The Surprising Impact Of Discrimination On Health

Last week, we called attention to the issues facing minorities and mental health, an appropriate topic since July is Minority Mental Health Awareness Month. Espyr joined its voice to the conversation about how minorities and disadvantaged groups in the US have poor access to mental health services and called for dialogue about an end to such disparities. This week, we examine a related issue. While it’s been long known that poorly managed stress can lead to costly and deadly heart related ailments, we have not understood the possible impact of chronic stress brought about by systemic discrimination on people’s health.   And specifically,  we haven”t fully grasped the role of discrimination – related chronic stress in creating higher risks for hypertension.

Discrimination and Hypertension

Hypertension or high blood pressure directly kills 1,300 American every day or about half a million annually. It puts sufferers at risk for other common causes of death such as heart disease and stroke. Over 30 million Americans have hypertension. The condition is very treatable with diet, exercise, and medication, especially when detected early. But despite medical advances, only about 1 in 4 with hypertension have their condition under control according to the US Centers for Disease Control and Prevention. Some of the highest rates of dangerous hypertension are in Southern states like Mississippi, Alabama, South Carolina, and Louisiana. These states all have large numbers of Black citizens. African Americans overall are known to have a higher risk of hypertension than do other racial or ethnic minorities. Is discrimination one reason for this racial disparity?

Hypertension and Black Americans

A recent study published in the journal Hypertension looked at this question and examined the relationship between discrimination and the incidence of hypertension. The researchers looked at whether everyday discrimination, lifetime or cumulative discrimination and the resultant stress associated with this were associated with hypertension. Their study involved 1,845 Black Americans aged 21 to 85. After adjusting for risk factors, socioeconomic status, gender and age, the researchers found that stress from discrimination, especially over a lifetime is associated with higher risks for hypertension.

The results of this study are not surprising. Researchers have been finding other disturbing patterns of racial disparities in health outcomes for many years. For instance, despite the marvels of 21st Century healthcare Native American and Black women in the US are three to four times more likely to die a pregnancy- related death than White women. Many factors may contribute to such disparities: poor healthcare insurance coverage, poor access to our unevenly distributed healthcare system in the US and other reasons. Could one reason be that the lack of cultural competency on the part of healthcare providers affects diagnostic interviews and inhibits early screening and treatment?

Looking To The Future

Healthcare costs are a concern for all of us- consumers, practitioners, businesses public policy makers and taxpayers. Will the Black Lives Matters movement help bring greater public and institutional attention to the role of disparity in health outcomes and create positive change – change that can improve people’s wellbeing and better manage healthcare resources?  We hope so.

About the Author

Norman Winegar, LCSW, CEAP, is the Chief Clinical Officer for Espyr. Norman has worked in the mental health field for over 30 years and is the author of four books on behavioral health topics. He is frequently called on for presentations and as a panelist to share his expertise and experience as a mental health professional.

Sources

Forde AT, Sims M, Muntner P, et al. Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study. Hypertension. 2020. doi:10.1161/HYPERTENSIONAHA.119.14492 https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.119.14492

US Centers for Disease Control and Prevention. Facts about Hypertension

https://www.cdc.gov/bloodpressure/facts.htm

Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928067/#R38

Petersen EE, Davis NL, Goodman D, et al. Racial/Ethnic Disparities in Pregnancy-Related Deaths — United States, 2007–2016. MMWR Morb Mortal Wkly Rep. 2019;68:762-765. doi:10.15585/mmwr.mm6835a3

Testing for Statistical Discrimination in Health Care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361135/

About Espyr

For over 30 years Espyr, has provided innovative mental health solutions to organizations operating  under some of the most challenging conditions. Espyr’s portfolio of customized coaching solutions help employers reduce healthcare costs by identifying and addressing employee mental health issues before they require more expensive, long term care. For more information on how Espyr can help your organization, call Espyr at 888-570-3479 or click here.