‘I Can’t Breathe’: Racial Injustice as a Determinant of Health Disparities

Amani M. Nuru-Jeter, PhD, is an associate professor of community health and human development, and epidemiology at the University of California, Berkeley School of Public Health, and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. Her research focuses on racial health disparities.

Eric Garner’s death and the failure to indict NYPD Officer Daniel Pantaleo have had a profound effect on communities throughout the United States. But it’s not just Eric Garner. This, and similar cases including Michael Brown, Tamir Rice, Trayvon Martin, and Oscar Grant, have put race relations front and center in the national debate.

I’m tired of it, this stops today...every time you see me you want to harass me, you want to stop me...please just leave me alone” –Eric Garner

These last words from Eric Garner are not that different from what we hear in our work with African American women in the San Francisco Bay area:

I think when I go out everyday some situation is going to happen as far as racism.

I think about it [race] all the time...everywhere I go, all the time.

I feel depressed at times when dealing with that stuff [racism] on a daily basis.

It starts to wear on you where you get depressed and you start thinking bad thoughts, and wondering if you’re really a valued part of society.

These statements suggest that it’s not just isolated acts of racial discrimination, but the chronic nature of racial discrimination that is particularly distressing for black Americans. The majority of black Americans report racial discrimination as a chronic stressor, and studies consistently show that chronic stress has a negative impact on health. This is partially due to the slow deterioration the body experiences from repetitive experiences of stress. Arline T. Geronimus, ScD, and colleagues found that black Americans age biologically at a faster rate than other groups. For example, black women are 7.5 years older biologically than white women of the same age.

In our own work, we find that the “wear” associated with chronic racial discrimination, referenced in the quotes above, is linked with poor health, especially among those who are vigilant about, or expecting, mistreatment because of their race. The constant awareness of one’s race and feeling the need to “brace yourself” for the possibility of being treated differently because of race, as we have found in our work, is a consequence of repeated exposure to racial discrimination. Eric Garner’s cry for help – I can’t breathe – exemplifies this “wear,” both literally and figuratively.

Some of these differences in aging bodies may be related to differences in the living conditions of blacks and whites. In a study we examined disparities related to income inequality among blacks and whites. Income inequality has become a hotly debated issue, and our research showed that it affects groups differently. Among whites, living in communities with higher income inequality was associated with fewer deaths, whereas among blacks higher income inequality was associated with a higher number of deaths. The difference is stark; the data show that higher income inequality is associated with 27-37 more deaths per 100,000 among blacks but with 400-480 fewer deaths per 100,000 among whites.

We found that racial segregation completely explained the higher death rates among blacks but did little to explain the link between income inequality and deaths among whites.

Data show that there has been little change in the racial composition of neighborhoods over time. People of color, especially blacks, continue to live in racially segregated communities. In fact, Blacks continue to experience the highest rates of racial segregation of any group. Racial segregation is part of a cycle of inequality and can deprive groups of access to important health-promoting resources such as healthy food options, quality schools, and parks and green space. Racially segregated low-income areas also have higher crime rates, substandard housing, and limited access to broader social networks limiting opportunities for upward social mobility and better health. Another characteristic of racially segregated poorer areas is hyper-policing and racial profiling.

The distress associated with racial discrimination coupled with racial vigilance, a learned response to chronic experiences with racial discrimination, can literally ‘age’ the body and may contribute to the poorer health outcomes already seen in racially segregated communities of color. However, studies show that when given the opportunity, these communities can thrive. In more racially integrated communities where blacks and whites live in the same neighborhoods with the same level of socioeconomic status, racial health disparities are reduced.

With the recent events in Ferguson and New York, continuing high rates of racial segregation, and the “aging” associated with chronic racial stress, racial equity may literally be a matter of life and death.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.