Discrimination and Health Status

Steven R. Peskin, MD, MBA, FACP

"You Can't Outrun Your Past"........ The title of a slide in a grand rounds presentation by Dr. David Kountz, senior VP for medical and academic affairs at Jersey Shore Medical Center and professor of medicine, UMDNJ-Robert Wood Johnson Medical School. The subtext is that the impact of being black in our society confers incremental risk across a range of cardiovascular and cardiometabolic conditions irrespective of socioeconomic status. A 1997 journal article by Thomas, et al. reported the results of a 23–25 year longitudinal surveillance study of a cohort of all black physicians who graduated from Meharry Medical College from 1958 to 1965 compared to an all-white cohort that graduated from Johns Hopkins from 1957 to 1964. The black physicians had much higher risk of cardiovascular disease (RR= 1.65), incidence rates of diabetes and hypertension twice that of whites, a rate of coronary artery disease 1.4 times as high, and much higher case fatality rates (52 percent versus 9 percent).

Most surprising to me from this study: Black physicians in this cohort had incidence of cardiovascular disease comparable to low socioeconomic status (SES) blacks. Higher SES in this well-educated, health-literate cohort did not improve health CV health outcomes. In the study of Women's Health Across the Nation (SWAN), everyday discrimination was positively related to subclinical carotid artery disease for black but not for white women, and chronic exposure to discrimination over five years was positively related to coronary artery disease in black women. A final study without a health care endpoint but one that drives home the impact of discrimination: Pairs of young, well-groomed, well-spoken college men with identical resumes apply for 350 entry-level jobs in Milwaukee. Two teams of applicants are white and two teams are black. In each team, one applicant says that he had served an 18-month prison sentence for cocaine possession. The study found that it was easier for a white male with a felony conviction to get a job than a black whose record was clean. Genetics, diet, physical activity, other factors certainly contribute. Nonetheless, these are sobering studies that strongly point to the adverse health consequences of allostatic load on the health of black Americans in the United States.

Steven R. Peskin, MD, MBA, FACP is Executive Vice President and Chief Medical Officer of MediMedia, USA, which publishes Managed Care

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