Racism: Social Determinant of Health in African Americans Racism is defined by Anthropology: The Human Challenge as a doctrine of superiority by which

one group justifies the dehumanization of others based on their distinctive physical characteristics. Although race is not a biological but a cultural construct, there is still a clear disparity in the health and mortality of people who have experienced systematic racism in America than those who have not. As a result of the racial discrimination experienced by blacks in American society, there is a perception of chronic stress that translates into a higher risk of chronic illness and lower life expectancy than those of Caucasians. For an African American living in the U.S., there are significantly higher health risks than those of other ethnic groups at any income level. As seen in the relationship between chronic illness and socioeconomic status, race plays a major role in the health of those affected by the social concept.

The anthropological aspect of this problem is that short-term changes or physiological adaptation occurs in response to a particular environmental stimulus (Haviland 285). Though racism is not a physical environmental stimulus, its affect on health can be seen. Often when chronic illness rates are published regarding African Americans, the rates are significantly higher than Caucasians. However, the increased risk of dying from a heart attack for African Americans compared to whites is attributed to biological difference rather than healthcare disparities or other social factors contributing to the development of heart attacks (Haviland 270). When the issue of health disparity is looked at through the lens of unbiased sociology, there is a clear

paradox. The United States has the highest GDP in the world, spends 2 trillion dollars on medical care and accounts for half of all health dollars spent globally. Yet, there are still 47 million Americans without healthcare coverage. In the most richest country in the world, where there are ideally self evident truths that all men and women are created equal, the U.S. ranks 30th in life expectancy; right below Cuba. One would assume that the cause of Americans being among the sickest people among industrialized nations would be the lack of health care, but this is not the case.

The cause of illness and disease isnt the lack of health care, states Dr. Ichiro Kawachi epidemiologist at the Harvard School of Public Health. This suggests that even if there were more healthcare benefits accessible to Americans, there would still be certain groups that would be sicker and have shorter lives. Often, social conditions are more powerful in shaping our existence than our genes. Dr Nicholas Christakis medical sociologist at Harvard postulates, There are ways in which society are organized that are bad for our health. Behaviors that cause major disease are often determined by economic status. In order to avoid smoking, eating a healthy diet and exercising, it is important to have access to education, income. These factors are what is called the social determinants of health (Kawachi). An interesting idea put forth by Robert A. Hahn, is that The effects of a persons social environment on sickness or illness behavior need not involve direct personal contact (Medical Anthropology 2010).

Social determinants are the major forces that shape health outcomes of people in the community states the director of public health in Louisville, Kentucky Dr. Adewale

Troutman. In the documentary, In Sickness and Wealth a case study conducted by Louisville Metro Dept. of Public Health and Wellness, showed stark differences in the health of people who lived in affluent districts compared to people living in less affluent areas. The areas of higher affluence where many residents place in the top 1% of income, the life expectancy is 80 years old, 2 years higher than the national average (In Sickness and In Wealth). In contrast, the areas where poverty was the highest had a life expectancy of 69.8 years. The rates of heart disease and cancer were also twice as high as poorer districts. This excess death is when premature death or deaths that should not have happened statistically occur as deaths within a population should be predictable within any one timeframe (In Sickness and in Wealth). Public health officials in Louisville illustrate this social gradient by giving examples of the different districts in the city and linking the economic well being to everyones health well being. In order to understand the concept of the social gradation or ladder gradation one has to understand that there are no clear-cut black and white distinctions between social status but fine gradations in wealth and health. Sir Michael Marmot of the University College of London conducted case studies in the 1970s about how social status affects disease rates among British workers. The Whitehall II study showed that the lower grade of employment, meaning the less control one has over his or her environment and the less their salary, the higher risk of death. This is particularly interesting because the United Kingdom has the National Health Service; basic guaranteed healthcare for its citizens. Even though the British have access to medical care, mortality is still higher in lower employment grades. Deaths due to smoking, obesity and high blood pressure only accounted for 25% of the 28,000 people studied (In Sickness and in Wealth).

In order to fully understand what is really happening here, the term social class in and of itself needs to be operationalized within the applicable context. Dr. Leonard Syme, Epidemiologist at UC Berkeley suggests that social class is not only a combination of education, access to medical care and housing but also more existential concepts like power, confidence, and a sense of security (In Sickness and In Wealth). Dr Syme goes on to illustrate, As you go through the alternative explanations, the one that seemed most impressive to me was this idea of control of destiny. I dont like that word. What I mean by it is the ability to influence the events that impinge on your life, even if it means not doing anything, but one way or the other, managing those pressures. The idea is that the effects of ones social class as affected by race has a discernable outcome on health. How these pressures that are carried by our bodies translates into health risk is seen through the biological stress response. The lack of control over ones livelihood triggers a cascade of negative effects upon the body. Naturally, our bodies are designed to handle short increments of stress, but prolonged exposure to environmental stressors will traumatize the body. These systems begin to work overtime. We produce too much cortisol. Chronically, cortisol can impair immune function. It can actually inhibit memory and can even cause areas of the brain to shrink, says Bruce McEwen, neuroscientist, Rockefeller University. Sir Marmot further elaborates, When you get prolonged activation of these stress pathways, they in turn affect heart rate variability, the ability to handle insulin and glucose, and those in turn, we think, increase risk of diabetes and heart disease (In Sickness and In Wealth).

Dr. Carol Shively, Wake Forest University, has been observing this phenomena in macaques for over 30 years. Macaques with less power and control are in a state of chronic stress. The evidence is in their stress hormone level (In Sickness and In Wealth). This stress hormone is known as cortisol. Dr. Shively observes: Same thing happened. He can play that game all day long with her, cause hes dominant. Its a very mild sort of harassment. A dominant animal has complete control over his life. He can go wherever he wants in the pen to do whatever he wants. That animal has all the control that it needs to create an optimal environment for himself. In contrast, subordinate animals have almost no control over what happens to them. They have to be watching all the time. With that highlevel vigilance comes increases in heart rate

The long term effects of cortisol in the body has a negative effect on tissues and physiology. Dr. Shively was able to show evidence of this by comparing cross sections of the arteries of dominant and subordinate monkeys. The subordinate macaque had a much larger atherosclerotic plaque than the dominant monkey. This monkeys ate the same food and both lived in the same environment. It is suggested that this increased health risk is simply due to social subordination. (In Sickness and In Wealth).

In yet another study, the cortisol levels of people with different socioeconomic statuses were measured. The more educated people were and the more income they had, the less cortisol they released throughout the day (Dr. Sheldon Cohen, Carnegie Mellon

University). Biologically, this translates into less stress being present in the body by people of higher social class.

The influence of social status on health continues even to the availability of nutritional food choices. In certain neighborhoods, there will be easier access to fresh fruits and vegetables, fresh meat and whole grains; than in other neighborhoods. Ann Diez Rouz, Epidemiologist at the University of Michigan explains, Of course these differences are not a natural thing. Its not the design of nature that these environments are going to be different. They arise as a result of policies or the absence of policies that create these enormous inequalities and resources. Dr. Troutman illustrates this point by using the example of Ninth Street, an urban low-income district in Louisville, Kentucky, : Is there adequate access to chain supermarkets in this area? The answer is no. As a matter of fact, why arent there zoning laws to regulate fast food outlets here? Enterprise zones to build businesses? Better transportation? Why isnt there more mixed income housing? (In Sickness and In Wealth).

As can be seen, there are very marked differences in social class and health. Particularly in the access of care and basic nutritional needs. The sum total of these factors contribute to the materialization of diminished health on an individual. Environmental and sociocultural factors play a major role as wellhuman physiological measurements have demonstrated the impact of sociocultural conditions upon human health. For example, a recent anthropological study of African Americans suggests that the psychological stress related to racial discrimination may contribute to higher

prevalences of hypertension in these populations (Dressler 1996) (Medical Anthropology 2010).

We know that social class has a negative effect on health, but what is even more interesting is the idea that across the social gradient, African Americans have a lower life expectancy. This means that even when a wealthy Caucasian and a wealthy African American are compared, the African American person will always have a lower life expectancy. Why? Race itself can cause stress and inherent health risk. Dr. Troutman elaborates: Im clear that on the social gradient, that line that we talked about earlier, that Im on the top of that line. Im highly educated. I have a medical degree. I have several other degrees. I make good money. I live in a good neighborhood. But I know that according to the research, if youre an African American, no matter what your social status, your socioeconomic status, your health outcomes are going to be worse than your white counterpart... As a physician, Ive been followed around the store. When I go in to buy something, Ive been looked at askance. Ive seen a woman grab her purse when I come into the elevator. And for goodness sakes - Im Dr. Troutman! You know, why This shouldnt happen to me, but it does.

Dr. Syme elucidates, Why should there be an elevated risk of disease in African Americans of higher social class? Bad genetics... Not true. When you look at other countries where the discrimination is not as prevalent you dont find those kinds of rates.

So somethings happening. It is apparent that there is more and more evidence to substantiate this idea. Tony Iton, Director of Public Health for Alameda County, California, argues, We can predict on aggregate, based on where somebody lives, high school graduation rates, and their income, how long they will live and when they will die. Now, obviously therell be exceptions to that, but for the most part well be right. And we should not be able to do that. Your life expectancy, how long you will live, should not be dependent on, essentially, the resources you have accessible to you (In Sickness and In Wealth).