David Williams Describes How Long-term and Pervasive Racism Has Caused Racial Health Disparities. But He Offers Hope and Solutions.
By COMMUNITY GRAND ROUNDS TEAM
ST JOSEPH, Mich. July 2018—A world-renowned expert on health inequities between black and white Americans gave two Berrien County audiences a sobering assessment of their causes and effects, while offering optimism and practical advice from little to big steps for closing the gap.
David Williams laid out the components of a pervasive and historically deep framework of institutional racism in the United States – “a truly rigged system” against black Americans that he calls “The House That Racism Built.”
The Harvard professor of sociology, public health and African American studies presented two lectures on July 10 to audiences at St. Joseph High School, in St. Joseph, Michigan, and Andrews University in Berrien Springs, Michigan.
More than 400 people attended the two events, which were also live-streamed to several sites. Audience members included professionals in medicine and allied health fields, social workers, government leaders, university faculty and students, and community members and leaders.
Williams‘ presentation – “The Biological Consequences of Racism: And What We Can Do About It” – was part of a three-year series titled “Community Grand Rounds: Healing the Trauma of Racism,” which is being co-sponsored by Lakeland Health and The Todman Family Foundation. The series is set in the southwest corner of Michigan, where stark differences in socioeconomic status underlie stark differences in health that are exemplified by the health disparities between the white residents of St. Joseph and black residents of Benton Harbor. Rather than prescribing solutions to the problem of health inequities, the planners of Community Grand Rounds (CGR) are engaging community members in the development of solutions called “CGR: From Courageous Conversations to Community Action.”
Quicker Than Your Eyes Blink
Williams noted that many individual acts of discrimination by white people are triggered by implicit bias, a mental process that is automatic and unconscious, and that occurs in one-third the time it takes to blink an eye. He said 70 to 80 percent of all Americans have an anti-black bias, a figure that includes 30 percent of black Americans.
Institutional racism and implicit bias together create a daunting obstacle. But, Williams is optimistic.
“I honestly believe that most Americans are people of good will and most Americans want to do the right thing. But our levels of knowledge are sometimes limited.”
“Most Americans are unaware racial disparities in health exist,” Williams said. Black Americans suffer higher incidences of many diseases and on average die younger than white Americans.
Berrien County, the site of Community Grand Rounds, is particularly suited for messages about racial disparities in health. According to the Robert Wood Johnson County Health Rankings, Berrien is positioned near the bottom of Michigan’s 83 counties. And, Michigan was ranked 35th in the nation for overall health in 2017 by United Health Foundation. In Berrien County’s census tracts that are predominantly African American, residents experience even poorer health than most other places in the county, with age-adjusted mortality rates 1.6 to 2.5 times higher than the state .
“When people see it as unacceptable, we will get action,” Williams said. “The single-biggest thing that we need to do is to identify how we can best tell the story of the plight of disadvantaged racial, ethnic and poor populations in the United States in a way that we, the American public, emotionally connect with.”
Place Is Paramount for Health
Lynn Todman, Lakeland Health’s executive director for population health, introduced Williams by emphasizing, as he did later, the critical importance of the overall community environment for a person’s health.
“It’s pretty clear now … that most of health is made in communities that we live in. It’s not made in our doctors’ offices,” Todman said. “It’s not made in clinics. It’s made in the houses that we live in, the workplaces that we go to every day, the communities, neighborhoods that we navigate every day, where we pray, where we play. It’s made in our community.”
Todman noted that two factors, access to care and behavior, are commonly cited for racial health disparities. But she said science is revealing a third factor. That is the role of social stressors – “racism in particular” – and how they are highly correlated with disease and illness.
Williams touched on this factor in his dense, rapid-fire presentations, laden with references to statistics and experimental studies. He noted, for example, that education is profoundly correlated with health for the general population. But equal education doesn’t mean equal health. He cited one study showing that whites with only high school degrees live longer than blacks with college degrees.
The ‘Missing Piece’
Williams suggested that racial discrimination could be “the critical missing piece of the puzzle” to explain such a biological gap. For instance, high levels of discrimination were linked in one study with a greater incidence of visceral fat among black women, leading to increased risks of heart disease, stroke and diabetes.
“Everyday discrimination is an independent predictor of premature death,” said Williams, who created the Everyday Discrimination Scale to measure what he said are the “the day-to-day little indignities” African Americans endure.
Little indignities take many forms. One, for instance, could be waiting longer than whites to cross the street because drivers do not allow black people to cross, according to a Portland, Oregon, experiment. Or, it could be an instance of institutional discrimination, as exemplified by the fact that black people on average waited 23 minutes to vote in the 2012 presidential election, almost twice as long as white folks. The difference was not because of any discrimination by poll workers, but because of such things as where the voting places were located, staffing and budgets.
Unfortunately, Segregation Succeeded
Williams devoted much of his talk to systemic racism – the systems, policies and practices of everyday life in the U.S. created generations ago by whites to suppress blacks – Williams calls it “structural racism.” He talked of great progress made for racial equality, including civil rights laws, but said the system still creates toxic, everyday stress for minorities, including African Americans. He called the evidence “overwhelming” of different outcomes “in so many domains of life,” including education, income, accumulated wealth of families, and health.
The sociologist hammered most on residential segregation by race, a system that he said accomplished what it set out to do. In a perverse sense, segregation was one of the most successful U.S. domestic policies in the 20th century. Where a person lives heavily determines “a broad range of outcomes – to the extent that “in public health today, many researchers say that your ZIP code is a stronger predictor of how long and how well you live in the United States than your genetic code.”
A leading economist, using sophisticated econometric models, revealed that erasing residential segregation would erase differences in income, education and unemployment, Williams said.
On September 27, the next speaker, David Ansell, MD, MPH, from Chicago’s Rush University Medical Center, will address Rush’s strategy to be a catalyst for community health and economic vitality on Chicago’s West Side and how those strategies can be applied to southwest Michigan.