Racism Can Make You Sick
When Kim Anderson found out she was pregnant in 1990, the successful, African-American attorney in Atlanta did everything right. She didn’t smoke or drink. She ate carefully and exercised. She got good prenatal care. So when her first child was born prematurely, weighing only two pounds and 13 ounces, she was both devastated and shocked.
Neonatologists Richard David and James Collins were not as surprised. Like others in their field, they had long noticed and been troubled by the racial disparity in premature births between African Americans and whites. But they had assumed, as had most in their field, that the reason more African-American babies are born prematurely was tied to health issues related to poverty – lack of access to medical care, for example, or poor nutrition.
Then they looked at the numbers. What they found, as explored in the PBS series Unnatural Causes, was that the chances of a woman giving birth prematurely was not just due to being poor, but being black. In other words, when other factors are accounted for, black women still had notably higher rates of premature births than their counterparts of other races. The cause, they believe, is stress that manifests in physical ways.
Researchers in numerous medical disciplines have been researching the effects of toxic or chronic stress on the body and have reached a near-consensus that, along with psychological and emotional responses to stress, there are corresponding responses in the body that can be harmful over time.
In pregnancy, one theory is that the reaction is hormonal. Stress hormones are part of the chemistry of pregnancy in normal conditions and can trigger labor when they reach a certain level. It stands to reason then that women who are already overloaded with stress hormones, as a result of their day-to-day existence, are more likely to give birth prematurely.
Other potential links between stress and premature births may include inflammation of the uterus or restricted blood flow to the placenta.
The link between discrimination and stress and the impact on physiology have been documented outside the field of obstetrics and neonatology as well. One study shows that merely anticipating having to deal with racism or prejudice leads to cardiovascular stress responses, including acute increases in blood pressure and heart rate.
While we are still learning a great deal about how racism shows up in the physiology of people of color, the social determinants that lead to those physical reactions have long been clear. Racism and discrimination touches public policy decisions, interacts with power differentials, underlies how institutions treat individuals and communities and ultimately, leads to poor health outcomes.