Racial Inequality and Matters of the Heart

Structural racism predicts worse cardiovascular health for blacks

Published on May 1, 2014 by Elaine Meyer

Blacks in states where they experience more systematic disadvantage than whites have worse cardiovascular health than those in states where they have greater opportunity, according to a study published in the journal Social Science & Medicine.

While past research has looked at the effects of self-reported experiences of discrimination on health at an individual level, this study is one of the first to examine how unfair treatment at an institutional level contributes to health, according to the authors, Dr. Katherine Keyes, an assistant professor of epidemiology, Dr. Mark Hatzenbuehler, assistant professor of sociomedical sciences, and Dr. Alicia Lukachko, a postdoctoral alumna of the Psychiatric Epidemiology Training Program, all from Columbia University’s Mailman School of Public Health.

To determine what the researchers call “structural racism,” which they define as “the systematic exclusion of blacks from resources and mobility in society,” they looked at the percentage of blacks compared to the percentage of non-Hispanic whites in each of the 50 U.S. states on several measures: holding a college degree, employment, incarceration, and participation in the state’s political system.

They found that blacks were more likely to report having had a heart attack in the past year in states where there were a low percentage of blacks and a high percentage of whites employed, well educated, and politically represented–representing greater inequality of opportunity. In states where blacks were more over-represented in the prison system relative to the percentage of the state that is black, they were at greater odds for a heart attack in the past year. Across the United States, blacks are jailed or put in prison from two to 14 times as much as whites.

Interestingly, the results indicate that structural racism plays a larger role than socioeconomic status in determining health outcomes: in states where on average blacks occupy lower socioeconomic status, the health disparities were not as pronounced as they were in states where the gap in opportunity between blacks and whites was greater.

structural racism

On the left is a section of an 1897 lithograph depicting scenes pertaining to African American history (copyright BF Hammond), and on the right is a street scene of modern Detroit.

“While inequality does track with socioeconomics of U.S. states, there is considerable variation; for example, states like Maine and New York have higher rates of inequality than would be expected given their economic profiles,” says Dr. Keyes.

As for whites, they reported better cardiovascular health in states where there was more structural racism.

“While many recognize that disparities in civil engagement, incarceration, and employment are problematic on a social level, this is among the first study to show an association between these structural forms of inequality and health.”

“These results raise the provocative possibility that structural racism may not only harm the targets of stigma but also benefit those who wield the power to enact stigma and discrimination,” write the authors of the study.

The only area in which structural racism did not appear to influence health in the direction the researchers expected was in job status. Black Americans in states with greater parity in terms of the relative percentage of blacks and whites in high status executive or managerial positions actually were at higher odds of a heart attack than those in states with a greater disparity.

This is not the first time researchers have observed this. Epidemiologist Dr. Sherman James found that blacks in high status positions cope with structural racism like the pressure to assimilate and defy negative racial stereotypes by putting forth high levels of effort, often at the expense of their health. Dr. James called this phenomenon John Henryism, invoking an American folk figure who worked himself to death while he was successfully competing against a steam powered machine.

“People with high levels of [John Henryism] and inadequate resources have a much higher prevalence of health disorders… because they drive themselves toward reaching specific goals at the expense of their health, often without realizing they are doing so,” says research that emerged from a 2006 symposium on the subject.

“While many recognize that disparities in civil engagement, incarceration, and employment are problematic on a social level, this is among the first of studies to show an association between these structural forms of inequality and health,” says Dr. Keyes. “Our results suggest that improving social conditions at a very macro level, which is logistically difficult but has been done many times before, may have positive health benefits for those Americans with the highest levels of many chronic adverse health events.”

Edited by Dana March

Elaine Meyer
Elaine Meyer has worked as a journalist covering education and legal news. She graduated in 2009 with an M.S. from Columbia School of Journalism and is currently the associate director of communications for Columbia’s Department of Epidemiology, where she carries out the department's mission of translating public health science to the larger public. Follow her @emeyer5.

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