ADDRESSING THE IMPACT OF RACISM ON HEALTH

By Dr. Lorne Foster

          The Family Service Association of Toronto initiated a progressive program called Growing Up Healthy Downtown, which brings together eight organizations across downtown Toronto in order to help marginalized, minority communities and inner-city families to develop healthy children.

          Growing Up Healthy Downtown is based on the idea that the development of healthy minority children requires “seeding the resources.” So, the mission is to broaden support for poor and minority families by providing participatory resources, such as support and education, and advocate with families and children on issues that affect their lives. The GUHD project empowers agencies to create opportunities for positive action and solutions to social problems. It also helps strengthen and build local communities, by attracting, developing and sharing to support children across downtown Toronto.

          Judging by some recent studies in medical science, it appears that initiatives like Toronto’s Growing up Healthy Downtown could not have come at a better time.

          For instance, in a recent study cited in the British Medical Journal, Dr. Kwame McKenzie, a psychiatrist at Royal Free and University College Medical School in London, U.K., concluded that racism plays a key role in the development of illness and countering it should be considered a national public health issue.

           “Considering racism as a cause of ill health is an important step in developing the research agenda and response from health services,” says Dr. McKenzie. "Yet, despite general agreement that racism is wrong there is little evidence of concerted initiatives to decrease its prevalence.”

          Another British study of 4,800 people finds that those who felt victimized by discrimination and forms of racism were twice as likely to develop psychotic episodes in the next three years.

          Studies examining how racism impacts health outcomes have been conducted in the United States as well. A group of Harvard researchers documented that a 1% increase in incidences of racism translates to an increase in 350 deaths per 100,000 African Americans. Being on the receiving end of overt or subtle racism creates intense and constant stress, some experts say, which boosts the risk of depression, anxiety, and anger – factors that can lead to or aggravate heart disease. Some research suggests it can also manifest itself in respiratory and other physiologic problems.

          Medscape Medical News report on surveys conducted Camara P. Jones, MD, MPH, PhD –  research director of Social Determinants of Health for the Centers for Disease Control and Prevention and a leading specialist on the health impact of racism – that consistently found that Whites rarely think about their race in the course of a day.  But 22% of Blacks surveyed said they constantly think about their race, and 50% said they think of race at least once a day –  they are constantly reminded of their Blackness.

          According to Dr. Jones this has a profound effect on health. “We know that Black folks are at higher risk of hypertension, but in childhood, there are no differences between Black and White blood pressure rates. By the time you get into the 25- to 44-year-old group, you start to see changes. We have evidence that in White folks, blood pressure is dropping at night, but not in Black people.” Jones postulates: “There's a kind of stress, like you're gunning your cardiovascular engine constantly if you're Black that results from dealing with people who are underestimating you, limiting your options. It results from little things like going to a store and if there are two people at the counter, one Black and one White, the White person will be first approached. If you have stress from other sources, like a bad marriage, it's not something you think about constantly. But the stresses associated with racism are chronic and unrelenting.”

          In addition to stress, numerous studies indicated that race even plays a role in the type of care received. In the United States, studies show that racial and ethnic minorities tend to receive lower-quality health care than Whites –  even when insurance status, income, age, and severity of conditions are comparable, according to a recent report by the Institute of Medicine (IOM). And in reviewing 81 studies comparing cardiac care received by Black and White patients, the Henry J. Kaiser Family Foundation and the American College of Cardiology Foundation report that 68 studies (84%) indicated that race played a role in the type of care received, with Blacks getting inferior treatment. Other factors that influence medical care have also been identified, such as a greater mistrust of the medical community among minorities, as well as communication problems between physicians and their culturally different patients.

          It is also to be noted, notwithstanding difference in national health care policies between the United States and Canada, Aboriginal people and Blacks throughout continental North America typically live sicker and die younger. Even when researchers control for social class and income, studies consistently reveal differential patterns of race in regard to heath care outcomes.

          The end result of all of this is, there is now a growing body of medical opinion around the world beginning to recognize and acknowledge the need to shift the traditional research focus from individual-level risk factors in healthcare, like physical inactivity, to societal-level risk factors like neighborhood safety and resource constraints that lead to physical inactivity.

          But perhaps more importantly, from a Toronto-centric perspective, community agency initiatives like The Family Service Association of Toronto’s Growing Up Healthy Downtown are already ahead of the scientific curve. They have already made the connection between the health of racial minority children and their formative social arrangement, and have taken the next step, setting out to invent grass-roots programs, social constructions and participatory resources to produce meaningful and progressive change, and a win-win society.