Multiple factors including socioeconomic status and access to health care have combined to erode Black men’s health.
By Anna Louie Sussman •
Illustration by Jamiel Law
One weekend afternoon two decades ago, Otis Brawley threw on a
pair of gym shorts and a t-shirt and started cleaning his garage. It was a
welcome bit of downtime from a demanding schedule as a senior investigator at
the National Cancer Institute, an aide to then-Surgeon General David Satcher,
and a staff physician at the Naval Hospital in Bethesda.
A Montgomery County police officer spotted
Brawley in the garage and called for reinforcement. The police questioned him,
and Brawley ended up handcuffed, face-down on the ground. Only after he
produced his driver’s license with the address of the house they were standing
in did the police back off.
“This is the price of being Black in America,”
says Brawley,
MD, a cancer expert and now a Bloomberg Distinguished
Professor.
Black men too often pay this price with their
lives in fatal police encounters. But there’s another price: their health,
which is eroded by multiple societal factors over their lifespan. In aggregate,
Black men have lower average life expectancy and higher rates of chronic
conditions like diabetes and kidney disease than white men.
Brawley, who has appointments in Epidemiology at
the Bloomberg School and in Oncology at the School of Medicine, directs a broad
interdisciplinary research effort looking at cancer disparities. These stem
from a complex mix of factors, including socioeconomic status, access to health
facilities, medical distrust, neighborhood and environmental factors—and, of
course, race.
Brawley emphasizes, however, that there are
very few biological differences between people of different ethnic or racial
backgrounds. Rather, race operates on a social level, showing up in how Black
men are perceived and treated—from violent encounters with law enforcement to
the slights of colleagues and the paternalism of doctors who second-guess Black
patients. Race also operates on a structural level, undergirding centuries of
marginalization that leave many Black Americans with less access to healthy
food, safe neighborhoods, educational and professional opportunities, and
quality health care.
Black men also have a lingering distrust of
the medical system. Men typically go much less frequently to the doctor than
women—and this is especially common for Black men, says Roland
Thorpe, Jr., PhD, MS, a Health
Behavior and Society professor and the founding director of the Program for
Research on Men’s Health.
“The first time we go to the doctor, we’re in
the ER, because we didn’t go get the annual check-ups,” Thorpe says.
Thorpe is the principal investigator of
the Black
Men’s Health Project, a longitudinal study launched two years ago in conjunction
with Tulane University researchers. The study—the first to focus exclusively on
the health of Black men—will recruit 10,000 Black American men and follow them
for at least 20 years. A questionnaire asks about issues particular to the
lives of Black men. Thorpe and future scholars will use this dataset to glean
insights such as how microaggressions and masculinity relate to cardiovascular
risk.
“We have a lot of psychosocial factors that
are known as key determinants of Black men’s health,” he says.
With participants from all over the U.S., the
study will gather the nuanced experiences of Black men across a range of social
and geographic milieus.
This is important because place has long been
recognized as a key determinant of health outcomes, affecting the quality of
housing, the availability of healthy food, or the adequacy of local medical
facilities. In the U.S., it has been inextricably bound with race due to
practices such as redlining, which denied home mortgages to would-be Black
homeowners and concentrated Black residents in neighborhoods with lower
property values. Not only do Black neighborhoods lack full-service supermarkets
or well-resourced hospitals, they are also more likely to expose residents to
threats such as hazardous waste or abandoned buildings that attract vermin and
crime.
When people conflate these place-based
attributes with the people living in these neighborhoods, it can lead to
unhelpful assumptions about the role of race in health, says Darrell
Gaskin, PhD ’95, MS, a Health Policy and Management professor and director of
the Johns
Hopkins Center for Health Disparities Solutions.
Recognizing the impact of living in an under-resourced or marginalized
neighborhood, says Gaskin, changes “thinking about race as a risk factor
because of who the person is” to understanding that “race in these United
States so much determines where you live, where you work, where you play, the
context you’re in,” he says.
For example, several of his studies found that
while under-resourced hospitals consistently had higher mortality rates, Black
and white patients treated in the same hospital had similar outcomes. “You
don’t see within-hospital differences in mortality rates,” Gaskin says. “It’s
not the person, but the context, which creates the problem.”
Like Brawley, Gaskin has had his own close
encounters with law enforcement, including an incident in which police pulled
him over, and officers emerged from six cruisers and approached him with their
guns drawn. (His temporary license plates had been stolen off of his new car
and they presumed he was a criminal.)
“The indignity that one must endure—if you
don’t express that rage … you start to internalize it, so it’s not a wonder
that people struggle with high blood pressure and have higher rates of stroke,
because you’re constantly on alert,” Gaskin says, citing writer James Baldwin’s
description of being a “relatively conscious” Black man in America is “to be in
a rage almost all the time.”
Marino
Bruce, PhD, MSRC, MDiv, a professor and director of the Program for
Research on Faith, Justice, and Health at the University of Mississippi Medical
Center, has had to negotiate this sensation in his own life many times,
including in academia—from coming out of the library and having a campus
policeman ask him to produce his student ID on his very first day at Davidson
College, to the invisibility he sometimes still experiences as a Black scholar
in a scientific field.
“I’m aware of a physical reaction during such
interactions,” Bruce says. “I can feel my blood pressure going up … your
breathing changes—what you’re trying to do is remain calm.”
Bruce, who is also an ordained Baptist minister,
is examining the role that faith and spirituality can play in improving health
outcomes and dealing with stress. In one study, he found that risks for
mortality for individuals who attended religious services at least once per
week were 45% less than for individuals who did not attend church at all. He
believes that when people connect to something larger than themselves,
especially a faith practice founded on principles of compassion,
forgiveness, and tolerance, they may become less reactive to stressors over
time.
“You also learn to cope with difficult
situations. If you’re mindful, and remember the difference between feeling and
thinking, you can think your way through them. This process can be beneficial
to your health,” Bruce says.
Cornerstone institutions in Black communities,
churches have historically pooled and distributed economic, political, and
social resources. They have also “affirmed African American men and
provided them with leadership training and opportunities,” Bruce notes.
Janice
Bowie, PhD ’97, a Bloomberg Centennial Professor and chair of the
School’s DrPH
Program, is also researching the role of faith and spirituality in
health outcomes and quality of life. While physicians may hesitate to ask about
a patient’s spiritual practice, they should be sensitive to whether it may
benefit a patient to have a hospital chaplain or someone from their faith pray
with them ahead of a surgery, for example.
“For many people, their faith is what sustains
them in their recovery,” Bowie says. “Sometimes when people are feeling very
down about a clinical outcome or a diagnosis, their faith and their
relationship with their faith community can be therapeutic.”
Bowie also believes strongly that research
must include community representatives from the outset. That so much of the
current research is being led by Black men gives her hope that the solutions
and findings will resonate with their intended beneficiaries.
“I see promise for Black men, when Black men
are leading those studies, designing those studies, and when they’re engaging
participants with them in delivering that work,” Bowie says.
It also means that researchers are set to
learn much more about how structural racism shapes Black men’s lived
experience, the allocation of critical resources, and the “weathering” effect
on their bodies. As Thorpe notes, it’s about time.
“I think we need to directly deal with the
issue of racism,” he says. “We’ve been skirting it for 401 years.”
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