The Link Between Racism and Early Aging
Early experiences of racial discrimination may increase the risk for early onset diabetes and heart disease for African Americans. Expert in health equity, Sierra Carter, discusses the implications and what can be done to help.
I’ve been interested in this topic since my undergraduate studies at the University of North Carolina at Chapel Hill, where I listened to scholars like Dr Robert Sellers, Dr Enrique Neblett, Dr Jules Harrell and Dr Tené Lewis conceptualize why Black people don’t live as long as other racial/ethnic groups. As a Black woman, I’ve also been personally invested in this topic to uncover and implement practices that promote health equity for the people I know and love. For more than a decade, I have been examining how racial discrimination acts as a chronic stressor just like other acknowledged factors (for example, trauma and environmental events) to affect health and we see a clear link.
From the research I’ve seen and conducted, racism works like other chronic stressors that we often talk about, such as trauma exposure and other environmental events. It is a pervasive stressor that is processed mentally and physically over time.
An essential framework for thinking about this process affected by racism is “weathering.” Our body has a natural cognitive and physiological response to stressors. For example, if you saw a bear, your body would have a natural fight-or-flight response. Your body would be on guard for the moment, but it would eventually calm down after the bear was gone. However, in the case of chronic stressors like racism, the “bear” never leaves and your mind and body could stay on high alert.
When our bodies live in environments that disproportionately lead to chronic stress, they are not able to reach a balance or homeostasis. That’s how weathering works: wear and tear of body systems over time due to continuous exposure to stressors like racism. Studies have shown that the process of weathering due to racism links to the racial health disparities seen in cardiovascular disease and diabetes among Black Americans.
It is critical to have interdisciplinary work to address the multi-level process of racism, which can be experienced on individual, institutional and systemic levels. It is vital to think about how we train future psychologists to work alongside other disciplines and translate findings to multiple audiences. Therefore, the psychology field could strive to ensure their training programs are more interdisciplinary so that future scholars are more equipped to address racial health disparities linked to racism and engage in transdisciplinary collaborations.
Several approaches and interventions have been developed by Black and Brown scholars to reduce the negative impact of racism. For example, Dr Riana Anderson and Dr Howard Stevenson developed the EMBRace program to reduce parent and adolescent racism-related stress by promoting racial socialization practices and familial bonding.
Additionally, Drs Monnica Williams, Isha Metzger and Farzana Saleem have worked on integrating and incorporating culturally-salient protective factors in racial trauma and treatments for Post-traumatic Stress Disorder (PTSD).
As a clinical researcher in this area, it is also important to note that although these interventions exist and are being further developed, it is not the responsibility of individuals who experience racism to have to build “resilience” to overcome the racism that was created by our society. To truly address the impact of racism, the responsibility lies on the systems and individuals who perpetuate this oppression to end and be held accountable for these practices.
Research clearly shows that experiences of racial discrimination are linked to trauma symptoms, with one study finding that racial discrimination was associated with 70 percent of trauma-related symptom outcomes.
Our diagnostic manual (DSM-5) makes a choice about what can be considered traumatic over time, but racism is not currently considered a traumatic experience. In the field, there are mixed views on whether racism should be in the diagnostic bounds of this manual as a traumatic stressor. Some viewpoints support the necessity for racism to be acknowledged as a traumatic stressor so that marginalized individuals can receive treatment. Other perspectives recognize that racism is not an “individual pathology” or disorder that needs to be in a diagnostic manual that often categorizes individuals as experiencing a pathology rather than acknowledging how marginalized groups are having very sane responses to unimaginable stressors.
Racism can also be considered a potentially unique stressor and traumatic experience because of its historical legacy in the US and its multi-systemic effects. Research has shown that racism not only exacerbates PTSD symptoms that lead to adverse health outcomes but interweaves with other traumatic stressors over time. For example, a Black man’s experience and witnessing of police brutality is often laden with race-related stress and non-race-related stress – they are not mutually exclusive. Further clinical research is needed to examine how racism can be considered a unique traumatic stressor and how it interconnects with other stressors to influence outcomes.
Research conducted by my team and collaborators seeks to understand this process and consider innovative avenues for prevention and intervention. A relatively recent research project examined the role of depressive symptoms as a mechanism driving the relationship between early life experiences of racial discrimination and accelerated biological aging in adulthood for Black Americans. This study predicted outcomes over a 19-year period with 368 subjects aged 10 to 29. Results indicated that higher self-reported racial discrimination at ages 10 to 15 was associated with high depression at ages 20 to 29, controlling for earlier depression at ages 10 to 15. This elevated depression, in turn, was related to accelerated cellular-level aging.
These findings support research conceptualizations that early life stress due to experiences of racial discrimination lead to sustained negative affective states continuing into young adulthood. This confers risk for accelerated aging, premature diseases (for example, cardiovascular disease and metabolic syndrome) and mortality in Black Americans.
Although there are intimate connections between racism, socioeconomic status and social class, racism still has unique impacts on health. For example, in the above research study, we also looked at living in poverty versus not living in poverty and discovered something opposite to our hypothesis – the link between racial discrimination and depression was stronger for Black youth who were not living in poverty. Therefore, the role of socioeconomic status in racism can be quite complex.
As another example, we often think that social class plays an important role in maternal health disparities experienced by Black women – which is often true. Yet, research has also shown that babies born to college-educated Black women are still more likely to have a lower birth weight than babies born to White women who dropped out of high school. This is one example of how racism could play a unique role in shaping and explaining health disparities outside of socioeconomic status alone.
We know that healthy lifestyle factors are important to reducing stress and helping to promote more optimal wellness. Therefore, when considering racism as a chronic stressor, research aligns with showing that healthy lifestyle factors can sometimes offset the toll of racism on health. However, when it comes to racism, individual-laden solutions (such as eating healthier, exercising and reducing substance use) do not eliminate the structural inequity that leads to the persistence of health inequities. Structural racism-related factors are often the root cause of why health disparities exist in the first place.
For generations, disenfranchised groups have been doing many things to protect against the negative impacts of racism. As clinicians and researchers, we aim to amplify these culturally-relevant strengths that may go overlooked from a Eurocentric viewpoint on healing and coping strategies. Protective factors that aid in reducing the impact of racism include racial identity, talking about and processing racist experiences with people in your social support network, mindfulness/self-regulatory strategies and engaging in forms of activism and hope in the face of oppression.
Some of our research is also beginning to highlight the potential need for collective healing approaches to address the collective wounds experienced among Black Americans who have witnessed and experienced racial injustice. This type of work has likely clinical implications for us to think about how individual therapeutic strategies (that is, individual one-on-one appointments in one location) can often silo community-driven and collective interventions that draw on practices of social connection and liberation to promote healing.