Overt Racism Linked to Poorer Health Outcomes for All

Nancy A. Melville

September 19, 2016

Blacks living in highly racist communities are at an increased risk for health problems, including heart disease; whites as well as blacks in such communities are at increased risk for heart disease–related deaths, findings that underscore the negative effects of racism for victims and racists alike.

"The take-home message is that living in a racially hostile environment is associated with increased risk of circulatory diseases for both the group targeted by the bias ― in this case, blacks ― as well as the group that harbors the bias ― in this case, whites," first author Jordan Leitner, PhD, a postdoctoral fellow with the Department of Psychology at the University of California, Berkeley, told Medscape Medical News.

The findings were published online August 29 in Psychological Science.

Health Disparities

The study involved an evaluation of data on nearly 1.4 million respondents of Project Implicit, an online initiative to assess racial bias, which began in 2002. It is the largest known repository of data on implicit as well as explicit bias.

The researchers compared that information with data from the Centers for Disease Control and Prevention on death rates in more than 1700 US counties during the same period.

After controlling for factors that included age, education, income, population, rural vs urban residence, and other factors, they found that in counties with the highest reported racial bias, blacks reported significantly less access to affordable healthcare, compared with counties with lower bias and in comparison with whites.

Rates of death due to circulatory diseases were higher in whites as well as blacks in highly racist counties compared with counties with lower racism; however, the relationship was stronger for blacks (P = .0004) than whites (P = .005).

"To our knowledge, this is the first research to show that racial bias from a dominant group (eg, whites) predicts negative health outcomes more strongly for the target group (eg, blacks) than for the dominant group," the authors write.

Whereas health disparities between blacks and whites in various diseases have been well documented, the study showed significantly higher disparities in highly racist communities. In counties with highly explicit racism, blacks had 62 more deaths per 100,000 than whites, compared with counties with low explicit bias, where the difference was 35 deaths per 100,000.

After adjustment for covariates, the authors predicted that 11 more blacks die annually from circulatory diseases in high-explicit-bias counties with an average population of 28,598 (95 deaths) than in those with low bias (84 deaths).

The findings also showed lower diagnoses for circulatory diseases among blacks in the highly racist communities, which the authors speculate could be a direct result of the lower access to healthcare in those counties.

Stress Related?

When looking beyond circulatory diseases to deaths from neoplasms, no similar increases were seen. Several mechanisms have been proposed to possibly explain the link between overt racism and the poorer circulatory disease outcomes, said Dr Leitner.

"One prominent theory is that the stress associated with living in a racially hostile community increases chronic inflammation, which in turn increases disease risk," he said.

"Another possibility is that racial hostility manifests through policy decisions that limit healthcare resources in predominately black neighborhoods. These policy decisions may also extend beyond healthcare ― for instance, racial hostility at the community-level might influence how policy makers regulate pollution in predominately black neighborhoods."

The increases in circulatory disease–related deaths even among whites are consistent with previous research that show racial bias to be linked to negative health outcomes, the authors note.

"One explanation for this finding, suggested by recent research, is that highly biased communities have decreased social capital (ie, trust and bonding between community members), which in turn predicts negative health outcomes."

Although not confirming a causative relationship between white racial bias and the health disparities, the study should spark further research into the relationship between the two, the authors suggest.

"Though these findings are correlational, they raise important questions about the potential pathways through which racial bias might influence health outcomes," said Dr Leitner.

The research was supported by the National Science Foundation and the Social Sciences and Humanities Research Council. Dr Leitner and the other authors have disclosed no relevant financial relationships.

Psychol Sci. Published online August 24, 2016. Abstract

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