There are strong and persistent data that suggest social factors — in addition to the typical pathophysiologic influences — have a significant impact on mortality. Often called “social determinants of health,” these forces can be challenging to notice and therefore easy to deny. However, evidence shows that they can have health-related consequences and increase patient mortality.

An NPR broadcast from December 2017 reported the disheartening statistic that the risk of mortality during childbirth is increased 3-fold in African American women. The story focused on a successful woman who held a high-ranking position in the US Department of Public Health Service and her journey toward death shortly after the birth of her daughter.

What’s most disturbing about the piece is its summary of the research and data that demonstrate the cumulative health impact of discrimination and bias, on both the conscious and subconscious level, on African American patients of all socioeconomic classes. Much of the story is told by the mother of the woman who died, and it paints an alarming picture of the medical missteps that led to her death. These include delayed or missed diagnoses, lack of attentiveness during the patient’s decline, and ignoring key symptoms that should have led to more intensive care.

During the broadcast, Arline Geronimus, a professor at the University of Michigan School of Public Health, coined the term “weathering” to denote stress-induced wear and tear on the body. “Weathering causes a lot of different health vulnerabilities and increases susceptibility to infection,” she said, “but also early onset of chronic diseases, in particular, hypertension and diabetes.”1 These conditions disproportionately affect black individuals at much younger ages than white individuals. Her research suggests weathering accelerates aging at the molecular level; in a 2010 study conducted by Geronimus and colleagues, the telomeres (chromosomal markers of aging) of black women in their 40s and 50s appeared 7.5 years older on average than those of white women.2

The author stated in a subsequent interview on NPR that much of her research on weathering was originally dismissed by many in the medical community, with skeptics voicing concern about such a concept. Geronimus noted that over time, the concept has gained traction in the medical community, but many physicians continue to have difficulty surrendering to the belief that illness can be caused by factors other than lifestyle choices and genetics.

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There is now significant evidence to support the concept that systemic discrimination and bias contribute to specific and identifiable causes of poor health in African Americans and other minorities. Addressing these issues will remain a challenge for the medical community as long as medical providers continue to ignore or dismiss the evidence that these problems exist.

References

  1. Martin N, Montagne R. Black mothers keep dying after giving birth. Shalon Irving’s story explains why. NPR website. https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why. Published December 7, 2017. Accessed June 26, 2019.
  2. Geronimus AT, Hicken MT, Pearson JA, Seashols SJ, Brown KL, Cruz TD. Do US black women experience stress-related accelerated biological aging? A novel theory and first population-based test of black-white differences in telomere length. Hum Nat. 2010;21(1):19-38.