- Researchers say a lifelong discrimination can increase the risk of high blood pressure in Black Americans.
- The experts note discrimination over a lifetime such as not getting certain jobs produces a different kind of stress than day-to-day discrimination such as being treated disrespectfully.
- Experts say understanding the effects of discrimination on health can lead to better treatments and prevention measures.
In the midst of a movement in this country to achieve racial equality, there’s more evidence why discrimination is so toxic.
The researchers say their findings break new ground and the study has important implications for healthcare practitioners.
“Traditional risk factors, such as diet and physical activity, have been accepted as important contributors to hypertension, but social factors such as discrimination have not been recognized as an important risk factor for health within the healthcare setting,” said Allana T. Forde, PhD, MPH, the study’s first author and a postdoctoral research fellow at the Urban Health Collaborative at Drexel University in Philadelphia, Pennsylvania.
The researchers used the data from 1,845 African Americans, aged 21 to 85, who were part of the Jackson Heart Study.
That database has focused on looking at cardiovascular disease among a large sample of Black Americans in the Jackson, Mississippi, area.
The participants reported their discrimination experiences. Researchers defined that as unfair treatment over a lifetime involving school, work, getting a job, housing, money, medical care, or services.
What did researchers find?
More than half of the study participants developed high blood pressure. Those who reported high or medium levels of lifetime discrimination had a 49 percent increased risk, after accounting for other risk factors.
“Discrimination should be recognized as a risk for hypertension. But more broadly our findings suggest that we need to look at societal factors, not just clinical factors, to understand why Blacks have higher rates of blood pressure than whites in the United States,” Forde told Healthline.
“These new findings from the Jackson Heart Study are quite provocative,” added Sherman A. James, PhD, a distinguished professor emeritus at the Sanford School of Public Policy at Duke University in North Carolina.
“In contrast to frequent perceived exposure to everyday racial discrimination — people not treating you with respect or thinking you’re not smart — frequent perceived exposure to lifetime racial discrimination — not getting a job, a bank loan, a house — proved to be an important risk factor for future development of hypertension,” James told Healthline.
“It’s possible that perceived lifetime discrimination in matters relating to one’s fundamental economic security and well-being is more intrinsically and perhaps more enduringly stressful than everyday discrimination,” he added.
Dr. Ikechi C. Nnawuchi, a psychiatrist and medical director of MBI Health Services in Washington, D.C., says he sees the results of lifelong discrimination in some of his patients, many of whom lived through the civil rights era.
“Racism either at the hands of society, or in more recent times, the police, are persistent topics during our sessions,” Nnawuchi told Healthline.
“Two gentlemen, in particular, always spoke of the injustice and racial discrimination they suffered growing up. They would grow more angry as they talked about their personal experiences,” he explained. “Both had poorly controlled hypertension. During the recent ‘Black Lives Matter’ protests, their blood pressures were even higher. Once, we had to call for an ambulance.”
“They talked about how the current situation brought back memories of physical abuse and feelings of helplessness, when they felt they had little or no voice,” Nnawuchi added. “Those with the most negative experiences with racism tended to have higher blood pressures.”
Nnawuchi says training in cultural sensitivity could help providers understand that there are long-term health effects of racial discrimination.
“It could go a long way to help patients express their pent-up anger, anxiety, and sometimes fears from their past experiences,” he said. “Acknowledging versus dismissing those experiences would help providers gain trust, build rapport, and help them give the best care to positively impact the health of African American patients.”
“This type of limited supportive therapy can positively impact the patient’s hypertension by giving them an avenue to vent, help them use positive coping skills, and reduce their need for using alcohol and cigarettes that are counterproductive to maintaining good health,” he added.
“Healthcare professionals who understand the importance of unique stressors like discrimination that impact the health of African Americans will be better equipped to provide optimal patient care to this population,” Forde said.
“However, medical care is not enough. More broadly, our results suggest how social determinants such as racism and discrimination affect health in measurable ways,” she added. “Addressing these factors is critical to reducing rates of chronic diseases.”
James says the fix is obvious.
“End structural racism and we’ll likely be amazed how quickly the cardiovascular health of African Americans improves,” he said.