished neighborhood of Harlem actually had a lower life expectancy than men living in Bangladesh. But poverty isn't the only story: A 2005 study published in the journal Social Science and Medicine concluded that even if incomes were equal, nearly 40,000 African Americans would die before their time every year.

Genes may also play some role in the health gap. Black people are certainly more likely than Caucasians to inherit sickle cell anemia, and some may have also inherited a tendency toward more common illnesses such as type 2 diabetes. Many experts once thought that genes also made blacks prone to hypertension, but a 2005 study published in BMC Medicine largely put this belief to rest. Among other things, the study found that black people living in Jamaica or Nigeria tended to have lower blood pressure than Blacks living in the United States.

Another theory currently under challenge is that blacks are more prone to type 2 diabetes, heart disease, and hypertension due to higher levels of visceral fat, or deep belly fat, often found in people with higher body mass indexes (BMIs). Visceral fat has been found to be metabolically active and is associated with a higher risk of type 2 diabetes, among other diseases. But a recent study of white, black, and Filipino women by scientists at the University of California San Diego surprised many researchers by showing that although black women in the study tended to have larger waists and higher BMIs, their levels of visceral fat were no higher than those of their white counterparts. Among women of normal weight, African Americans' levels of visceral fat were actually lower than those of both Filipino and white women.

While biology and higher rates of poverty can put African Americans at a health disadvantage, stress may be another tipping point. Of course, anyone of any race can suffer from stress, but African Americans seem to carry an especially heavy load. In 2006, Geronimus and colleagues took a new approach to measuring the stress burden of more than 6,500 people of different races and ages. Using data collected in a national health survey, Geronimus identified 10 physical signs of stress, including blood pressure, cholesterol levels, and BMI. The approach wasn't a perfect measure of stress -- all 10 factors are also reflections of lifestyle -- but it did provide a stark view of a population in peril.

As reported in the American Journal of Public Health, the results showed "weathering" in action. After about age 35, African Americans started showing far more signs of stress than whites. The gap between blacks and whites grew larger with age, exactly what would be expected from a slow, gradual buildup of stress. The load was especially heavy for black women. As Geronimus notes, these women often face the difficult -- and stressful -- task of caring for children and keeping the family intact. Overall, the study suggests that stress may age black people prematurely by about 10 years.

Other experts agree that stress is a leading factor behind the racial divide in health. Writing in a 2007 issue of the Annual Review of Psychology, researchers from the University of California at Los Angeles concluded that race-based stress attacks health from many angles, including the brain, immune system, nervous system, and heart. Even the happiest and healthiest people may eventually succumb to such a barrage.

The hazardous level of stress faced by African Americans has many potential sources. As reported in the Annual Review of Psychology, worries about violence or employment keep many African Americans in permanent readiness for "fight or flight." Their bodies are constantly on edge, and their health may be eroded by the strain.

But even if a black person has a steady job and lives in a safe neighborhood, he or she may not be able to escape discrimination, an extremely stressful fact of life. "If you talk to any successful, well-educated African American, they all have stories about not being able to get a cab or being stopped by police," Geronimus says. "We have a belief in this country that you are rewarded for your efforts. They feel that people discriminate against them no matter what they do. It enrages them more."

Racism -- real or perceived -- can have an immediate impact on a person's health. A 2004 study published in the journal Social Science and Medicine found that African Americans who sensed discrimination at work reported especially high levels of on-the-job stress. Compared with African Americans who didn't feel discriminated against, they were also especially likely to have high blood pressure.

The idea that racism can take a physical toll isn't exactly new. A survey of the scientific literature published in the American Journal of Public Health in 2003 found 53 separate studies that investigated the link between discrimination and health. The authors noted that although there have been gaps in the research, there is still substantial consistency among the studies they have reviewed and that discrimination can be associated with poorer health overall, including problems with depression, high blood pressure, and heart disease. The authors concluded that "systematic exposure to experiences of discrimination may have long-term consequences for health."

The path between discrimination and illness, of course, may not be a direct one. As reported in the American Journal of Public Health, many of those 53 studies painted a complicated picture. For instance, several studies found that the impact of discrimination on blood pressure varied depending on a person's coping style, economic situation, or gender. Other studies found that African Americans who sense racism on a regular basis are more likely to smoke or drink excessively, providing another explanation for the poor health of people subjected to discrimination.

Stress is still a mysterious entity, and many questions remain. Researchers are just now beginning to examine the racial differences in stress among other minorities, such as Hispanics and Asians. And they're just now starting to address the biggest question of all: What can be done to protect African Americans from overwhelming stress? For now, only one thing's clear:

Until blacks and whites more evenly share the load of stress, the health gap is bound to remain -- and blacks will continue to be on the wrong side.

-- Chris Woolston, MS, is a contributing editor to Consumer Health Interactive. A former staff writer for Hippocrates magazine, he has written for Health, WebMD, and other journals. He is also the co-author of Generation Extra Large: Rescuing Our Children from the Epidemic of Obesity (Perseus paperback, 2006).

References

First published February 26, 2007
Copyright © 2007 Consumer Health Interactive

Or Find More On:

Back to top of page