Stress is your body’s response to a threat, and it all begins in your brain. The moment you feel unsafe, your hypothalamus signals that something is up. Your adrenal glands pump stress hormones. Adrenaline makes your heart race; you become more alert as your breath quickens and your muscles tense. Cortisol activates the urge to fight or flee, while disrupting body functions that are not immediately helpful in surviving the present danger, but are essential to long-term health.
“The body is not designed to live in that place all the time,” said Dr. Eudene Harry, a medical lifestyle expert and member of the American College of Emergency Physicians. But in this extended moment of national crisis, some in the United States are — and have been — facing exactly that. And research suggests it is disproportionately hurting the health of people of color in this country.
For months, the world has sat on edge while the COVID-19 pandemic disrupts life and takes lives, with no end in sight. In recent months, numerous killings of black Americans — Ahmaud Arbery, Breonna Taylor, George Floyd — at the hands of white, current or former law enforcement officers have prompted passionate, sometimes volatile protests. Those pains are fresh, but the deadly perils of systemic racism, as well as the chronic stress that comes with it, are not.
A normal stress response is designed to last for a brief period of time, followed by rejuvenation, according to Harry. But when this response is activated over and over again for prolonged and indeterminate durations, it takes its toll on you, said Dr. Vaile Wright, who directs health care innovation for the American Psychological Association. Your metabolism can get thrown out of whack. Your immune system can end up weaker. You are more likely to develop cardiovascular disease, hypertension, obesity, depression, anxiety and insomnia.
Research has shown that concern about discrimination among black Americans fuels health problems, including poor sleep and depression. In a 2014 study published in the American Journal of Public Health, researchers culled data from 2001 to 2003 in the Chicago Community Adult Health Survey to study the relationship between race-related vigilance, or anticipation of discrimination, and hypertension. In this study of more than 3,100 people, researchers found that black people reported the highest levels of higher levels of stress linked to being treated negatively as a result of their race.
“Vigilance may represent an important and unique source of chronic stress that contributes to the well-documented higher prevalence of hypertension among Blacks than Whites,” the authors concluded. An exponentially higher rate of black Americans (40 per 100,000 for women and 50 per 100,000 for men) die of hypertension than white Americans (about 15 per 100,000), according to federal data. And chronic stress linked to racism, the study suggested, is as great of a risk factor for high blood pressure and heart-related health problems as smoking tobacco or having elevated levels of cholesterol.
‘Pandemic within a pandemic’
Health disparities have adversely affected black and brown communities for a long time, said Dr. Damon Tweedy, associate professor of psychiatry and behavioral sciences at Duke University School of Medicine and author of “Black Men in White Coats.”
For decades, black Americans have endured higher rates of infant and maternal mortality, diabetes, heart disease and stroke and asthma. Combined, these higher rates shave years of life expectancy for black Americans compared to white Americans. And black Americans are more likely to report a lack of trust in their health care providers, fueled at least in part because some physicians have said they viewed black patients more negatively than white patients. After decades of medical abuse, botched disaster responses and government neglect, there’s a name for the mistrust black Americans have for the medical community — the “Tuskegee effect” — invoking one of the nation’s most infamous and unethical medical experiments conducted on black men that only ended in 1972 after news media alerted the public this was happening.
The coronavirus pandemic is further proof of these disparities.
Since January, more than 2 million Americans have been diagnosed with COVID-19, according to data from Johns Hopkins University, and more than 113,000 Americans have died from the disease. A disproportionate number of those who have died or suffered severe health outcomes from the virus have been black.
While black Americans make up 13 percent of the nation’s population, they account for 24 percent of all confirmed U.S. deaths linked to the virus where the person’s race was known, the COVID Tracking Project reported. But the complete picture is still blurry because some states have provided incomplete data about people’s race and ethnicity when they die of COVID-19, FiveThirtyEight found.
What public health officials do know is that the coronavirus is most deadly in people with preexisting conditions such as diabetes, high blood pressure and heart disease that are manageable given the right medical care, nutrition and quality of life.
Tweedy said the psychological impact of stress of systemic racism on black Americans “has been underestimated,” and that added strain has contributed to higher rates of those exact ailments, as well as overall mortality, among black Americans compared to white Americans.
“It’s not excuse-making,” he said. “It’s a reality.”
As a black physician, Tweedy said he is glad that the long-standing issue of health disparities in black and brown communities is receiving recognition, but at the same time, he said he is exasperated because it took a pandemic for people to see how jarring these disparities are when “people have been talking about it for 30 to 40 years.”
Enduring COVID-19 while being confronted with persistent police violence “really creates a perfect storm” for black Americans, said Dr. Michael Lindsey, who directs the McSilver Institute for Poverty Policy and Research at New York University and has studied the effects of racism on mental health in black youth. In a 2019 study, researchers analyzed federal data from 2013 to 2018 and found that black men and boys faced more than twice the risk of dying during a police encounter than white men and boys. Disproportionately higher rates of death linked to the virus and to police violence among black Americans has been described as a “pandemic within a pandemic.”
“It makes you feel as if your life is fragile,” Lindsey said. And that feeling makes lives actually more fragile, by eating away at people’s health.
On May 25, Minneapolis Police Officer Derek Chauvin kneeled on George Floyd’s neck in a parking lot while three other officers restrained him. For nearly nine minutes, Floyd lay on the ground, begging for his life until he became unresponsive.
When Lindsey and his mother watched the video of Floyd’s final minutes and heard him call out in desperation for his own mother, Lindsey said they both cried. Watching the video traumatized them, he said. “You feel it in your body.”
Can the stress cycle be broken?
If you are overwhelmed by what is happening, you are not alone, Wright said. But what should you do? It is important to recognize those feelings of fear, panic, hopelessness and collective grief are valid, both in yourself and in others, she said, and to not judge yourself for having them.
One challenge that COVID-19 brought is a feeling of boundless uncertainty. That complicates the ability to plan basic functions of life, like walking outside your home or buying milk at the grocery store. Instead of ruminating on that feeling of helplessness, Wright said focus on what is in your control, like your own thoughts and behaviors.
Wright recommended what she calls the “foundational four” of getting enough sleep, eating healthy, being active and staying connected to your support network. To secure these elements, she suggested relying on a routine to reinforce “structure in our life.”
Looking more broadly at how the current conditions are especially harmful to communities of color, Wright said, “We also just need to be reaching out to people in our lives with a high degree of empathy right now.”
“Let them know that you’re there and that you hear them,” she said, but don’t try to presume to fix the problem because “this problem doesn’t have a fix right now.”
In recent days, Lindsey said these check-ins from his white colleagues have been incredibly important and supportive. He added that participating in protests can offer a profound catharsis, especially among black Americans. But if you are experiencing an inability to function at work or relate to other people in your life, Lindsey said “that is an indication that it’s time to see a doctor” for more formal treatment. However, even before the pandemic and the economic recession that followed, black Americans were more likely to be uninsured, a significant barrier to accessing needed health care.
The American Psychological Association has noted that while “African Americans are just as much at risk for mental illness as their white counterparts,” they “receive substantially less treatment,” in part due to limited access to those services.
People’s response to what is happening is not a one-off but a continuous struggle with repetitive trauma, Tweedy said. To identify chronic stress in one’s self, he urged people to listen to those closest to them. Most of his referrals come from people whose loved ones expressed concern about them, he said.
Harry observed that, in her practice, black patients often say they feel ignored or that no one is hearing what they are saying. This observation is not isolated, and research has historically shown black and brown patients are less satisfied than white patients with the relationship they have with their physicians, including interactions with their doctor and the degree to which their doctor displays cultural sensitivity. To produce better health outcomes in black and brown communities and narrow disparities, she said health care providers must do a better job of listening to all patients.
“We’ll never get that if we’re not creating a space where people feel heard,” she said.