During a recent meeting about violence and trauma in marginalized communities, Wizdom Powell, PhD, asked a young man of color in attendance, “What do boys and men in your community need to thrive?”
“Love,” the young man replied. “The problem for us is that you [adults in society] look through us. You don’t see us, and you don’t love us,” he continued. “And so what we do is we go out and we find our love in other places. We make our own love.”
Powell, the head of the Health Disparities Institute at UConn Health, recalls being floored by the young man’s response, which attested to the resilience of vulnerable people in dire situations.
“I think they have a lot of the answers,” Powell said of marginalized young people after recounting the impactful exchange. “Unfortunately, we [as a society] don’t listen enough to them.”
In a new report from the American Psychological Association (APA), Powell and a team of researchers are spotlighting a serious problem in the United States: Racial and sexual minority men and boys are among the nation’s unhealthiest people.
The report outlines how a constellation of factors — traumatic events like sexual assault and discrimination, substance use, depression, and violence — contribute to poor health outcomes and shorter life spans for members of these communities.
The statistics are jarring. For example, African-American men have an average life span that’s six years shorter than white men, the APA report notes.
Suicide among black children under 18 has spiked 71 percent in the past decade.
For these individuals, the factors damaging their health are beyond their control. “These outcomes are not the byproducts of poor health behaviors or individual failings,” stressed Powell. “In fact, there are larger structural forces at play.”
The structural forces are substantial
Boys and men of color experience higher rates of poverty, unemployment, and incarceration than their white counterparts. Their environment harms their health.
Members of this group are likelier to live in areas with high crime rates and exposure to toxic chemicals. These areas also have limited access to healthcare, education, and occupational opportunities.
Gay and bisexual boys and men also face unique health challenges.
This group is still the most severely affected by HIV. In fact, half of black gay and bisexual men will acquire the virus in their lifetime, reports the Centers for Disease Control and Prevention (CDC).
Additionally, gay and bisexual youth face rising rates of bullying, suicide, and hate-based violence, which have escalated in today’s political climate.
A recent report from the independent research institute RTI International backs up the APA report, noting the intersection of these identities are especially vulnerable.
For instance, the APA report’s chapter on violence outlines how homicide is the leading cause of death for black males ages 15 to 34. And gay males are more likely to experience violence than other sexual minorities.
The toll isn’t just physical, either. Discrimination and violence are stressors that harm mental health as well.
Moreover, health disparities between all African-Americans and whites are sizable. Diseases and chronic conditions, like high blood pressure, diabetes, and stroke, impact African-Americans at earlier ages than white people.
The CDC’s report also notes members of this community ages 18 to 49 are twice as likely to die from heart disease than whites. And African-Americans ages 35 to 64 are 50 percent more likely to have high blood pressure.
The CDC reports that in the United States, 47 percent of AIDS diagnoses in 2016 were from members of the African-American community.
Why is this happening?
Clearly, there are many factors at play. But what’s killing members of these communities can be summed up in one word: bigotry.
The aforementioned health threats aren’t unique variables. Rather, they function “as interdependent and as intersecting forces, not operating in silos but operating conjointly to produce negative health outcomes,” Powell said.
Powell also points out that the crisis affecting these communities should come as no surprise.
“Every day you turn on the television, there’s a news story about yet another incident where racism is... at the root of it, or discrimination, or homophobia is at the root of it,” Powell said.
“And these larger structural forces concern me because they’re… difficult for us to talk about as a nation. I think we have a challenge, still, with having those unnerving, transparent conversations about inequity and social justice,” she said.
Dr. Alex Keuroghlian, director of the National LGBT Health Education Center at The Fenway Institute and psychiatrist at Massachusetts General Hospital and Harvard Medical School, has observed firsthand how “minority stress” — the anxiety that comes from experiencing everyday acts of discrimination, victimization, and microaggression — takes a toll on health.
“Not a week goes by that I don’t have a patient tell me that they are experiencing serious psychological distress as a result of what they perceive to be a far much less tolerant and much more hostile cultural and political climate right now toward them and toward their identity,” Keuroghlian said.
Minority stress can shorten a life span because it can lead to a host of mental health problems, including anxiety, depression, and post-traumatic stress disorder (PTSD).
Many people experiencing minority stress turn to substance use to cope, which in turn can lead to issues like long-term addiction and less visits to the doctor for primary and preventive care. Physical health issues can follow as a result.
Social determinants of stress faced by vulnerable people — like poverty, unemployment, and social isolation — can lead to worse health outcomes as well.
Keuroghlian has found that the act of identifying minority stress can be beneficial for a patient, “so folks don’t attribute challenges in their life to personal failure, but correctly attribute it to societal stigma. That can be very liberating and empowering.”
He advises those dealing with minority stress “to seek out health systems that are going to be inclusive and affirming so that people can get the preventative care and treatment that they need to live long, healthy lives.”
Powell also points to the resilience she’s witnessed from minority men in the face of hardship as a reason for hope.
“Even in the midst of great trauma and difficulty... [the LGBTQ community and communities of color] have an incredible capacity for advocacy and for moving forward,” she said. “I always say, we can learn so much if we just were to watch the ways in which these communities have risen up out of the ashes in the aftermath of things that most people couldn’t even imagine experiencing.”
Yet resilience alone isn’t enough to address a health crisis
“Queer people need to exercise a lot of resilience in order to make it through,” Keuroghlian said. “But the burden shouldn’t be on the people within a vulnerable minority population. It should be on society to provide a more equitable climate and a system for everybody.”
Greater access to care is a key component of this more equitable future. Yet, men from minority communities face obstacles. Their sex is one.
Most girls will first encounter a doctor’s office at an early age due to reproductive health. Boys, on the other hand, may not enter a doctor’s office until they become involved with organized sports, if they’re athletic.
If they’re not, that’s one less opportunity to gain access for a physical or a screening for potentially life-threatening health issues.
African-Americans and Hispanics — especially men — report higher levels of distrust in doctors and hospitals than whites, according to research by a University of Pennsylvania team reported in the American Journal of Public Health.
One reason for this distrust is the history of discrimination and exploitation from the medical community. In an infamous example — the Tuskegee syphilis experiment — the U.S. Public Health Service observed untreated syphilis in hundreds of black men from 1932 to 1972.
A shortage of black doctors may also be a factor. A new study published in June by the National Bureau of Economic Research notes only 4 percent of doctors are black, even though African-Americans comprise 13 percent of the population.
Researchers also found that black male patients may be more comfortable being treated by black doctors. In the new study, 62 percent of black men agreed to cholesterol tests from a black doctor. Only 37 percent agreed to this test from a nonblack physician.
Queer men face their own hurdles to healthcare, too. Homophobia and AIDS-related stigma keep many from getting HIV testing and treatment, especially if a person fears being “outed” to their community by a trip to the clinic.
If a patient is closeted due to stigma, he’s also not receiving optimal healthcare, as queer men have unique physical and mental health needs.
Moreover, many rural communities lack LGBTQ centers or health centers with staff trained in treating LGBTQ patients. According to a 2017 report, 13 states have no LGBTQ health centers, which would offer HIV testing, wellness programs, and counseling services.
How can society help these men?
Expanding Medicaid, which offers healthcare to low-income families, is “low-hanging fruit,” Powell said.
She observed that the passage of the Affordable Care Act, or Obamacare, sparked “a huge uptake” in coverage of these men, especially those without children. At present, 18 states have opted against having the Medicaid expansion, in part due to the partisan politics surrounding Obamacare.
Beyond expanding Medicaid, workplaces can institute more flexible policies to allow workers time to take off for routine health exams, physicals, and preventive screenings.
The government can also offer more resources to former prisoners in areas like education, employment, and healthcare in their transition back into society.
But policies that support marginalized communities won’t write themselves, Keuroghlian stresses.
“People can show up at the polls and vote in the midterms this fall... for candidates who believe in policies that support equity for all. That’s probably [one of] the best things folks can do,” he advised.
The “rigid notions of what it means to be a man” are also responsible for poor health, says Powell.
“Boys and men are less likely to talk about what’s happening in their interior lives. And that concerns me, because we can’t treat or address what isn’t spoken about or what is invisible,” she said.
In this regard, the media “has a critical role to play in disrupting narratives around masculinities that may be harmful,” Powell said, “and a critical role to play in lifting up images and displays of masculinity that can be positive and nuanced and less rigid.”
This conversation, Powell stresses, should move beyond “toxic masculinity,” which “doesn’t create an opportunity for us to talk about positive displays or potential positive displays of masculinity,” she said.
Steven Canals — the co-creator of “Pose,” an FX drama about New York’s ballroom scene in the 1980s — knows firsthand the importance of being represented in the media.
“As a young closeted boy, I never saw myself reflected in film, TV. Had I seen myself, it would have normalized the experience I was having, and I likely would have spent less years battling internalized homophobia — which we know can lead to depression, anxiety, and suicide,” Canals said.
“Media has the ability to affect how we view ourselves by affirming our identity, which studies have proven can increase self-esteem,” he added. “This is why it’s essential that we have positive, accurate portrayals of historically marginalized communities.”
But one doesn’t need to be a Hollywood mogul to make a difference
Concerned individuals can examine how they can use their own privilege to help those in need.
“Ask yourself, are there resources here that could be leveraged to support communities that are marginalized or disadvantaged?” Powell said.
Supporting community organizations with donations or volunteering is one way to help.
Another? “I’m a big proponent of everyday acts of kindness,” she added.
Above all, it’s essential to view the problems that face these men “as issues that are affecting us all,” Powell stressed. “Often, when we think about these things, it’s very easy to want to silo them and think about them as, like, not my problem,” she said.
“Our fates are really linked,” Powell concluded. “This is all of our work. And when it’s done and done well, I think we have the better opportunity for having healthier families, communities, and by virtue, a healthier nation.”