Discrimination, Stress, and Health Across the Life Course

There is a paucity of research that seeks to understand why race disparities in health across the life course remain elusive. Two such explanations that have been garnering attention is stress and discrimination. This symposium contains papers seeking to address the impact of discrimination or stress on African American health or health disparities across the life course. Brown and colleagues examine the differential effects of chronic stress exposure by means of latent class analysis on mental and physical health in the HRS. Analysis revealed four subgroups, each demonstrated a typological response pattern with the most pronounced health consequences for high stress exposure, appraisal and few or no coping mechanisms. This suggests an alternative approach to examining the stress-health link by using a combined person- and variable-centered approach. Thomas Tobin and colleagues evaluate the life course processes through which early life racial discrimination (ELRD) and racial centrality shape adult allostatic load (AL) among older Blacks in the Nashville Stress and Health Study. Findings indicate that racial centrality is protective against adult high AL for those who experienced racial discrimination as children or adolescents. Cobb and colleagues examine how multiple attributed reasons for everyday discrimination relates to all-cause mortality risk among older Blacks in HRS. The authors report the 3 or more attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life. This collection of papers provides insights into how discrimination or stress impacts African American health or health disparities in middle to late life.

Discrimination, Stress, and Health Across the Life Course

There is a paucity of research that seeks to understand why race disparities in health across the life course remain elusive. Two such explanations that have been garnering attention is stress and discrimination. This symposium contains papers seeking to address the impact of discrimination or stress on African American health or health disparities across the life course. First, Nguyen and colleagues examine 1) the associations between discrimination and objective and subjective social isolation and 2) how these associations vary by age in using data from the National Survey of American Life. Discrimination was positively associated with being subjectively isolated from friends only and family only. This relationship varied by age. Discrimination did not predict objective isolation. Second, Brown examines evidence of the black-white paradox in anxiety and depressive symptoms among older adults using data from 6,019 adults ages 52+ from the 2006 HRS. After adjusting for socioeconomic factors, everyday discrimination, chronic conditions, and chronic stress, there are no black-white differences in anxiety and depressive symptoms. Third, Cobb and colleagues investigate the joint consequences of multiple dimensions of perceived discrimination on mortality risk using mortality data from the 2006-2016 HRS. The authors report the number of attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life. This collection of papers provides insights into how discrimination or stress impacts African American health or health disparities in middle to late life.

Examining COVID-19 and HIV: The impact of intersectional stigma on short- and long-term health outcomes among African Americans

The COVID-19 pandemic has exacerbated the health disparities and structural racism among African Americans. We examined overlaps between the COVID-19 pandemic and HIV epidemic using an intersectional stigma framework through the lens of Critical Race Theory. Intersectional stigma, medical mistrust, and decreased likelihood of referral for HIV and COVID-19 testing leads to decreased engagement in the healthcare system. Social inequities increase health disparities and lead to increased rates of chronic diseases, which increases the risk and severity of COVID-19. Solutions to mitigate impact among African Americans include increasing engagement regarding African American health, funding, and providers of color.

Health and Medicine

The medical and health care history of African Americans is a small but growing field of historical study. Much of the research done on the subject in the early 20th century was conducted by black medical professionals themselves. John Kenney, Booker T. Washington’s personal physician, authored one of the very first studies of black medical professionals, The Negro in Medicine, in 1912, while other a number of other black physicians, including Midian O. Bousfield and Paul Cornely, authored numerous books and articles on the black medical experience in the early and mid-20th century. The field was, in many ways, founded by the legendary Howard University Medical School Professor Dr. W. Montague Cobb, who, while not a historian by training, was among the first to chronicle the contributions of black physicians, hospitals, and medical schools in his articles for the Journal of the National Medical Association (the black counterpart to the Journal of the American Medical Association) and for the NAACP’s The Crisis. Perhaps the single most important activist in the struggle for integration in the medical profession, Cobb’s writings provide invaluable insights into the fight for the desegregation of hospitals, professional associations, and medical schools. Finally, Cobb was central in collecting and assembling the papers of prominent black physicians, and, due to his efforts, Howard University’s Moorland-Spingarn Research Center houses the most significant manuscript collections regarding African-American health care and medicine. In addition to Howard University, important manuscript collections regarding black health care are housed at the Amistad Center at Tulane University, at Meharry Medical College Archives, and at Fisk University’s Special Collections. Not surprisingly, the focus of most historians of black healthcare has been on issues of slavery, including Todd L. Savitt’s classic work Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia (1981) and Deidre Cooper Owens’ Medical Bondage: Race, Gender, and the Origins of American Gynecology, as well as studies that focused on racial discrimination in the American health care system, such as Edward H. Beardsley’s, A History of Neglect (1987) and Thomas J. Ward’s Black Physicians in the Jim Crow South (2003). The Tuskegee syphilis study has been one of the few African-American healthcare topics that has received wide attention, most famously in James Jones’s Bad Blood: The Tuskegee Syphilis Experiment (1984, 1993), and increasingly there has been more attention paid to issues regarding the impact that government policies have played in black health, including David Barton Smith’s Health Care Divided: Race and Healing a Nation (1999) and David McBride’s Caring for Equality: A History of African American Health and Health Care (2018).