In the healthcare world, a major point of debate are health disparities — the gap in the quality of health and health care across racial and ethnic groups. A lot of the discussion centers around the effects implicit and explicit bias has on health outcomes. An equally significant piece is the impact genetic factors can have on health. Depending on your racial or ethnic background, you may be more at risk for certain diseases.
Why are some conditions more common in certain groups?
Genetically humans are extremely similar, however, studies have found that some diseases are more prevalent in people with a common ancestry. Over the evolutionary history of humans, groups developed certain gene patterns to adapt to their environment and survive.
For example, sickle cell disease — an inherited red blood cell disorder in which there aren’t enough healthy red blood cells to carry oxygen around the body that is common in people of African descent — is an adaptation to stave off malaria. Normally, the red blood cell takes a round, flexible shape but for those with the sickle cell gene, the cells take on a sickle or crescent moon shape, which provides a protective advantage against malaria. Studies show that having the sickle cell trait provides 60% protection against malaria death. Even as humans moved about the earth to areas where malaria is prevalent, the variations remained.
Are all racial differences in health related to genetics?
Genetic adaptations can have a serious effect on a person's health care needs, longevity, and well-being. But not all health differences are inherited. To use a Fit In analogy, it’s possible that Ife and Denise are more genetically different from one another than either of them are from Alex L. But statistically, Ife and Denise are at an increased risk of developing heart disease than Alex. Black women are disproportionately affected by cardiovascular disease, cancer, uterine fibroids, and fertility.
Why do these differences happen if they aren’t genetic?
The answer is multi-pronged and it starts with acknowledging a little lie. When we said genetics isn’t always involved, that isn’t exactly true.
Ife and Denise are statistically at an increased risk of cardiovascular disease because Black people are genetically predisposed to high blood pressure. Living in the hot, dry climates of Africa, Black people developed a salt sensitivity in which their bodies retain salt and water to avoid dehydration. But in North America and Europe, where the climate is cooler, the body does not need to retain water and sodium for survival. What was once an evolutionary advantage, has become a disadvantage — the excess salt and water raises blood volume, which raises blood pressure. High blood pressure damages the arteries of the heart and leads to heart disease.
Now that we got the genetics out of the way, again, we can address the other factor that contributes to an increased risk of certain diseases. No matter what the disease, they have a common thread — racism.
Why does racism insist on rearing its ugly head in healthcare?
The simple answer is because it doesn’t want you to be great. The more complex answer is health care is a Venn diagram of historical and current ills that often negatively affect Black people's health outcomes.
When we look at environmental factors, Black people live mostly in urban centers, which have higher rates of air and water pollution. They are also more likely to live in food deserts, with less access to affordable fresh fruits and vegetables, and are less likely to have access to parks or recreational resources. It doesn’t take a genius to figure out that bad, air, bad, water, bad, food, and less exercise is a recipe for disaster.
Compound that with socioeconomic factors like disproportionately high taxes, poorer schools, higher rates of joblessness, and lower wages, that recipe is turning into a really funky stew. When we bring the health care system into it, the stew becomes rank.
In addition to a documented history of mistreatment, Black people are left out of the discussion in advancing health. Despite being disproportionately affected by uterine fibroids (nearly a quarter of Black women age 18 to 30 have fibroids compared to 7% of white women), research funding for the disease pales in comparison to cystic fibrosis, a less prevalent condition that affects mostly white people. A study found that Black researchers studying health disparities are less likely to be funded by the National Institutes of Health.
What can you do to improve your health outcomes?
While there are a ton of factors outside of your control, you have the ability to improve your health through healthy lifestyle choices. It goes without saying eating healthy and exercising regularly are important for feeling well and living long. For conditions with genetic links like sickle cell disease or breast cancer, find out about genetic testing to see if you carry the trait. Also advocating for yourself in health care environments can go a long way. Talk to your doctor about your family history of diseases and potential risk factors. If you have a dismissive doctor, find another one who takes your concerns seriously.