The Toxic Power of Racism

Like many of us, I was inspired by Sen. Barack Obama's recent eloquent speech on healing racial and other divisions in this country. His words resonated with my personal experiences. In 1981, for example, when my friend and I moved to Boston to start our medical internships at Massachusetts General Hospital and the Brigham & Women's Hospital, the landlord forced us to find another place to live when he saw that she was African-American.

In his speech Senator Obama was careful to point out that access to affordable health care is a human issue, not one reducible to the color of our skin or the color of our states, Red or Blue. As he said, "This time we want to talk about how the lines in the emergency room are filled with whites and blacks and Hispanics who do not have health care, who don't have the power on their own to overcome the special interests in Washington, but who can take them on if we do it together."

However, a growing body of research during the past few years indicates that one of the most glaring inequalities experienced by African-Americans is the disparity in health care that they receive. This week, for example, the New York Times reported that the Department of Veterans Affairs found that black patients "tend to receive less aggressive medical care than whites" at its hospitals and clinics, in part because doctors provide them with less information and see them as "less appropriate candidates" for some types of surgery.

Statistics tell the story. A new government report found the difference in life expectancy between poor black men and affluent white women to be more than 14 years (66.9 vs. 81.1 years)! African-Americans have a higher risk of dying from chronic ailments such as coronary heart disease and high blood pressure than any other ethnic group. Only part of this disparity is explained by differences in income and access to adequate medical care. On average, the most affluent African-Americans suffer more health problems than the least affluent whites.

In the past decade more than 100 studies have been published documenting the harmful effects of racial discrimination on a variety of health measures in African-American men and women. For example, a recent study that followed nearly 60,000 African-American women for six years found that women who reported on-the-job racial discrimination had a 32 percent higher risk of breast cancer than others who did not. Women who said they faced racial discrimination on the job, in housing and from the police were 48 percent more likely to develop breast cancer than those who reported no incidents of major discrimination. Another study of African-American women found that those who reported chronic emotional stress due to their experience of racism had more severely blocked carotid arteries (which supply blood to the brain) than those who did not. In yet another study perceived racism was associated with a significantly increased risk of uterine fibroids in black women, and this was unrelated to differences in health care utilization.

Some critics say that racism cannot be objectively measured and so does not lend itself to rigorous research. However, the latest studies show that it is the perception of chronic stress that determines whether or not it is harmful. For example, two people in the same job may react very differently to a boss's demands -- one may perceive them as an exciting challenge and not experience them as stressful, whereas the other person may experience them as chronically stressful and have a higher likelihood of illness. While the experience of racism, like any chronic stress, is subjective, the harmful effects can be quite real. The effects can be both direct (increased blood pressure, decreased immune function) and indirect (more smoking, drinking and overeating, less exercise and social support).

This area of research is controversial for some, as it can be misused to further polarize and fan the flames of anger and blame. To me, however, awareness is the first step in transformation and healing. Chronic hostility, fear and hatred are among the most toxic forms of stress. Chronic stress due to racism affects everyone, not just African-Americans. As Senator Obama shared, "a similar anger exists within segments of the white community." Even his beloved white grandmother, who "once confessed her fear of black men who passed by her on the street, and who on more than one occasion has uttered racial or ethnic stereotypes that made me cringe ... Resentment builds over time." In another example, Arab-Americans experienced a period of increased harassment, violence and workplace discrimination in the weeks immediately following Sept. 11, 2001. A study of pregnant Arab-American women in the six months following 9/11 compared with a year earlier found a significantly elevated relative risk of poor birth outcomes.

Well then, what can we do about it? As we understand how chronic stress leads to illness, we begin to understand even more profoundly that how we treat each other, and how we talk with each other, matters -- not only in our quality of life but even in our survival. "Just words" can harm or heal. We can all find many reasons to righteously justify our anger and fear, but we have more constructive choices. When we can connect the dots between what we do and how much we suffer -- from both chronic stress and increased illness -- then we can make different choices that are a lot more enjoyable and healthful.

When we are angry with someone, we empower the person we hate the most in that moment to make us stressed out or even sick. That's not smart. Seen from that perspective, the most "selfish" thing we can do is to be more compassionate, tolerant and forgiving. When we forgive someone, it doesn't excuse their actions; it frees us from our own chronic stress and suffering, so it's in our own self-interest.

As then-President Bill Clinton said in his address to the Nigerian parliament in 2002, "Some things you just have to forgive and let go. That's one thing I learned from my friend Nelson Mandela. I asked him, 'When you were taking your last walk for freedom, didn't you hate your oppressors again?' He said, 'I did for a while, after all. Look, they kept me for 27 years. I didn't get to see my children grow up. I felt hatred and I was afraid. I hadn't been free in so long.' And then he smiled at me and he said, 'If I still hated them when I got outside the prison gate, I would still be their prisoner.' He said, 'I wanted to be free, and so I let it go'."

In his speech Senator Obama concluded, "In the end, then, what is called for is nothing more, and nothing less, than what all the world's great religions demand: that we do unto others as we would have them do unto us. Let us be our brother's keeper, Scripture tells us. Let us be our sister's keeper. Let us find that common stake we all have in one another, and let our politics reflect that spirit as well."

All divisions are man-made. In an era in which war and terrorism -- at home and abroad -- are often based on racial, religious and ethnic differences, rediscovering the wisdom of love and compassion may help us increase our survival at a time when an increasingly divided country and world so badly need it.

Originally published in Newsweek.

Comments

[oracle99]

Good post ...I moved to Boston in 1985 and found out as you did it's racial problems. This is I think what Barack Obama wants ..a dialogue on race. It is long overdue in this country. Barack makes me feel inspired that people can trascend the color of their skin and arrive at a new awareness that we all are equal.

[Ohg]

This time the tide is turning in favor of responsible leadership.......
http://thefiresidepost.com/2008/03/27/this-time-the-tide-is-turning/

[jaxson]

Thank you, Dr. Ornish,

You've written a powerful piece we can all learn from, no matter our race. Stress is a killer and the management of stress truly does begin with our own efforts.

I'm caucasian and teach in a federal correctional institute. Taken together, health care stats for black Americans, combined with income distribution, home ownership, incarceration rates and household wealth tell a clear story of on-going racism in the nation. While I agree that access to health care is a national problem shearing across race, take almost any disparity in this society and underneath it there will be a bottom layer of racism. It is our national wound, still suppurating these many years after the Civil Rights movement.

It is appalling that we have an opportunity to elect a national leader who understands the nation and has at least the potential to begin a dialog on its divides, but descend instead into a cauldron of accusation and race-baiting. It would give me great pleasure to see Senator Obama elected President, but I fear that race will once again divide us.

[mikey683]

I'm a member of a group of Americans that it's still OK to hate. I'm not allowed to marry. I'm not allowed to adopt a child in some states.Until recently we weren't even allowed to dance with each other! Members of my community are routinely beaten on the street and if you’re killed there will be people there to picket your funeral. Many times our civil rights are put up for popular vote. Obama doesn’t think I should be allowed to marry. I'm a gay man with aids. My community wasn't mentioned in the "brilliant speech". The hypocrisy is breathtaking. You want to talk mortality rates? Half the friends I had what I was in my twenties are dead.

[klmebane]

its not fair how they discriminate against us. but think about it: with so many people who still hate us, what would obama have done to his chances if he had spoken about us?? on a positive note, i hear mike gravel is going libertarian. he could give obama a run for his money if he gets the nod... then they'll have to let him debate and quit marginalizing him.

[iswearington]

mikey683...as chastizing as some of my blogs are...i don't have any hate genes. gay people should have the same rights as everyone. but when gays put themselves front and center...the people who do hate gays...win every election.those of us who tolerate gays never win the power we need to protect you.the northern blue collar and southern racists using false religion...and anti-black...anti gay code words have set this country back 2 centurys. we should be debating rising property taxes on mars.. instead debating whether or not americans should have medical care. that should be a human right like clean water and a roof over our heads.i suggest that gays work quietly to elect people who will help gays.there are enough gay people in this country to swing every election .given the fact that every plank in the republican platform fries deep south and northern blue collar archie bunker racists in smoking hot grease...one would think they would have learned not to vote republican...but they haven't. the diatribes of black ministers against gay people goes unnoticed while those against the israeli apartheid system in the west bank and against the racists whose every action is against black people are used against obama.it would appear... to paraphrase george orwell...that some people are more equal than others.

[eaglecapri]

I used to work in a physician's office. What I found odd was that new 'hot off the press' medications the drug reps presented to the physicians seemed to always be presented to black patients first. If the results were good (condition treated, little side effects, etc), these meds were then offered to their white patients. Coincidence? No, just subliminal racism at its best. You'd think we'd be beyond the Tuskegee experiment days (when black males were unknowningly not given treatment for syphillis so that researchers (white) could learn the effects of untreated syphillis), but a slightly different version lives on.

http://en.wikipedia.org/wiki/Tuskegee_Study_of_Untreated_Syphilis_in_the_Negro_Male

[StinkyPete]

A mitigating issue could be that new medications are very expensive and not covered by insurance if any. New meds are accompanied by generous quantities of 'free samples' distributed to physicians. Perhaps these 'free samples' are predominately given to blacks due to inability to pay for them and or lack of insurance. The alternative is older generic drugs that they may not be able to afford anyway.

[eaglecapri]

StinkyPete,

Prescriptions were written. Don't try to justify it! Black does not = an inability to pay. There were more whites that did not have insurance than blacks. So what? I know it's hard to stomach, but this is our (black folks) reality. If the Tuskegee Experiment could happen why not this?

[eaglecapri]

Plus, there were always samples of ALL medications on-hand. The operative words are NEW MEDS! Why were black patients given the option of trying NEW MEDS (samples or not) and not their white counterparts? Feel free to explain it away!...

[tiedtothewhippingpost]

You idiots just forget stats and always have some sort of weird explanation for the reason some will not forget the past. You guys are always tossing pink, white guys at us like the fellow that wrote this piece. And then portray the black guy as some sort of super human that should never have been held down by these pink guys. Hell, i'd be wondering too if I were black, but luckily I go by stats.


Most victims of race crime—about 90 per cent—are white, according to the survey "Highlights from 20 Years of Surveying Crime Victims", published in 1993.

Almost 1 million white Americans were murdered, robbed, assaulted or raped by black Americans in 1992, compared with about 132,000 blacks who were murdered, robbed, assaulted or raped by whites, according to the same survey.

Blacks thus committed 7.5 times more violent inter-racial crimes than whites even though the black population is only one-seventh the size of the white population. When these figures are adjusted on a per capita basis, they reveal an extraordinary disparity: blacks are committing more than 50 times the number of violent racial crimes of whites.

According to the latest annual report on murder by the Federal Bureau of Investigation, most inter-racial murders involve black assailants and white victims, with blacks murdering whites at 18 times the rate that whites murder blacks

[beright]

Whippingpost, no words for you ... it's clear that you're addicted to your toxic hatred. I pity you.

Dr. Ornish, this is a finely written piece. I empathize with folks like you who are intelligent enough to speak the truth only to have it meet with violence from your own people. I empathize with the work you have to do with your own people. Keep it up though; it's necessary. The universe is calling us to a higher order.

[StinkyPete]

He is not too far off the mark here. Just weigh the following stats relative to population percentages {roughly 4x whites vs blacks?) and you can see the trend that he refers to.

http://www.fbi.gov/ucr/05cius/offenses/expanded_information/data/shrtable_05.html

The best place to start is here

http://www.ojp.usdoj.gov/bjs/pub/html/ntcm.htm

You might need to do some arithmetic - but the trend is clear.

Unfortunately, missing here is a frank discussion re Black /Hispanic racism vs whites. It is very real and severe. My suspicions are that it is more prevalent and extreme than white vs Black/Hispanic racism. No references, just my own experiences and observations.

[tgood]

A lot of us do see the " big picture". Since when do we need someone to lead us ? At one time, the President of the United States was in office to reflect the will of the majority. The Jesse Jacksons of the world keep the blacks thinking they have to be lead around like children, and it appears too many whites are headed towards that same type of thinking.

I don't give a hoot what your color is. If you're old enough to vote, you're old enough to realize that each and every person will have to be responsible for themselves because the days of the government wiping our noses is over. It's big business first and citizens be damned. Let's not get into fighting over every perceived bit of racism that can be drummed up while we're lead down the path of even more government , more taxes and more socialist programs that enslave us all. Obama isn't a saviour any more than any other politician.

Please don't be sad for those of us who see Obama very, very clearly. We've seen the other two candidates enough years not to be fooled by them and really don't see Obama as being any different--he's just better with speeches. And talk is cheap. It always has been. It's gotten some of the worst presidents in history elected hasn't it ?

[klmebane]

perhaps, but i would rather take a chance with obama, than pick mccain or hillary when i know they won't do shit but fuck this country up worst. maybe i should just give up on america like you have... become an expat perhaps?

[Ariesjill]

Thank you, Dr,. Orish....staggering illustration. I make no distinctons among the "isms," they are all the same, eroding everythng fine: to individuals a-categori­cally....f­orget the survival of a given culture over time.
All the isms have common foundation; fear, feelngs of inadequacy compounded by ignorance leading to estrangement from truth and discernment and objective thinking.

An egregious example which springs to mind, it distilled the whole thing: the OJ trial. The late and briliant Mr. Cochran won the case in voir dire, understanding internalized rascism among African-Americans, esp of a certain age....and making sure he got as many such victims of that seated as he could manage.
He knew...not one of them had the option to experience or judge OJ as a real individual, or the evidence, objectively. He knew this sickness would reduce them to seeing OJ as some luminary Brother now, surely being victimized. More BLIND Loyalty via an ISM.
Even if Mark Fuhrman....an objectively brilliant GUY, who, in many ways has redeemed himself since this apocalypse....HAD NOT showed up with HIS little ism infestation, the defense would have won anyhow

Poor Marcia Clark just didn't get this nuance...nor did her very smart African -American co-prosecutor.
Neocons feed this lifeforce-eating virus by shrewdly exploiting it.....except ,so do rabidly ambitious, end justifies the means pseudo liberals....like the Clintons. And anyone who CAN....reveals volumes about who they really are.

[mommamia526]

I have experienced all sorts of hardships in my life. I finally learned that it is not OTHERS who determine my state of mind, I am the person controlling it. Of course, my religion taught me that as well, but to fully accept and understand it helps to experience it. I have had strokes, for example, and I can not afford to be angy or upset. It literally takes me out to even contemplate it. It is ugly how this society puts people in classes and cubicles, but we can not wage a collective war against this. Each of us has to understand how things work. For example, we get upset if *no one* loves us. Yet, if someone loves us whom we can not stand, it only irritates us. What makes a difference is how we decide to feel about others. It is an inside job for each of us. After we have done our own work, we can start to teach others about this. Racism is not the issue here. Personal interaction is the issue.

[mommamia526]

Healthcare, Dr. Ornish, is not a race issue. It is a national issue. It is a veterans' issue. It is a poverty issue. If you can pay the price it does not matter what race you are, simple as that. We need universal healthcare, we need to cut overhead, such as Medical Malpractice Insurance/Lawsuits. We need regulation of insurers. Mr. Obama and his family have no healthcare issues. And they are African Americans, are they not? 40-50% of females have hypertension, all females, of all races. Poverty, taking care, alone, of children and often grandchildren, and the overload of work and stress causes illness. Racism may add to that stress, but there are others who have similar stresses. Persons of other minorities, immigrants, people with disabilties, etc. We need to look at where the healthcare dollar goes. To insurers rather than patients and doctors and facilities. To investors. To waste, such as transferring whole families to another state for care for veterans. Injecting race, as important as this is, into healthcare, economics, and international politics makes no sense to me.

[ritenow]

You might need to check out the new PBS series:

http://www.unnaturalcauses.org/

Contrary to belief - ignorance is not bliss!

[Bacowall]

Dr. Ornish what surprises me the pundits, they actually thinkBarack is trying to score points in addressing this issue.
If we talk about there are chances as a nation, we can try to fix it -- ignore, see it as platitiude, it festers turns into something else. What I can add, the truth shall make us free!

[1849]

Try reading "Medical Apartheid" by Harriet Washington.

[yrerbendr]

Thank you Dr. Ornish for this article. As a physician I have admired your work and committment to healing. Your comments reflect your deep understanding of the power of emotional stress to cause physical harm. Obama speaks to these issues in a similar deep way. As a poitician he is the first I have heard who speaks from experience of healing the wounds of division, racism, and poverty. May he have the strength to stand up to the forces of darkness and racial hatred that so plague our Country.

[klmebane]

"understanding of the power of emotional stress to cause physical harm"

also known as a psychosomatic affect.

[nk007]

Dr. Ornish:

Thank you for your informed and thoughtful comments. The tragedy is that people like you are never given a chance by the sensational news media -especially the 24 hours cable news on tv- to dialogue with the vast majority of Americans. Great post!

[PioneerKing]

Dr. Ornish:

What is sad is that this data is not new. When you get the opportunity just give some of the doctors at places like Howard University a call and they will provide you with copies of studies that revealed this type of information decades ago. Also, one should never forget our nation's indifference in it's Tuskeegee experiment.