SAMHSA’s Office of Behavioral Health Equity: Trauma, Racism, Chronic Stress and the Health of Black Americans.

SAMHSA’s Office of Behavioral Health Equity, on June 3, 2020 response to a technical assistance question they received:

“We’re also looking for anything that can help us approach individual and community level trauma and racism. I’m particularly interested in the health impact of chronic stress for Black Americans. Are you aware of anything that’s out there?”

There is significant research on the connection between racism, racial violence and health and behavioral health. Leading researchers in this area include David Williams (Harvard School of Public Health), James Jackson (University of Michigan), Ted Corbin and colleagues from Drexel University School of Public Health, and Thelma Bryant-Davis (Pepperdine University, examines police violence and excessive force through a trauma lens).

Key Findings

  • Racial discrimination damages individuals, hurts their health and prospects and shortens lives. Racism affects health in profound ways through systems built up over the years and now “locked in place, replicating social inequality.”
  • The stress and trauma of racism and its manifestation affects victims and witnesses; individuals and entire communities. Repeated violent altercations between residents in communities of color and police traumatize whole communities, and contribute to depression, anxiety, anger, fear, mistrust and other psychosocial problems. Those who have been directly victimized are likely to develop PTSD. Complex and historical, intergenerational trauma are retriggered by these events.
  • The burden of being a person of color in America includes the stress from the anticipation of violence in everyday life; diminished access to good health care and education; and, more broadly, socioeconomic differences that might not exist if the individuals were not targeted, marginalized and deprived of the tools to make their lives better.
  • For example, African-Americans are known to be relatively more susceptible to hypertension, or abnormally high blood pressure, than White Americans. In the past, the perception that they were genetically disposed to the condition was common. What predicts hypertension is the social context. It’s not consistent with a simple Black gene causing high blood pressure. White Americans have higher blood pressure than Black people living in Africa.
  • “At every level of income and education, there is still an effect of race,” even wealthy Black Americans are statistically less healthy than affluent White people. “Health disparities are large and persistent over time. About 220 African-Americans die every day in the United States who would not die if their death rates were similar to those of White people.”
  • Housing segregation is the most pernicious agent of racism in the country, a system of public policies and lending practices that channel Black people into neighborhoods where no one else wants to live. This happens in every sizable city in the country, and has for many decades, forcing most African-Americans to live in less desirable circumstances than White people do. “Even when they are living in the same city, Blacks and Whites are living under very different environmental conditions.” “If you could eliminate residential segregation in America, you would completely erase Black–White differences in income, education and unemployment, and reduce single motherhood by two-thirds. All that is driven by the opportunities linked to geographic space. That is the power of racism.”
  • Mechanisms connecting stress to disease have been established for decades. Similarly, mechanisms linking the stress, burden and omnipresence of racism have more recently been identified. Chronic stress produces hormones that damage the body over time. This damage, called allostatic load, can be measured and scored using health data (e.g., cholesterol, blood pressure, cortisol levels) and is a measure of cumulative adversity and disadvantage. High allostatic load scores have been linked to lower life expectancy and higher rates of chronic disease.
  • Evidence suggests that environmental and social factors contribute to differences in allostatic load scores by race and gender. For example, upon arriving in the United States, Black African immigrants have lower allostatic load scores than Black people born in the country. Studies also show that Black immigrants’ allostatic load scores increase the longer they live in the United States. Race and gender differences in allostatic load scores are not explained by different rates of poverty: At all income levels, Black women have the highest allostatic load scores.
  • In part, this mechanism has been used to explain the higher rates of infant mortality/morbidity among African American women, including poor pregnancy outcomes, such as pre-term birth and low birthweight.

Population: African American

Links to Resource:

Date: 2020