Racism—both on a personal level and in overall society—negatively affects the mental and physical health of millions of people, according to the Centers for Disease Control and Prevention. These health issues, and some ways to rise above them, are addressed in this Q&A with Lynne D. Richardson, MD, Co-Director of the Institute for Health Equity Research at Mount Sinai, and Professor of Emergency Medicine, and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai.
“Racism is a public health crisis that is damaging to all of us, regardless of race or ethnicity,” Dr. Richardson says. “We need to use all of the tools at our disposal to fight it, and to improve our own individual and our collective emotional and physical well-being.”
Lynne D. Richardson, MD
How does racism affect mental health?
That is a big question. The impacts of racism happen at various levels because, of course, racism happens at various levels. There is the experience of being personally discriminated against, whether that’s racial slurs or hate crimes or the experience of being followed in a store because you’re under suspicion that you’re going to steal because of the way you look. All of those sorts of macro and microaggressions really undermine your sense of self-confidence, your sense of self-esteem, and your sense of safety. It’s like having repeated traumas on your mental and emotional well-being.
There is a lot of evidence that racism of various kinds has a destructive impact on mental health, and there is a growing awareness of the importance of structural racism in that picture—this includes limited access to societal resources, like housing, food, job security, and health care. The persistent inequities in the way that those resources are distributed across our society have an impact on our mental health and well-being. It’s those persistent negative messages that you are not valued, that you are not protected. This is why we see huge disparities in conditions like depression. African Americans are much more likely to have more severe symptoms. They have a longer course of illness, and they experience greater levels of disability from depression compared to white patients. This is also why rates of youth suicide are exploding in the black community, with something like a 73 percent increase over the last decade of suicide attempts among young people of color. In terms of suicide death rates, the fastest growing segment are black children between the ages of five and 12. We are seeing the impact of racism and the harmful effects that it has on mental health reflected in this epidemic of suicide among black youth.
How does racism affect physical health?
Racism affects physical health in direct ways. Due to structural racism, you may be more likely to live in housing that is substandard, housing that has environmental toxins or irritants that directly impact your health. You are more likely to live in a neighborhood where there are higher levels of air pollution, where there are higher levels of violent crime. You are more likely to not get the health care that you need, and so you may have a higher burden of disease and more avoidable complications of illnesses like hypertension, diabetes, heart failure, or asthma. These effects are cumulative, and they directly impact the physical health of communities that are experiencing the effects of structural racism.
There is also a connection between mental health and physical health. We know that the assault on your mental health also affects your body. It affects your immune system and makes you more susceptible to disease. It affects your hormonal system and results in problems with your adrenal regulation. So the more we understand about how complex health disparities are and about all the things that create these differences in health between blacks and other groups, the more we understand how racism is often a root cause of many of these effects.
What are some ways to feel better?
I think it is important to not only talk about the negative ways in which racism impacts black people, but also to remember all of the strengths that have helped us to get to where we are today. I think that we have to pay attention, to take care of ourselves and take care of each other, especially given the recent impact of the COVID-19 pandemic. I think it is even more important that we lean on our strong social supports of families and friends. For many people, spirituality is a source of strength and comfort.
In addition, I think we have to try to directly address the inequities that are leading to these negative impacts on our mental and physical health. I have a colleague who talks about spreading hope, as a strategy to deal with what we are facing as we combat the effects of racism—and I love that image.
What are some ways to help?
I think all of us have an obligation to advocate for anti-racist policies, and that happens at every level. There are societal issues. There are policies and processes in every institution that we belong to. There are things that we can do, in every place we are, to try to understand how the structural inequities are embedded in our society, and to start to dismantle them. We need to do that where we work, where we go to school, where we worship. In every context, we all need to be doing this anti-racism work if we really want to make a difference and we really want to end these long-lasting, persistent effects of racism on communities of color.
What else should people know about racism and health?
There is a lot of discussion now about implicit bias. One of the things that is not widely understood about implicit bias, or unconscious bias, is that while it may happen at a subconscious level on the part of the person who has the bias, it has a very explicit impact on the person who is the recipient of the bias. There is often a sense that because this kind of bias is not intentional it’s not harmful, but it is very harmful, and it results in micro aggressions that do create repeated micro-traumas that erode our physical and mental health.
Therefore, I think everybody has individual work to do on themselves to understand the extent to which they have internalized the biases that are pervasive in our society. At the same time, we should work at a higher level collectively on our organizations and institutions and try to eliminate the structural racism that is persistent and pervasive throughout our institutions.