Race-related stressors and their health impacts: How racism is making people sick

More than unease, race-related stressors could cause illness in the long run.

Writer: Alice Ho
Editor: Lucy Masdin
Artist: Lia Bote

Race has long been a topic of contention in mainstream media and academic discourse, and it remains so as the world sees a spike in reports of racial violence. However, in addition to immediate casualties and grievous injury, race-related stressors have also been harming racial minorities in more insidious ways.  

Marginalised communities exhibit higher incidence, morbidity and mortality of diseases compared to non-marginalised communities. The idea that stress makes you sick is not new, but what’s different here is that these health disparities are largely driven by environmental stressors rather than individual habits. Thus, there is a need to understand these stressors and how they cause negative health outcomes, so that they can be resolved. 

It is helpful to classify race-related stressors into institutional and perceived racism.  Institutional racism, also known as structural or systemic racism, refers to discrimination by major institutions and systems against racial minorities, such as education, employment, healthcare, and criminal justice. For example, the Social Metrics Commission reported that 46% of Black households in the UK are in poverty, compared to just under 19% of White households. Being disadvantaged in terms of nutrition, poverty, violence in the environment and psychosocial stress, it is no wonder that racial minorities have disproportionately poorer health outcomes. In the US, people of colour are more likely to live near areas of increased air pollution than White Americans. This puts them at higher risk of disease in virtually every organ in the body ‒ from the heart and lungs to the bones and skin. Hence, institutional racism limits access to healthy lifestyles and health services, contributing to racial health disparities.

Conversely, perceived or interpersonal racism occurs at an individual level, taking the form of daily microaggressions, or one-off encounters with hate crime. They reduce self-esteem and create uncertainty about the future, resulting in greater psychosocial stress. These stressful experiences can begin early in life. In a 2019 study in Australia, 40% of year 5 to 9 students from non-Anglo or European backgrounds reported experiencing racial discrimination by their peers. In the UK, almost half the respondents to YMCA’s 2020 Young and Black report felt that racism is the biggest roadblock to academic achievement. To assess the levels of perceived racism, hundreds of studies have used the Everyday Discrimination Scale, a questionnaire that tallies discriminatory encounters. Respondents who report a higher frequency of discrimination also tend to have poorer physical and mental health outcomes. 

Besides institutionalised and perceived racism, race-related stressors can also be classified as acute or chronic, referring to instantaneous or short-term events and long-term challenges respectively. 

How exactly do stressors affect health? One model indicates that dealing with racial discrimination leads to allostasis, where the body allocates energy towards physiologically adapting to short-term stress. In evolutionary terms, this is favoured because it delays somatic damage long enough to ensure survival and reproduction. However, it comes at a cost ‒ frequently activating the stress response results in the deterioration of internal regulatory systems in the long run. This is known as ‘allostatic load’, which can manifest as chronic diseases, such as high blood pressure, diabetes and hypertension.

What is even more alarming is that these stressors, when experienced in childhood, can influence gene expression. The growing field of epigenetics has shed light on the dangers of race-related stressors during early development, where phenotypic plasticity is highest. If conditions such as maternal insulin resistance, hyperinsulinemia and diabetes are present during pregnancy, more insulin and glucose could be transported across the placenta, increasing the chance that the foetus experiences similar weight gain and metabolic dysregulation. Likewise, prenatal exposure to certain pollutants was linked to lower DNA methylation of a retrotransposon repetitive element in the human genome. 

Importantly, these poor health outcomes are due to environmental stressors, not innate genetic differences ‒ women of African descent born abroad were 25% less likely to have an infant with low birth weight, compared to those born in the US. This difference was absent between White women.

In light of COVID-19, the existing health disparities have become even more obvious. Firstly, research shows that BAME communities in the UK are more susceptible to conditions such as diabetes, obesity, asthma, and depression, which in turn puts them at higher risk of severe COVID-19 disease. Secondly, due to allostatic load, individuals have a poorer stress response, which directly leaves them more susceptible to COVID-19. This could in part explain why the mortality risk was twice as high in Black communities. 

While the problem of race-related health stressors is a complex one, there are ongoing efforts to devise and implement solutions. At UCL’s own Centric Lab, research projects are underway, aiming to “help rehabilitate people through better urban policy and public health strategies that support our health”. In addition to providing educational resources, the Centric Lab designs and executes initiatives such as Know Your Health, a website and guide document created in collaboration with PLP Labs and design studio COMUZI. Here is how it works: individuals are encouraged to enter their address, and receive feedback about the potential environmental stressors they face. Next, they are offered a chance to advocate for change in their neighbourhood and those nearby. The project emphasises raising awareness among the local community about their own health, and allowing them to stand up for it. 

There is an urgent need for further research on how complex biological mechanisms enable race-related stressors to impact health. In order to promote better public health, underlying stressors and their mechanisms must be understood and accounted for by professionals across all disciplines ‒ medical staff, policy makers ‒ and affected communities themselves. Most importantly, the best solutions should be made by incorporating voices from the community, instead of taking a top-down approach and relying solely on what officials believe works best. 

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