Systemic racism is designed to disadvantage and oppress People of Color (POC) through limited economic mobility, access to health care, hiring discrimination, residential segregation, and biased enforcement of policies and laws resulting in numerous negative poor health outcomes.1,2,3,4 Police brutality in the killing of George Floyd and Breonna Taylor, two recent examples, are manifestations of more egregious and persistent societal problems embedded in historical contexts and reflective of White entitlement and perception of superiority.5,6 Compared to Black males, female victims of police brutality have not been widely publicized. Only recently have movements such as Say Her Name spotlighted these encounters.7,8 Importantly, each time police brutalize POC and the events are aired or broadcasted, people in general, especially, POC, experience traumatic effects including, anger, agitation, frustration, outrage, and helplessness.9 Pause for a moment and reflect on these negative experiences, occurring repeatedly and cumulatively overtime. Consequently, the negative responses for POC cause profound debilitating physical, psychological, and behavioral effects with continued exposure5,10 that some metaphorize as “weathering.”11 The objective of this paper is to highlight the health consequences of racial injustice and systemic racism and provide practical recommendations for actionable and supportive interventions to contribute to racial justice.
The resultant negative health consequences from cumulative stress that emanate from racial injustice are clear and have been extensively investigated.12,13,4 Although minimal progress has been made to address the root causes, the plethora of evidence suggests alarmingly profound negative health outcomes that must not be ignored. Allostatic load is the accumulation of stress over time and its effects on the body and brain.14,12 Brain and body responses target important body systems and functions such as physiologic (immune, autonomic, cardiovascular, neurocognitive, gastrointestinal, and metabolic systems) psychologic (stereotype threat, internalized racism, racial identity), and behavioral (poor lifestyle practices, low productivity),5,15,10,12 resulting in increased risk and vulnerabilities for a myriad of illnesses for POC. Specially, these may include, anxiety, depression, taking risks, excessive reaction to situations, cancer, obesity, hypertension, diabetes, infections, negative birth outcomes, pregnancy-related deaths, and other related disorders.4,12,10,16 Immigrant people, who are often shown to be healthy initially, develop similar risks and vulnerabilities as their U.S. born counterparts overtime with persistent exposure to discrimination, racism, and exclusionary practices.17 Thus, demonstrating that allostatic load resulting from chronic stress is a real public health threat in the U.S., which must be addressed to realize racial justice and health equity for a healthy population. Additionally, the mechanisms associated with allostatic load outcomes may be influenced by sex, environment, genes, age, among others.5,12 The cumulative stressful effects lead to the substantiated overall unhealthy and increased mortality rates of POC.10,17,18 Without addressing the root causes of racial injustice and racism, the trend will continue as seen with the disproportionate burden of the COVID-19 pandemic on POC;18,19,20 It is even more critical now to address racial injustice because “… health equity benefits everyone”13 (K. Sebelius, Secretary, HHS, p.1). Efforts to realize racial justice and health equity must be made within the context of the historic backdrop that established laws propagating racism for over a century and continue to view POC as less than, inferior, and unentitled6,15 to provide a framework for effective responses to racial injustice and systemic racism.19
Prevention efforts for racial injustice and systemic racism have mostly focused on individual level interventions. The notion that if only individuals do certain things, racism will be eliminated has been widely touted. Decades of empirical and theoretical data demonstrate that while individual interventions are a great starting point, even more important, are systemic level interventions to address the legitimation and normalization of laws and policies that suppress and oppress POC.
Viewed through the lens of the social determinants of health and the intersections of biases (race, gender, immigrant status), we offer evidence-based recommendations12,14,21 utilizing a holistic, multi-level, and multi-faceted approach to reduce allostatic load.22,12,16 At the individual level, physical exercise has been shown to relieve stress, depressive symptoms, strengthen cognitive resilience, improve physical and mental health, and body weight among participants who show high levels of allostatic load.12 Social support and social interaction increase the adaptation and coping from stressors, thus increasing resilience that would be helpful in countering the negative effects of stress. Yoga and meditation improve sympathetic nervous system function and cortisol levels through reduction of stress, blood pressure, lipids, better cognitive function, and other physiologic measures.12,21,23
At the systemic level, efforts should be placed on widespread programs that are equally distributed across neighborhoods and class for more effect and sustainability across generations for sustainability.1 For example, policies that promote well-being and mitigate childhood poverty, provide adults with socio-economic access and opportunities to propagate economic mobility, and increase workforce diversity.22 Also, important is establishing policies that ensure the collaborative and coordinated engagement of more POC in research19 by providing the grants, mentorship, and tools to support the conceptualization of systemic racism, develop frameworks to further our understanding of the mechanisms of systemic racism, and implement the appropriate interventions.4,22,24,25,26 Required training for employees at all levels would help bridge the knowledge-gap to provide the historical context and recommend strategies to address racial injustice as a recipient and an observer.22,19
Importantly, at the most granular level, the inclusive, intentional, and thoughtful interactions of White People with people from diverse backgrounds is warranted. Specifically, consciously treating, speaking to, supporting a POC the same way a White Person would be treated provides enormous opportunities for the recognition and acknowledgement of behaviors that could potentially incite discrimination and exclusionary practices.5 With thoughtfulness and intentionality, we will “go all IN” to usher in a new day for racial justice.
For progress to be made important questions must be asked and investigated to deepen understanding. For example, how should the daily impact of racism experienced by POC be investigated and quantified? How should the multilevel and intersectional factors (gender, class, culture, etc.) of racism be investigated and quantified? How should policing be reframed? What is the level of funding to address racism at the granular and systemic levels? What are the roles of policy makers and professional organizations in facilitating this process? Should gymnasiums and yoga studios be run free of charge by the government for equal access? How should data be mined to inform the implementation of these interventions?
To ensure that the recommendations are implemented and sustainable, institutions, health providers and researchers must lead to support, commit, and act. We call on clinicians and academic scientists to systemically investigate the root causes of racial injustice, systemic racism, and other discriminatory practices and contribute to its eradication for positive overall health outcomes. With the new White House Administration and the first female and Person of Color as Vice President of the United States, there is renewed hope for justice, equity, and multiple dimensions of health.
*The Women’s Health and Health Equity SIGs are collaborating on a series of publications to evaluate challenges of racial injustice and systemic racism and provide practical and actionable recommendations to begin to succeed in racial justice, health equity, inclusion, and consequently, better health outcomes.
Jessica Gorzelitz is the Women's Health SIG Trainee Co-chair and has made substantive contributions to the discussions. Her position as a fellow at the NIH requires that she obtains approval for co-authorship. Approval is pending at the time of this publication.