How racism makes us sick

Why does race matter so profoundly for health? David R. Williams developed a scale to measure the impact of discrimination on well-being, going beyond traditional measures like income and education to reveal how factors like implicit bias, residential segregation and negative stereotypes create and sustain inequality. In this eye-opening talk, Williams presents evidence for how racism is producing a rigged system -- and offers hopeful examples of programs across the US that are working to dismantle discrimination.

An article in the Yale Alumni Magazine

told the story of Clyde Murphy,

a black man who was a member
of the Class of 1970.

Clyde was a success story.

After Yale and a law degree from Columbia,

Clyde spent the next 30 years

as one of America's
top civil rights lawyers.

He was also a great husband and father.

But despite his success,

personally and professionally,

Clyde's story had a sad ending.

In 2010,

at the age of 62,

Clyde died from a blood clot in his lung.

Clyde's experience was not unique.

Many of his black classmates from Yale

also died young.

In fact, the magazine article indicated

that 41 years after graduation from Yale,

the black members of the Class of 1970

had a death rate
that was three times higher

than that of the average class member.

It's stunning.

America has recently awakened

to a steady drumbeat

of unarmed black men
being shot by the police.

What is even a bigger story

is that every seven minutes,

a black person dies prematurely
in the United States.

That is over 200 black people

die every single day

who would not die if the health
of blacks and whites were equal.

For the last 25 years,

I have been on a mission

to understand why does race

matter so profoundly for health.

When I started my career,

many believed that it was simply
about racial differences

in income and education.

I discovered that while
economic status matters for health,

there is more to the story.

So for example, if we look
at life expectancy at age 25,

at age 25 there's a five-year gap
between blacks and whites.

And the gap by education
for both whites and blacks

is even larger than the racial gap.

At the same time,
at every level of education,

whites live longer than blacks.

So whites who are high school dropouts

live 3.4 years longer
than their black counterparts,

and the gap is even larger

among college graduates.

Most surprising of all,

whites who have graduated from high school

live longer than blacks
with a college degree

or more education.

So why does race matter
so profoundly for health?

What else is it
beyond education and income

that might matter?

In the early 1990s,

I was asked to review a new book

on the health of black America.

I was struck that almost every single one

of its 25 chapters

said that racism

was a factor that was hurting
the health of blacks.

All of these researchers

were stating that racism was a factor
adversely impacting blacks,

but they provided no evidence.

For me, that was not good enough.

A few months later,

I was speaking at a conference
in Washington, DC,

and I said that one
of the priorities for research

was to document the ways
in which racism affected health.

A white gentleman stood in the audience

and said that while he agreed
with me that racism was important,

we could never measure racism.

"We measure self-esteem," I said.

"There's no reason

why we can't measure racism
if we put our minds to it."

And so I put my mind to it

and developed three scales.

The first one captured
major experiences of discrimination,

like being unfairly fired
or being unfairly stopped by the police.

But discrimination also occurs
in more minor and subtle experiences,

and so my second scale,
called the Everyday Discrimination Scale,

captures nine items

that captures experiences

like you're treated
with less courtesy than others,

you receive poorer service
than others in restaurants or stores,

or people act as if they're afraid of you.

This scale captures

ways in which the dignity and the respect

of people who society does not value

is chipped away on a daily basis.

Research has found

that higher levels of discrimination

are associated with an elevated risk
of a broad range of diseases

from blood pressure to abdominal obesity

to breast cancer to heart disease

and even premature mortality.

Strikingly, some of the effects
are observed at a very young age.

For example, a study of black teens

found that those who reported higher
levels of discrimination as teenagers

had higher levels of stress hormones,

of blood pressure

and of weight at age 20.

However,

the stress of discrimination

is only one aspect.

Discrimination and racism

also matters in other
profound ways for health.

For example, there's
discrimination in medical care.

In 1999, the National Academy of Medicine

asked me to serve on a committee

that found, concluded
based on the scientific evidence,

that blacks and other minorities

receive poorer quality care than whites.

This was true for all kinds
of medical treatment,

from the most simple

to the most technologically sophisticated.

One explanation for this pattern

was a phenomenon
that's called "implicit bias"

or "unconscious discrimination."

Research for decades
by social psychologists

indicates that if you hold
a negative stereotype

about a group in your subconscious mind

and you meet someone from that group,

you will discriminate against that person.

You will treat them differently.

It's an unconscious process.
It's an automatic process.

It is a subtle process, but it's normal

and it occurs even among
the most well-intentioned individuals.

But the deeper that I delved

into the health impact of racism,

the more insidious the effects became.

There is institutional discrimination,

which refers to discrimination

that exists in the processes
of social institutions.

Residential segregation by race,

which has led to blacks and whites living
in very different neighborhood contexts,

is a classic example
of institutional racism.

One of America's best-kept secrets

is how residential segregation

is the secret source

that creates racial inequality
in the United States.

In America, where you live

determines your access to opportunities

in education, in employment,

in housing and even
in access to medical care.

One study of the 171 largest
cities in the United States

concluded that there is not even one city

where whites live
under equal conditions to blacks,

and that the worst urban contexts
in which whites reside

is considerably better than the average
context of black communities.

Another study found

that if you could eliminate statistically

residential segregation,

you would completely erase
black-white differences in income,

education and unemployment,

and reduce black-white differences
in single motherhood

by two thirds,

all of that driven by segregation.

I have also learned

how the negative stereotypes

and images of blacks in our culture

literally create and sustain

both institutional
and individual discrimination.

A group of researchers
have put together a database

that contains the books,

magazines and articles

that an average college-educated
American would read over their lifetime.

It allows us to look within this database

and see how Americans
have seen words paired together

as they grow up in their society.

So when the word "black"
appears in American culture,

what co-occurs with it?

"Poor,"

"violent,"

"religious,"

"lazy,"

"cheerful,"

"dangerous."

When "white" occurs,

the frequently co-occurring words

are "wealthy,"

"progressive,"

"conventional,"

"stubborn,"

"successful,"

"educated."

So when a police officer

overreacts when he sees
an unarmed black male

and perceives him
to be violent and dangerous,

we are not necessarily dealing
with an inherently bad cop.

We may be simply viewing

a normal American

who is reflecting
what he has been exposed to

as a result of being raised

in this society.

From my own experience,

I believe that your race

does not have to be
a determinant of your destiny.

I migrated to the United States

from the Caribbean island of Saint Lucia

in the late 1970s

in pursuit of higher education,

and in the last 40 years,

I have done well.

I have had a supportive family,

I have worked hard,

I have done well.

But it took more for me to be successful.

I received a minority fellowship
from the University of Michigan.

Yes. I am an affirmative action baby.

Without affirmative action,

I would not be here.

But in the last 40 years,

black America has been
less successful than I have.

In 1978, black households
in the United States

earned 59 cents for every dollar
of income whites earned.

In 2015,

black families still earn 59 cents

for every dollar of income
that white families receive,

and the racial gaps in wealth
are even more stunning.

For every dollar of wealth
that whites have,

black families have six pennies
and Latinos have seven pennies.

The fact is,

racism

is producing a truly rigged system

that is systematically disadvantaging
some racial groups in the United States.

To paraphrase Plato,

there is nothing so unfair

as the equal treatment of unequal people.

And that's why I am committed

to working to dismantle racism.

I deeply appreciate the fact

that I am standing on the shoulders

of those who have sacrificed
even their lives to open the doors

that I have walked through.

I want to ensure
that those doors remain open

and that everyone
can walk through those doors.

Robert Kennedy said,

"Each time a man" --
or woman, I would add --

"stands up for an ideal

or acts to improve the lot of others

or strikes out against injustice,

he sends forth a tiny ripple of hope,

and those ripples can build a current

that can sweep down the mightiest walls
of oppression and resistance."

I am optimistic today

because all across America,

I have seen ripples of hope.

The Boston Medical Center

has added lawyers to the medical team

so that physicians can improve
the health of their patients

because the lawyers are addressing
the nonmedical needs their patients have.

Loma Linda University
has built a gateway college

in nearby San Bernardino

so that in addition
to delivering medical care,

they can provide job skills

and job training

to a predominantly minority,
low-income community members

so that they will have the skills
they need to get a decent job.

In Chapel Hill, North Carolina,

the Abecedarian Project has figured out

how to ensure that they have lowered
the risks for heart disease

for blacks in their mid-30s

by providing high-quality day care

from birth to age five.

In after-school centers
across the United States,

Wintley Phipps and the US Dream Academy

is breaking the cycle of incarceration

by providing high-quality
academic enrichment and mentoring

to the children of prisoners

and children who have
fallen behind in school.

In Huntsville, Alabama,

Oakwood University,

a historically black institution,

is showing how we can improve
the health of black adults

by including a health evaluation

as a part of freshman orientation

and giving those students
the tools they need

to make healthy choices

and providing them annually
a health transcript

so they can monitor their progress.

And in Atlanta, Georgia,

Purpose Built Communities has dismantled
the negative effects of segregation

by transforming a crime-ridden,

drug-infested public housing project

into an oasis of mixed-income housing,

of academic performance,

of great community wellness

and of full employment.

And finally,

there is the Devine solution.

Professor Patricia Devine

of the University of Wisconsin

has shown us how we can attack

our hidden biases head on

and effectively reduce them.

Each one of us

can be a ripple of hope.

This work will not always be easy,

but former Supreme Court Justice
Thurgood Marshall

has told us, "We must dissent.

We must dissent from the indifference.

We must dissent from the apathy.

We must dissent from the hatred
and from the mistrust.

We must dissent

because America can do better,

because America has no choice
but to do better."

Thank you.

(Applause)