Race, Racism, and the Accelerated Aging Hypothesis

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Race,Racism, and theAccelerated Aging
Hypothesis

• Camara Phyllis Jones, MD, PhD
• Harvard School of Public Health

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Overview

• Use of race
• Content of race
• Levels of racism
• Systolic blood pressure by race
• Accelerated aging hypothesis
• Anti-racism interventions

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Race associated differences

• Routinely documented
• Poorly explained
• Treated as confounding

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Dangers

• Impedes advance of science
• Limits primary prevention
• Perpetuates biological determinism

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Race as proxy

• Socioeconomic status
• Culture
• Genes

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Race is a precise measure

• Social classification
• Differences in life experience
• Effects of racism

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Race is a social construct

• Born with a heritage
• Assigned a race
• Variable between countries
• Variable over time

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Levels of racism

• Institutionalized
• Personally-mediated
• Internalized

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Institutionalized racism

• Differential access to the goods, services, and
  opportunities of society by race
• Examples
• Housing, education, employment, income
• Medical facilities
• Clean environment
• Information, resources, voice
• Explains the association between socioeconomic
  status and race

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Personally-mediated racism

• Differential assumptions about the abilities,
  motives, and intents of others by race
• Examples
• Police brutality
• Physician disrespect
• Shopkeeper vigilance
• Waiter indifference
• Teacher devaluation
• Prejudice and discrimination

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Internalized racism

• Acceptance by the stigmatized races of negative
  messages about our own abilities and intrinsic
  worth
• Examples
• Self-devaluation
• White mans ice is colder
• Resignation, helplessness, hopelessness
• Not believing in others who look like us
• Accepting limitations to our full humanity

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Levels of Racism

• A Gardeners Tale

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Institutionalized racism

• Initial historical insult
• Structural barriers
• Inaction in face of need
• Societal norms
• Biological determinism
• Unearned privilege

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Personally-mediated racism

• Intentional
• Unintentional
• Acts of commission
• Acts of omission
• Maintains structural barriers
• Condoned by societal norms

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Internalized racism

• Reflects systems of privilege
• Reflects societal values
• Erodes individual sense of value
• Undermines collective action

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Who is the gardener?

• Government
• Power to decide
• Power to act
• Control of resources
• Dangerous when
• Allied with one group
• Not concerned with equity

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How often do you think about your race?

• Never
• Once a year
• Once a month
• Once a week
• Once a day
• Once an hour
• Constantly

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Summary

• Use of race
• Routinely documented
• Poorly explained
• Content of race
• Rough proxy for SES, culture, genes
• Precise measure of racism
• Levels of racism
• Institutionalized
• Personally-mediated
• Internalized

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Background

• Elevated blood pressure
• Prevalent
• Confers risk
• Differs by race
• Race-associated differences
• Well-documented
• Poorly explained
• Genetic basis inferred

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Why study distributions?

• Preserve information on location, spread and
  shape
• Describe populations
• The Strategy of Preventive Medicine

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Projection methods

• Do two distributions differ?
• If so, how do they differ?
• Shape?
• Spread?
• Location?

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National Health and Nutrition Examination Survey

• Survey design
• Probability survey
• All 50 states
• 1971-1975
• Medical history
• Direct examination
• Systolic blood pressures
• 2,178 black females
• 9,778 white females

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Systolic blood pressure by race

• Same-age comparisons
• No differences in childhood
• Shape differences in middle age
• Age-shifted comparisons
• Acceleration of age-dependence
• Shift of entire distributions

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Significance of age-shifting

• Blood pressure and age
• Social meaning of race

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Accelerated aging hypothesis

• Black-white differences in health outcomes in the
  United States are due to accelerated aging of the
  black population compared to the white
  population.
• Accelerated aging of the black population in the
  United States is due to racism.

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Anti-racism interventionsInstitutionalized
racism

• Partner with communities
• Decision-making
• Agency
• Control of resources
• Address structural barriers to equity

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Anti-racism interventionsPersonally-mediated
racism

• Document patterns of differential treatment
• Make equity a goal
• Enforce adherence to protocols
• Respect and value all people
• Identify white privilege

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Anti-racism interventionsInternalized racism

• Cultural affirmation
• African-centered education
• Seven principles of Kwanzaa
• Knowledge of personal and group history
• Address institutionalized racism

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Dual Reality

• A Restaurant Saga

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Understanding

• this
• bus
• we
• are
• on