I’m talking about a pandemic of stress, which already has profound implications for the mental and physical health of black Americans and will have a dangerous impact long after the novel coronavirus has been contained.
Covid-19 makes everything that’s already bad about a hundred times worse. That is why the pandemic is hitting disadvantaged communities so hard. People in these communities were already struggling to support their families in low-wage jobs, living in substandard housing they could barely afford and beset by violence and pollution in their neighborhoods. They had multiple, chronic stresses.
Stress is a normal part of life. But when it is a persistent, daily experience, it exceeds our ability to cope. The resulting physical response leads to increased incidence of high blood pressure, heart disease, obesity, diabetes and other health problems.
Now layer covid-19 on top of that.
The virus is not only killing black Americans in disproportionate numbers. It is also forcing them to risk their health and their lives as essential workers, to care for loved ones who become sick and to attempt to self-isolate in crowded living conditions. Many have lost their jobs, their small businesses or their homes.
During the pandemic, children of color may be exposed to traumas with lifelong implications, such as the premature loss of the people closest to them, prolonged parental unemployment and food insecurity. These kinds of profound disruptions during childhood increase the risk in adulthood for heart disease, stroke, cancer, diabetes, chronic lung disease, Alzheimer’s and suicide.
For these kids, the crisis isn’t a matter of 12 or 18 months. Its impacts will shape an entire generation.
Because of racial discrimination, black Americans are more affected by stress than whites. Years ago, I developed the Everyday Discrimination Scale, a comprehensive series of questions to assess commonplace experiences like being treated with less respect or courtesy than others or receiving poorer service in a store or restaurant. Today, a large body of research shows that everyday experiences of racial discrimination create physiological responses that lead to premature aging — meaning that people who experience these particular stresses are biologically older than their chronological age.
In Georgia, researchers studied African American teens over four years. By age 20, those kids who reported consistently high levels of discrimination also had higher levels of stress hormones, higher blood pressure, more inflammation and higher levels of obesity. In another study, pregnant black women who reported high levels of discrimination were more likely to give birth to babies who weighed less than 5 pounds, 8 ounces, putting them at risk of a range of serious health complications.
The unrelenting stress that so many black Americans experience means their physiological systems for coping with stress never get a break. They are always on high alert. One study found that black people’s blood pressure levels do not decline at night as much as white people’s do. Even when sleeping, they cannot relax.
Tragically, covid-19 is increasing the stress of bereavement in black communities. Compared with white children, black children are already three times as likely to lose a mother by age 10. Black adults are twice as likely to lose a child by age 30 and a spouse by 60. The pandemic has multiplied these losses and the traumatic effects on families and communities, while denying black Americans the opportunity to grieve their losses together.
And some efforts to fight covid-19 may exacerbate everyday experiences of discrimination: There are early concerns that efforts to enforce social distancing rules may disproportionately target black and Latino people.
If we want to combat the wide-ranging public health effects of the coronavirus pandemic, we must target not just the unique stresses covid-19 has placed on black people but also the chronic stresses felt across black communities. We need mental health services available through community-based organizations such as churches and neighborhood advocacy groups; protocols that will help manage the increased risks for patients of color; and opportunities for education and a living wage that put people on a path to health and well-being from an early age.
Because so many black people live in circumstances that make them vulnerable, covid-19 is hitting them harder. We can’t allow the added burden of stress to damage and shorten the lives of those who survive.