Discrimination, hypertension, and well being disparities in African People – . Well being Weblog
In the past few months we have all seen the results of a significant disruption to daily life due to the COVID-19 pandemic, high unemployment and civil unrest due to chronic racial injustice. These overlapping waves of societal insults have begun to draw the necessary attention to the importance of healthcare disparities in the United States.
Direct links between stress, discrimination, racial injustice and lifetime health outcomes have not been well studied. However, a recent article in the journal Hypertension looked at the link between discrimination and increased risk of hypertension (high blood pressure) in African Americans.
Study links discrimination and hypertension among African Americans
It is known that African Americans are at greater risk of high blood pressure compared to other races or ethnic groups in the United States. The authors of the hypertension study hypothesized that one possible explanation for this inequality is discrimination.
The researchers reviewed data on 1,845 African Americans, ages 21 to 85, who participated in the Jackson Heart Study, an ongoing longitudinal study of risk factors for cardiovascular disease in African Americans in Jackson, Mississippi. The participants in the hypertension analysis did not have hypertension during their first study visits between 2000 and 2004. Their blood pressure was checked during two follow-up study visits from 2005 to 2008 and from 2009 to 2013 and they were asked about blood pressure medication. They also reported their own experiences of discrimination through home interviews, questionnaires and clinical examinations.
The study found that higher stress due to lifelong discrimination was associated with a higher risk of high blood pressure, but the association was weaker when risk factors for high blood pressure such as body mass index, smoking, alcohol, diet, and physical activity were taken into account. The study's authors concluded that lifetime discrimination can increase the risk of high blood pressure in African Americans.
Discrimination can have direct and indirect effects on high blood pressure
Discrimination is a chronic stressor that has been suggested to contribute to harmful outcomes, including high blood pressure. Discriminatory acts can directly affect high blood pressure through the stress pathway, triggering an increase in hormones that cause blood vessels to constrict, the heart beats faster and blood pressure rises. Discrimination can also contribute to the development of high blood pressure through unhealthy behaviors such as unhealthy diet or lack of exercise. People can even avoid seeking medical help for fear of being discriminated against in a medical setting.
Two other longitudinal studies (a type of study that follows participants over time) looked at discrimination and high blood pressure. A 2019 study published in Annals of Behavioral Medicine found that everyday discrimination in a sample of middle-aged white, African-American, Latin American, and Asian women may be associated with an increased risk of high blood pressure. Another 2019 study in the International Journal of Environmental Research and Public Health found a link between chronic discrimination and high blood pressure in a large sample of African American women.
There are differences in the health indicators
Racial and ethnic health differences are reflected in a number of national health indicators. For example, in 2002, non-Hispanic blacks followed non-Hispanic whites in the following areas:
- Those under 65 years of age with health insurance (81% of non-Hispanic blacks versus 87% of non-Hispanic whites)
- Adults over 65 years of age vaccinated against influenza (50% versus 69%) and pneumococcal disease (37% versus 60%)
- Women receiving prenatal care during the first trimester of pregnancy (75% versus 89%)
- Adults aged 18 and over who regularly participated in moderate physical activity (25% versus 35%).
In addition, non-Hispanic blacks had significantly higher proportions of deaths from murder and children and adults who were overweight or obese compared to non-Hispanic whites.
Many factors contribute to health inequalities
For African Americans in the United States, health disparities can mean past deaths related to developing chronic diseases such as diabetes, high blood pressure, stroke, heart disease, decreased quality of life, loss of economic opportunity, and perceptions of injustice. In our society, these differences lead to sub-optimal productivity, higher health care costs and social inequality.
It is clear that several factors contribute to racial and ethnic health disparities. These include socio-economic factors such as education, employment and income; Lifestyle factors such as physical activity and alcohol consumption; social and environmental factors, including educational and economic opportunities, racial / ethnic discrimination, and neighborhood and working conditions; and access to preventive health services such as cancer screening and vaccination.
Resolving health inequalities for African Americans is certainly within our societal reach. It requires state and national leadership, adequate resource allocation, and larger and more focused clinical investigations.
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