David Williams: Is Racism Bad for Your Health?

David Williams: Is Racism Bad for Your Health?

Racial inequality has long been a social problem, but is it also a health problem? Harvard University’s David Williams sits down with Piya Chattopadhyay to discuss how discrimination and racism affect a person’s health.

racial inequality has long been a social problem and our next guest says it's also a health problem joining us now to detail how discrimination affects a person's health and well-being is David Williams sociologist at Harvard University hello thank you for coming on to the program thank you it's good to be here with you you're here in Toronto delivering a lecture called race and health a healthy future for us all yes how is race a public health issue race is a public health issue because your race in most countries of the world predicts how long and how well you will live so depending on what race you are we can say something powerfully about the quality of your life the length of your life and how good your health will be okay let's look at some numbers of life expectancy of blacks and whites in the US to give our viewers a snapshot of the disparity at least in that country okay we all know women live longer than men despite their race about into their late 70s early 80s the real gap here is with men white men right now are living to their mid-70s black men just below 70 what do you infer from those numbers um I mean those numbers remind us of a trend that has existed from the earliest health data in the United States and that is that whites live longer than blacks and although the good news is that life expectancy for both whites and blacks have increased over time and we've had some narrowing of the health gap we still have the persistence of that racial gap in health and importantly it reflects the fact that we still have the persistence of social inequalities race is in part a proxy for social inequality in society from that chart life expectancy for black women still higher than white men what's that about black women have made progress over time there is a racial gap in health there's also a gender gap in health so black women at disadvantage compared to white women but they do slightly better than white males scientists determined and long time ago that race is a social construct rather than a biological category so how can there be it a different life expectancy than for blacks and whites that's a really good question I like to think of it this way the fact that you and I know what race we belong to tells us more about our society than about a biological makeup because race is not capturing much about biological distinctiveness the superficial external characteristics that that race reflects doesn't have much to do with whether we get sick or not whether we get sick or not has to do with the opportunities to be healthy in the places where we spend most of our time our homes our communities our workplaces and race in most societies reflects differential access to the desirable goods and resources in a society so basically what I'm saying is blacks and other disadvantaged groups in the United States like American Indians and increasingly Hispanic populations and Pacific Islanders have worse health than whites because they tend to live in poorer neighborhoods because they have higher levels of stress and distress linked to racism is one type of stress we can talk more about but in general they have lower levels of income they have jobs where they have higher levels of negative occupational exposures so as you go across every domain of life they are socially disadvantaged and our bodies keep track and keep a record of all the negative exposures that we have and so we have racial differences in health and in life expectancy disparities caused by socioeconomic status disparities caused by larger social social inequalities including socioeconomic status absolutely okay we often talk about you know outcomes based based on demographics like middle-class family for example how they do so should a black or Latino middle class family expect to have the same health outcomes as a white middle-class family that's a really good question when I started my academic career and research in this area some 25 years ago most researchers believed that a racial differences simply reflect the differences in income education and occupation and if you compare blacks and whites at the same level of income and wealth and education there would be no racial difference what we now know is that yes there are large gaps in health by education so middle-class blacks do a lot better and live a lot longer than poor blacks but at every level of income and education black still have poor health so in addition to the standard risk factors linked to education and income there is something else about race that matters and I have been doing work trying to unpack what else it is about race and what are the ways in which the experience of being black in a society has consequences for that just to be clear that same black middle-class family higher healthy outcomes that a poor white family in in some analyses yes but remember at every level of income and education that a white person is doing better than a black person with the same level of education as he or she is okay what do you attribute that to so we we are we are trying to understand what else it is about race and I think we think it's three things number one if you look at a college-educated black person today so their social status is high but a college-educated black person today is more likely to have been born poor more likely to have experienced deficits and access to good nutrition and access to good medical care in early childhood higher levels of what we call early childhood adversities the toxic stress holes in childhood and our bodies keep a record of all our lifetime exposures so that even if today your high status you still suffer for some of the earlier life exposure so that's number one you've got to take a life course perspective into account secondly in the United States all the indicators of socioeconomic status and not equivalent across race what do I mean by that I mean if you look at on average a level of education at the same level of education White's earn more income than blacks and on average income in the hands of a white person buys more goods and services than in the hands of a black person and that may sound really crazy because on average blacks live in worse places but the cost of goods and services are higher the rent per square foot is higher the cost of insurance is higher the cost of a lot of goods and services are higher in the poor places where blacks and Hispanics are more likely to live so you don't get as much precious in power of income and at every level of income at similar levels of income White's have greater wealth than blacks then you know income is the flow of resources into the household wealth is the economic reserves that blacks have so that's the second issue that even though we're saying they are equivalent they're not really equivalent but certainly and and most importantly I think for our conversation the r-word racism still matters for health in multiple ways well as you say there are a range of reasons why these health disparities exist absolutely so I want to pick up on the third one okay our word is you say yes how can be certain that it's racism that is very good question we racism operates in multiple ways and there are scholars who have studied racism over time so I'll give you one example of racism that most people don't even think about racism operates through institutional mechanisms and what we mean by that it's not what any individual person does there's no no action on the part of an individual person but there are policies and procedures that could have been put in place 50 years ago a hundred years ago that still have consequences in the United States we have a very powerful one it's called residential segregation in the early twentieth century the United States Society American Society develop policies to separate blacks from whites in terms of the areas where they could live it was the law of the line it was supported by the banks and by realty agencies and everyone had bought into this differences well it's no longer the law of the land it's been ruled illegal by the Supreme Court in the 1960s but still Americans today are just slightly less segregated than blacks in South Africa were on the legally mandated apartheid so although it's no longer the law the custom has maintained these differences in living circumstances and where you live in the United States determines what school you go to it determines your access to employment opportunity it determines the quality of housing you have it determines whether your neighborhood is a healthy community or an unhealthy one it even determines your access to high-quality medical care so in the u.s. we now say that your zip code are in the UConnect Canada we see the postal code we call it ZIP code in the United States your zip code is a stronger predictor of how long and how well you live then your genetic code you've entered postal codes in Canada your data is born out of the u.s. yes do you have a sense of how these racial differences in health play out here in Canada we do there are Canadian researchers who have been study and I think that's been less focus in Canada on the race variable but they are Canadian researchers who have been studying race in Canada and a finding similar patterns to what we find in the United States particularly there's been researchers looking at discrimination the subjective experience of discrimination as one type of stressful life experience that has health consequences you talked a little bit about the makeup of residential situation in the u.s. today I just want to sort of talk about the story behind the numbers yes I know things are still slightly the same but things have changed over the substrain three or four decade so how has situation changed its improved yes there are lower levels of segregation today than there was in 1960 1970 1980 every census the levels again in lower however most of the decline in segregation refers to the fact that there is now one or two black families living in a census tract that used to be all white but the fundamental structure of the concentration of poverty of blacks in in in particular areas of cities and a concentration of poverty and all of the urban ills that go with that that structure has not changed much in recently so the disparities in health haven't changed in three to four decades disparities in health have become slightly smaller but they're still large let me explain to you just how big the disparities are imagine a fully loaded jumbo jet with 265 passengers and crew taken off from the Toronto Airport okay and everybody on board dying and that happened today and tomorrow and every day next week and every day next month and every day for a year that's what we talk about when we say they are black white differences in health in the United States 265 black people die prematurely every single day in the United States so these are huge differences that that we cannot just accept when there is a lot that we can do to change the plain feel and to create opportunity for better health for all we'll talk about what we can do but but I do want to ask you in terms of health treatments is discrimination manifest in those terms as well absolutely between 2000 and 2002 I served on a panel for the Institute of Medicine it's the highest scientific medical authority in the United States and the United States Congress had voted to ask the Institute of Medicine to answer a simple question and this was the question when blacks and other minorities enter healthcare context in the United States does their race determine whether or not they get good quality medical care and the report was issued in 2002 and what we found that virtually across every single area of medicine blacks receive and other minorities receive poorer quality of care than whites do I everything's will be colorblind it is and and but but it's complicated our health care providers are part of our society they were raised in the society and they have been fed the same cultural racism that is so deeply embedded in society let me give you an example of the kinds of differences we find dr. Todd was an emergency room physician at UCLA Medical Center in Los Angeles and he asked a simple question when a patient comes into the UCLA emergency room with a broken bone in the arm or legs does the patient's race determine how whether they get pain medication or not and he found that 25% of white patients in the past year had gotten no pain medication compared to over 50% of Hispanic patients had gotten no pain medication dr. Todd was a good researcher he said it must be something else so he statistically took into account what time the patient came to the ER how long is spent in the emergency room whether they got injured on the job or not whether they spoke English or not virtually every other social demographic factor and the strongest predictor of whether patient got pain medication was the patient being Hispanic dr. Todd moved to Atlanta to Emory University repeated the same study at emergency rooms in Atlanta and found a black patient going to the emergency room with a broken bone in the arm Oleg is less likely to get pain medication than a white patient and that's just one example of a pervasive pattern across every single area of Melanie helped me understand that though because it's hard to imagine that a doctor would look at someone say black man with broken leg white man with broken leg you white person will get pain medication you black person maybe sometimes probably no how does that happen that is correct what we offered as a the best explanation for this phenomenon for which today we have good hard evidence is a phenomenon that social psychologists have been studying for three or four decades it's called unconscious or unthinking bias or discrimination based on negative stereotypes and this is what the research shows and by the way I want to emphasize this is not about American doctors this is not about Americans this is not about white people it's about how all human beings process information if I hold a negative stereotype about a group and I meet someone from that group my next two words are important it's automatic and it's unconscious I do it I don't know that I do it I will treat that person differently that is I will discriminate against that person and I there was no intent on my part there was no hostility on my negative stereotype is not an individual decision it's not an individual decision it's based on these negative images in your mind for that group and it's not just about race if you have negative stereotypes about gay people about fat people about old people and you meet someone from that group you will treat them differently in a broad range of social context in society and the ER is no different and the ER is no different and physicians and other health care providers are parts of the societies in which they were raised all right broaden this out for me what are the economic costs associated with racial disparities in health the economic costs associated with racial disparities in health are substantial a study was done about two years ago that suggested that racial inequalities in health cost the US economy 310 billion dollars a year and that is both the additional cost of treating illness one and even the bigger cost was lost productivity when people are sick and not able to work when people are dying prematurely we are losing that level of economic productivity in other words what I'm saying is that racial inequalities in health literally hurt the productiveness of the American population and hurts America's economic competitiveness on a global level so it's an important issue to address not only for the wonderful humanitarian reasons of giving everyone the best possible life they would have but also for the national reasons of having the best workforce and the most productive workforce that you can have okay provide us with the data the evidence the big question of course that is what do you do about it what do you suggest health authorities other governments other authorities do to address this problem that exists as you argue not just in the United States but in almost every country in the world there is a lot that can be done remember I said that the determinants of health are primarily driven by the opportunities to be healthy in the places where we live learn work play and worship and that means no one sector of society has the answers we all need to work together to create a culture of good health a culture that promotes better health in our schools that encourages our kids to be active that promotes good nutrition we need in our neighborhoods to to break the linkage between the minority composition of the neighborhood and exposure to violent crime and access to employment opportunities and access to safe places to walk and access to fresh fruits and vegetables so there's a lot that we can do for health care providers we need to raise awareness levels that they're these human processes that occur and that you would naturally have treat someone differently the the biggest strategy for health care providers is to be aware that that could be me I could actually discriminate against social groups that I am NOT a part of without any intent on my part and that awareness can facilitate a number of strategies that healthcare providers can do to minimize engaging in such behavior what about universal health care would that help universal health care would help it's it's not a magic bullet as health care in most Western societies is not heavily focused on prevention so that it functions to a large degree as a repair shop taking care of us once we get sick but not being a driver of whether we got sick or not in the first place there are preventive strategies and I'm kind of generalizing but by and large our health care system is not focused on prevention on the other hand their disparities not only in getting sick once in the videos get sick how long you live what's the quality of your life what's your level of impairment are all a function of good quality health care so providing universal access to care is one important step one foundation building block to everything that we need to do to improve health you're hopeful that we can turn this around change it I am absolutely hopeful there is my presence here reflects a conversation in this country about these issues and across the world and in multiple countries there are more people paying attention to these issues and I think we are all people of goodwill I think most people are shocked to hear of the kinds of statistics we are talking about and I think we need to provide tools that particularly policymakers can make so that they can bring a focus of health into all policies and take the steps that are needed to provide better health for all David Williams appreciate your time thank you very much for coming in thank you it's good to be with you support Ontario's public television donate at t v– org


  1. Racism is bad for our health it brings stress and fear. Especially as a black person I feel scared for my man to be killed or to be accused of a Mistake and be killed by a police 👮‍♀️

  2. White racism died 2 generations ago. But racism against whites is alive and well. Both Blacks and hispanics exhibit racist attitudes towards whites in greater and greater numbers and it is perpetuated by the LEFT wing media and by the likes of the people above.

  3. Racism is mostly dead. We need to move away from the Idea of Racism (a conscious decision to discriminate) and toward the idea of Racial Bias (a subconscious act of discrimination). We can't continue to brandish good people with the tittle of Racist, when they don't know what they are doing. Calling white people racist for subconscious action is counter productive.

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