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Tufts Public Health » Environment, Racism » Racism and public health: How environment shapes wellbeing

Racism and public health: How environment shapes wellbeing

Racism and other forms of oppression – whether based on ethnicity, gender, language, sexual orientation, nationality, or other characteristics – act separately and together to cause disease. While individual behavior plays a role in health, it is only one small piece of the puzzle. “We have to name those things that are interfering with optimal health outcomes,” says Linda Hudson, ScD, Assistant Professor of Public Health and Community Medicine.

Camara Jones, President of the American Public Health Association, describes three categories of racism: institutional or systemic forces; personally mediated interactions between individuals, and internalized psychological effects on targeted people.

One institutional mechanism that negatively impacts health is redlining. Redlining refers to the practice of refusing to provide services (such as mortgages) to people based on where they live. In the U.S., redlining has historically targeted communities of color and other minority groups. Ta-Nehisi Coates writes:

“Housing determines access to transportation, green spaces, decent schools, decent food, decent jobs, and decent services. Housing affects your chances of being robbed and shot as well as your chances of being stopped and frisked.”

Housing, in other words, affects access to a variety of factors – from clinics to nutritious meals to safe spaces to exercise outdoors – that in turn affect health. HOLC Map of Greater Boston

HOLC map of Greater Boston
Image via Urban Oasis

Maps from the Home Ownership Loan Corporation (HOLC), an agency created by the New Deal, show neighborhoods in Boston and around the country rated by credit risk. One note from a 1937 description of a red “hazardous” area reads: “Infiltration of Foreign – negro.” Lenders denied critical home loans to residents of such neighborhoods, while making funds available to green “best” areas (“Infiltration of Desirables”). Some scholars argue that these maps were used as tools for redlining.

At the interpersonal level, race affects the relationship between patients and providers in ways that harm the quality of medical care. Black patients experience poorer communication with physicians than white patients. Physicians are less likely to prescribe pain medication to black or Hispanic patients than to white patients who report similar symptoms. These differences may stem from unconscious bias or from perceptions that certain populations do not need or deserve the same treatment.

Racism can also take a toll on individuals through biological mechanisms. “Racism is associated with increased levels of stress,” explains Hudson. “Stress results in increased levels of cortisol, [a hormone that responds to perceived threats]. Cortisol builds plaque in the arteries, leading to increased blood pressure.” Studies show that this cascade can increase the risk of heart disease and other health issues among racial/ethnicity minorities.

Addressing systemic racism and its health effects requires a long-term and multifaceted process. The environment around minority communities – “where you live, where you work, where you play” – is important, says Hudson. Government structures (like the HOLC maps) shape this environment. For example, in the court system, sentences for possessing certain drugs used predominantly in minority communities are more severe than penalties for other similar drugs. Scholars refer to this smoothed path from communities of color to incarceration as the school-to-prison pipeline.

To counter this environmental pattern, Hudson says, public health professionals and others must build another kind of pipeline, one that provides support and opportunities for vulnerable young people. The environment, she explains, can “either nourish or diminish them.” Through Tufts’ Teachers and High School Students Program, Hudson and other colleagues mentor students interested in public health and the biological sciences each summer. The high schoolers complete a project, attend presentations, and discuss the political and environmental forces that influence differential health outcomes in conversations fueled by readings such as Rebecca Skloot’s The Immortal Life of Henrietta Lacks.

Such conversations should continue throughout a public health career, says Hudson. Individuals can educate themselves by diving into the literature. Professors and students alike can tie issues of social justice into classroom conversations. For everyone in the field of public health, Hudson says, getting involved with a professional organization is key. In a time of political change, she says, “we need to…put our collective [efforts] and financial resources into organizations that we believe are really going to be in the forefront of being able to have a voice.”

by Cayla Saret, MPH Candidate ’17

Filed under: Environment, Racism

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