Chronic Racism is Itself a Killer

Lakeland Health Embarks on 3-year ‘Conversation’ to Help a Racially Polarized Community Understand the Latest Science

By TED HARTZELL

ST. JOSEPH, Mich.— Lynn Todman is serious about getting a message to the doctors, other front-line health care workers and everybody else in the area served by the Lakeland Health system. Lakeland’s executive director for population health is so serious that she and her husband are even paying for a three-year education effort.

The message: People who are subjected to chronic, structural racism are at a higher risk of suffering life-harming, even life-shortening changes that occur in the body’s very “building blocks”— its cells. The chronic stresses of racism can lead to higher incidences of diseases, including asthma, diabetes, depression and heart disease, as a person’s DNA responds to the stresses. Damaging changes can even be passed on genetically to children and grandchildren, according to the emerging fields of epigenetics and social genomics.

Todman is hoping to inspire “a regional conversation” and awareness of this scientific knowledge.

The subject has particular relevance to Lakeland. The population it serves is polarized along racial lines — what Todman calls “hyper-segregation”—and along health outcomes, too.

The predominantly African-American communities of Benton Harbor and Benton Township were shown in a data-rich study published in late 2016 to be among the places in Berrien County with the worst health outcomes. Portions of Benton Heights and Benton Harbor had age-adjusted mortality rates 1.6 to 2.5 times higher than the state average. Other areas of Berrien County fared poorly in mortality rates, too, but the cluster of areas with high mortality rates in Benton Harbor and Benton Township is striking. Todman led that study, a joint effort of Lakeland and the Berrien County Health Department.

“Being black is a risk factor for death in Berrien County,” Todman says.

Making the ‘Rounds’

And now, through their family foundation and in partnership with Lakeland, Todman and her husband, Michael, a retired Whirlpool Corp. executive, will be spending $150,000 for a 2018-2020 series of speeches by national and local experts entitled “Community Grand Rounds: Healing the Trauma of Racism.” The first presentation was in April.

In a hospital setting, the term grand rounds refers to a formal meeting where physicians discuss the clinical cases of one or more patients, sometimes in the presence of patients. “My grand rounds is for the community as well,” Todman says.

Todman makes clear that the focus of Community Grand Rounds is the long-term, institutional racism built into the fabric of exclusionary cultures like the places in Benton Harbor and Benton Township with their super-high mortality rates.

She describes life that is akin to being on a constant state of high alert. Faced with a perceived threat, the mind automatically and instinctively signals the body, triggering the body’s stress response. But if the stress is long-term and the stressors are built into a person’s environment, then over time this hyper-activation to stress can take a toll on the body.

It is this sort of day-to-day stress that Todman is keying on, not what often comes to mind when the word “racism” is spoken – things like racial slurs or poor treatment in a store, though these are products of a racialized environment.

The ‘North Star’

Todman has a doctoral degree in urban and regional planning and a history of “always being involved in social justice kinds of issues.” Among her areas of expertise are urban poverty, health equity and the role played by social conditions — a person’s overall environment — in the person’s health.

She talks of her “north star,” the vision that motivates and guides her in this project.

Her guiding vision is to help the health care employees of Lakeland and the general public understand that “the other part of the puzzle” of bad health outcomes for people living in isolated environments is that sometimes the changes happen at the cellular level of their bodies.

Todman says “the conventional narrative” offers two explanations for the far worse health outcomes of residents in places like the health-distressed areas of Benton Harbor and Benton Township.

The first explanation points to limited access for the things people need to be healthy, including jobs, health care, affordable transportation, good housing, good education and grocery stores within reach. The second explanation blames unhealthy lifestyle choices in such matters as diet, exercise, smoking and alcohol consumption for contributing to health problems.

But something deeper and, in a word, invisible, also seems to be taking place, according to recent studies. It is the biological harm that comes from living in an exclusionary, marginalized culture, as filtered through people’s experiences or perceptions of their environment.

“Our social experiences impact our health, right down to the cellular level,” Todman says. Specific kinds of social experiences of isolation can produce specific bad results. Racism is one such experience of isolation and marginalization that reaches in and changes cells for the worse.

She’s talking about “the chronic stress associated with day-in and day-out discrimination, not the occasional episodes, but the chronic episodes,” and how this kind of stress can be “toxic to the body and can impact gene expression,” heightening the body’s stress responses. “It can change immune functions, it can change inflammation processes in the body and therefore impact the onset and progression of disease.”

Our Responsibility to Make Changes

While Todman concedes that poor health choices play a role, she says some bad choices come from living in social conditions that narrow the opportunities, making it harder to make good choices. She hopes Community Grand Rounds will lead to a wake-up call. “We, as a society that creates these racist structures, bear some of the responsibility as well.

“Ideally the Lakeland Health system takes the information and works closely with the community we serve to identify and implement some action items that help to reduce the experience of racism in our community,” Todman says. “So it may mean policy changes, programmatic reforms that reduce the barriers to access to those things that people need to be healthy, that reduce people’s experiences of individual and institutional racism.”

One hoped-for outcome is that Lakeland’s work in this field will become a model for other health systems to adapt for themselves.