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Racism’s Relentless Toll on Black Health in America

From chronic stress to cancer, racism ‘weathers’ Black Americans’ lives over time.

Stephanie McWoods looking out at Lake Merritt in Oakland, California. The therapist wants to disrupt what it means to be a strong Black woman. (Meika Ejiasi for Vox and Capital B)

This story was produced in partnership with Vox as part of the discrimination issue of The Highlight.

OAKLAND, Calif. — On most warm days, Stephanie McWoods catches the California breeze with the bubble wand she keeps on her patio. Sometimes, the bubbles float, then burst midair. Other times, when they don’t pop, it is unclear how many miles they travel. A captivating mystery. 

On the surface, it seems mindless. But for the therapist, it is a joy carefully curated to combat the chronic stress of living in a predominantly Black neighborhood in Oakland where life expectancy is on average 15 years lower than the wealthy white areas of the city further north.

Her 4-year-old daughter joins the bubble blowing occasionally. And Barry, their Cavalier King Charles spaniel, watches along. It’s an added layer of protection against the pressure that McWoods feels contributed to her 69-year-old mother’s death in January from pancreatic cancer. 

As her mother battled the disease, McWoods picked up the book Inflamed: Deep Medicine and The Anatomy of Injustice

It wasn’t long after she cracked the pages open before she had to close the cover, leaving pages unread. Within it, the authors outlined how racism intertwined with the surge in inflammatory diseases like gastrointestinal disorders and asthma. They unpacked how the air we breathe, the food we eat and the inability to escape racial violence bleed into medical illness. Too close to home, she thought. 

What she read was part of a larger concept introduced decades ago, called “weathering,” which refers to the idea that the constant stress of living in an unjust society contributes to poor health outcomes in marginalized communities. It’s like a rock being slowly eroded by the outdoor elements, surviving the storms as the force repeatedly chips away at its strength. Around the time Arline Geronimus, now a public health researcher at the University of Michigan, coined the term “weathering,” Dr. Camara Phyllis Jones was digging into the accelerated aging hypothesis. Jones attributes the pervasive health disparities to the stress hormones that are elevated when Black Americans endure racism, and as a result some people’s bodies age prematurely. 

Stephanie McWoods with her daughter at the edge of Lake Merritt in Oakland, California.

These ideas outline the forces that have contributed to historically dismal health disparities, from maternal mortality to heart disease and cancer.

“The impacts of racism are why we see what we see,” says Jones, a family physician and past president of the American Public Health Association. “Racism is foundational in our nation’s history, and yet many people are in staunch denial of its continued existence and profoundly negative impacts on the health and well-being of our nation.”

Read more: Discrimination isn’t just infuriating. It steals Black people’s time.

It’s as if Black people have tightened their ab muscles, bracing for a gut punch but never relieving the pressure. They sleep knowing they have to do it all over again. A car constantly revving its engine. Tiny paper cuts that, over time, destructively multiply. A body living in an unbroken cycle of fight or flight. 

McWoods’ mom felt it.

In the neighborhood where she grew up in Chicago, the average life expectancy was lower than the wealthier white areas of town, much like the community where McWoods now lives in northern California. Stress was high, she says, and her mother was consistently on high alert. 

“I know for a fact that is what played a role in her health outcome,” McWoods  says.

‘There’s a lot happening to us’

Across the San Francisco Bay Area, like much of the country, those with higher incomes and more wealth live longer compared with those who earn less, one report shows. The poorest neighborhoods tend to have the largest concentration of Black residents. And as a result, they have the lowest life expectancy. 

Segregation influences health. Policies that affect housing, education, income, homeownership, and employment have a profound impact on residents’ physical and mental well-being. And how racism is embedded within those social structures and institutions disturbs the health of Black Americans. 

This discrimination outside of medical spaces also trickles into health care settings, where Black patients are more likely to be dismissed and treated with racist algorithms and insufficient technology. The cumulative burden of chronic stress, referred to as allostatic load, wears down the body. 

“That’s how it kills you,” said Dr. Tony Iton, a senior vice president at The California Endowment. “That’s how racism gets under your skin and kills you.”

It all culminates in Black Americans being at higher risk for heart disease, cancer, stroke, diabetes, asthma, homicide, and myriad other health issues, compared with others. California data shows that, even among the wealthy, childbirth is deadlier for Black women. 

“Just being Black makes you tired,” said Dr. Michael LeNoir, an Oakland-based allergist and pediatrician. “We’re the only population that probably does not benefit health-wise from increasing your socioeconomic status.” 

Experts say the disparity is due, in large part, to structural racism, which is about the opportunities people are afforded — or not afforded — by race. That can include the quality of schools that people are able to attend, the availability of safe, green, open-air parks or neighborhoods free of pollution, and water free of lead. It also involves the consistent exposure to explicit discrimination and the stress of processing microaggressions in majority-white spaces. 

“It doesn’t just so happen that people of color in this country are overrepresented in poverty while white people in this country are overrepresented in wealth,” Jones says. “For each group, there’s some initial historical injustice that is perpetuated today.”

The effects of policies like redlining and “separate but equal” schooling often ripple into bleak health outcomes for Black Americans. The disparities aren’t as much due to genetic or biological differences, but rather attributable to structural disadvantages associated with race in this country. Continued exposure to emotional strain raises the level of stress-related hormone cortisol in people’s bodies, therefore affecting inflammation and disease rates.

“There’s nothing intrinsic in us,” says Jones, “there’s a lot happening to us.”

The Great Migration didn’t ease racism’s toll

In the Bay Area, many Black folks have found themselves stuck within a more covert form of racism than what their families fled the Deep South to escape. And it’s bleeding into their health outcomes. 

Bakari Olatunji has been a vegan since 1980, he says, motivated in part by what he saw his family going through. He lost his mother to colon cancer. His dad died of a stroke. His older brother’s liver failed. Bullets killed his younger brother. 

“When I look at the death of my mother and father, I see colonization,” the 68-year-old says. When he was asked if the stress of being Black played a role in the death of his loved ones, Olatunji’s answer was clear. 

“How can it not?”

Read more: How car culture fuels racial inequality

His parents moved the family from Shreveport, Louisiana, to the West Coast when he was 6 years old in an effort to shield their babies from the racism they refused to talk about. But they couldn’t escape it. There were the white people at the clothing store in Hayward, California, that told Olatunji and his brother they don’t serve their kind there. And, years later, the cops who pulled him over and said he fit the description of someone who had robbed a local shop.

“It’s worse out here because people let their guards down,” he says.

He has lived in Oakland for 60 years, and believes the homelessness and poverty Black folks are facing are worse now than ever before. He credits his good health to his veganism. 

“It’s hard for me to live a good life and not be stressed.”

Like Olatunji’s family, Ben Darden fled blatant racism in Houston. In 1952, he moved to stay with an uncle and go to college. At the University of California, Berkeley, he was one of few Black students among thousands, he said.

Stephanie McWoods blowing bubbles in front of Lake Merritt in Oakland. (Meika Ejiasi)

He experienced racism, but didn’t know what to do about it. “Down there it’s direct,” the 88-year-old says. “Out here, they just don’t embrace you.”

Darden’s inability to find a job despite a top-notch education was what angered him most. Some of his Black friends ended up working at the toll booths, he recalls. “There was not a chance, even with an education.”

There wasn’t much to do about his anger, he says, except sit it in. As he recounted his life, he was waving a sign that read, “HONK FOR PEACE,” on the corner of International Boulevard and 98th Avenue in Oakland. It was a Friday evening in April, and a small crowd was protesting gun violence in the community. The sky melted orange as the sun set. Darden was double masked underneath his KN95.

Although he’s not convinced stress played a role in his high blood pressure, prostate issues, and kidney problems, weathering and the accelerated age hypothesis may explain a piece of his story. 

Their impacts may be “hard for us to realize because we live it from the cradle to the grave,” LeNoir says. “It is so insidious at times that we don’t recognize the pressure that is on each of us.”

‘To be Black is to be under duress’

At 15 years old, Eric McDonnell’s mother fled Mississippi to settle out west. The year was 1957, the same decade of the Brown v. Board of Education case, the Montgomery Bus Boycott, and the lynching of 14-year-old Emmett Till.

The decision to leave was about escaping the terror of the Deep South, as McDonnell puts it.

 “It almost didn’t matter what she found in San Francisco,” he says.

Instead of the brutality of the South, the family would battle a far more subtle — but acute — racism in California. One that would gradually wear on McDonnell’s body over the years, the symptoms appearing in adulthood. 

It was a steady stream of stress. There was his daily fear of living, moving. Existing. McDonnell, now chair of San Francisco’s African American Reparations Advisory Committee, was on constant alert. How would the cops react to him on the street? What discriminatory expectations did his boss have of him as a Black man?

He couldn’t escape the feeling that he was being hunted. Unsafe. Unprotected. He wondered who would be in each room he walked into, questioning if they valued his life. An all-consuming cloud of angst followed him. 

McDonnell learned to suppress all that was weighing on him. He mastered the art of hushing the emotions that spiraled to the surface due to the stress. In some ways, he says, the high functioning alcoholism perfected the practice. 

It manifested in other ways, too. His blood pressure began to creep up, leading to a hypertension diagnosis about 10 years ago. When asked if he thought the stress of being Black affected his health, McDonnell did not hesitate. “No question,” he says. “No question.”

He is also battling Bell’s palsy, a condition that leaves one side of the face weak. The doctors traced McDonnell’s case back to stress. The left side of his face is temporarily paralyzed. 

Some years back, he lost a loved one to heart disease. Another to a brain aneurysm. It is hard to tie scientifically to weathering, he says, but he wholeheartedly believes that affected their health outcomes. 

McDonnell does not see his experience as unique, he says. “To be Black is to be under duress.”

McWoods, the therapist, sees it in her clients. 

Some are still fearful of local public transportation after the 2018 murder of Nia Wilson, a young Black woman who was stabbed as she was standing on a platform, in an unprovoked attack. Many more are navigating microaggressions in majority white professional spaces, particularly in the Bay Area’s tech industry, where young Black folks find that they are one of few. After George Floyd’s murder, says McWoods, there was an expectation for them to still produce despite the mass grief and vicarious trauma they felt. 

How could they maintain an intense pace of work while simultaneously not being understood? What emotions could they share with their colleagues? Will they be seen as too emotional? Incompetent?

Discrimination at work, one study found, is linked to increased risk of high blood pressure.

“African American health, if left to its own devices, is actually quite good,” Iton says. “It’s the social pressures of racism and discrimination that lead to the weathering, and ultimately, the increase in chronic disease and premature death.”

These days, McWoods tries her best to safeguard against racism’s wrath. She wants to disrupt what it means to be a strong Black woman.

“I have seen a lot of strong Black women,” she says, “and I haven’t seen their pace change.”

That’s why McWoods goes on walks, to break up the stress sitting inside her body, hoping the tightness will release, protecting her from the same illness that took her mother. That’s the best treatment for the quiet, but dangerous, weight of racism.

The movement, the bubbles, the outdoors.