The Real Cause of Disparities in Health Outcomes
By: Anthony Biglan
Tags: Racism, Discrimination, Nurturance, Disparities, Evidence Based Medicine

Why do Black, Native American, and Hispanic people have worse outcomes with Covid-19 than White people? It is true that they have higher rates of obesity, diabetes, and cardiovascular disease and that these conditions make death more likely. However, these disparities are themselves due to frequent exposure to threat, intimidation, and discrimination. It will not be enough to prevent or treat obesity, diabetes and heart disease. We must make neighborhoods, schools, and families safe and nurturing.

Consider the experience of Charlene and Samuel Holly. In November 2012 Charlene was sitting in her home holding her infant granddaughter. Five other grandchildren were there as well. Suddenly, eight police officers dressed in battle fatigues broke down her door. They held the family at gunpoint for half an hour while they ransacked the house. They repeatedly shouted obscenities at the children, the oldest of which was 13.

Humans are exquisitely wired to detect and remember threat. Think about a distressing experience you had when you were a child. How long has it been since that happened? I am 76 and I vividly remember the day a classmate ridiculed me because I had some food on my teeth. A trivial event, but I remember it 60 years later. Black people are exposed to far more stressful experiences and much more frequently than I was. Research shows unequivocally that repeated activation of the stress response takes a toll on the body.

Holly’s six grandchildren were assaulted in 2012 at ages between one year and 13 years old. That would make them between nine and 21 today. Do you think they remember the night the police broke down their door and threatened them with guns? Do you think they have an adverse stress reaction when they see police officers?

The most disadvantaged neighborhoods in the U.S. are overwhelmingly populated by Black and Hispanic people. We will not reduce the disparities in the nation until we reduce the conditions in these neighborhoods that account for the bulk of these disparities. And it will not be sufficient to try improving health habits so long as people are living in neighborhoods where threat and aggression are experienced on a daily basis due to police harassment, poverty, crime, punishment in schools, and conflict in families and the community.

That is why the Coalition of Behavioral Science Organizations is working to build support for a nationwide, long-term effort to ameliorate conditions in these neighborhoods. In addition to the huge challenges of increasing prosperity and transforming public safety from warrior cops to respectful public servants, we need to help our most disadvantaged communities come together to make their schools, families, and neighborhoods more nurturing. The residents of these neighborhoods have been the victim of trauma. And what we have learned about trauma is that it is not enough to simply cease traumatizing people. They will carry the scars of their experience forward in ways that continue to undermine their health and the wellbeing of those around them. We need to promote safety, kindness, compassion, and respect.

Bio-behavioral scientists have learned a lot about how replacing social stress with nurturance can prevent the development of chronic stress-related disease. The work of Gene Brody and Velma Murray at the University of Georgia has shown that helping Black families develop nurturing ways of raising adolescent boys can prevent the development of the physiological processes that result in premature death.

For too long we have ignored the role of adverse social experience on health, including the way that racism and discrimination kill people. If we want a society where everyone lives a long and healthy life, we must evolve neighborhoods and communities that are full of kind, caring, compassionate people who listen to each other with respect and work to improve well-being of everyone.

(Figure provided by The COVID Tracking Project at The Atlantic Creative Commons CC BY 4.0 license.)