Sharpest Scalpel Volume 3, Number 3 | Page 17

Sharpest Scalpel Opinion Piece:“ Is Discrimination, Bias and Stress Leading to Poor Health Outcomes for Black Women?”

By Dr. Tavonia Ekwegh, DNP, MPH, APRN Faculty Assistant Professor and Assistant Director of Doctor of Nursing Practice

While it has been abundantly clear and indisputably significant through our nation’ s history that racism and racial discrimination have led directly to the deaths of many Black men and women throughout the years, the dirty little secret is that discrimination and marginalization can also be indirectly catastrophic to the health of the minority community. It occurs by slowly, methodically, and irrevocably eroding the mental and physical well-being of those on the receiving end of discriminatory practices and attitudes.

The term weathering was first coined in 1992 by Dr. Arline Geronimus, professor in the Health Behavior and Health Education department at the University of Michigan in Ann Arbor. She found in a study entitled“ The weathering hypothesis and the health of African-American women and infants: evidence and speculations” that“… the health of African-American women may begin to deteriorate in early adulthood as a physical consequence of cumulative socioeconomic disadvantage.”

Although this was a hypothesis at the time of the 1992 study, Dr. Geronimus has since convincingly vetted the premise in her later work, including in a 2006 paper that concluded,“ Blacks experience early health deterioration as a consequence of the cumulative impact of repeated experience with social or economic adversity and political marginalization.” In defining the phenomenon during an NPR Radio broadcast in 2018, Dr. Geronimus referenced the death of Erica Garner, an activist for social justice and the eldest daughter of Eric Garner, a man who died from a police choke hold in New York in 2014.

Garner, only 27 years old at the time of her death, died of a heart attack in December 2017. Dr. Geronimus described Garner’ s death as like playing a game of

Jenga, i. e., removing small piece after small piece until you eventually collapse from a lack of structural support. Jenga is a game where an opponent’ s movement might affect one’ s approach. Concerning human behavior, Jenga demonstrates decision-making and strategy when faced with obstacles. You hang on as long as you can to your health, but in the end, every lost piece ultimately stacks on top of each other in a sort of tenuously faltering tower of health, until the accumulating weight is too great and there is simply nothing left to lean on.

Black women in particular face risks to their health from systemic socioeconomic discrimination. Research by Nancy Krieger, a Professor of Social Epidemiology at the Harvard T. H. Chan School of Public Health, found that early-life exposure to Jim Crow laws led to negative health effects decades later. For instance,“… in 1960 to 1964, the Black infant death rate was 1.19 times higher in the Jim Crow era than in the non-Jim Crow era,” and that among U. S. women currently diagnosed with breast cancer,“… being born in a Jim Crow state heightened black women’ s risk of being diagnosed with tumors that have a worse prognosis.”

The cumulative burden of chronic stress and life events( weathering), like those experienced by black women in our country, is referred to as an allostatic stress load, which refers to cumulative chronic stress over time. It is a quantifiable condition that impacts significantly more black women than white women. In a study published by the Journal of the National Medical Association in 2012, Black women were found to have a notably higher allostatic load score than white women( 2.6 vs 1.9), resulting in higher mortality among Blacks and underscoring“… the importance of chronic physiologic stressors as a negative influence on the health and lifespan of blacks in the United

CDU College of Medicine | PG. 17