Brain–body pathways linking racism and health.

Abstract

Racial disparities in health are a major public health problem in the United States, especially when comparing chronic disease morbidity and mortality for Black versus White Americans. These health disparities are primarily due to insidious anti-Black racism that permeates American history, current culture and institutions, and interpersonal interactions. But how does racism get under the skull and the skin to influence brain and bodily processes that impact the health of Black Americans? In the present article, we present a model describing the possible neural and inflammatory mechanisms linking racism and health. We hypothesize that racism influences neural activity and connectivity in the salience and default mode networks of the brain and disrupts interactions between these networks and the executive control network. This pattern of neural functioning in turn leads to greater sympathetic nervous system signaling, hypothalamic-pituitary-adrenal axis activation, and increased expression of genes involved in inflammation, ultimately leading to higher levels of proinflammatory cytokines in the body and brain. Over time, these neural and physiological responses can lead to chronic physical and mental health conditions, disrupt wellbeing, and cause premature mortality. Given that research in this area is underdeveloped to date, we emphasize opportunities for future research that are needed to build a comprehensive mechanistic understanding of the brain-body pathways linking anti-Black racism and health.

Discrimination and Cardiovascular Health in Black Americans: Exploring Inflammation as a Mechanism and Perceived Control as a Protective Factor

“…As theorized by many scholars of Black-White health disparities in the U.S., persistent exposure to social disadvantage (e.g., discrimination, racism, etc.) may cause chronic stress that leads to heightened or dysregulated activity of biological systems, which ultimately contributes to the development of chronic health conditions (10–12,24,68). The mediating role of CRP and fibrinogen observed in the present study aligns with this theory, as it demonstrates the innate immune system as a potential biological pathway connecting experiences of discrimination and to greater burden of cardiovascular conditions.…”

“…Indeed, anti-Black racism (present and historical) embedded within our society has created multiple systemic, cultural, and individual-level disadvantages for Black individuals in the U.S., including increased exposure to discrimination. Repeated exposure to discrimination can impact cardiovascular health through multiple mechanisms (6)(7)(8)(9), including via chronic activation of regulatory physiological systems (5,10). Such activation can ultimately lead to "wear and tear" on these systems and contribute to risk for and the development of cardiovascular disease (11)(12)(13).…”

“…Such activation can ultimately lead to "wear and tear" on these systems and contribute to risk for and the development of cardiovascular disease (11)(12)(13). Critically, many scholars have proposed that the immune system may be a particularly important biological system linking experiences of discrimination to poor cardiovascular-related outcomes (10,(14)(15)(16). This is because the immune system has evolved to not only be responsive to physical threats to the body (e.g., infections, tissue damage, etc.…”

“…This link between discrimination and inflammation is important, given that inflammation is implicated in the pathophysiology of many cardiovascular diseases and conditions (29,30). Consequently, it is widely theorized that inflammation may be a mechanism through which discrimination can contribute to worse cardiovascular health among Black Americans (3,4,10,13). Yet, most research exploring this theory has only looked at associations between discrimination and indices of cardiovascular health or inflammatory markers separately (4,14,15).…”

Ethnic/Racial Disparities in DNA Methylation Age Profiles across the Lifespan

“…In fact, social adversities during the early years of life can weaken physiological systems, and these deteriorated systems can become fixed and be DNA METHYLATION AGE PROFILES ACROSS THE LIFESPAN reflected in individuals' weakened immune systems, disrupted neural activity, and dysregulated hypothalamic-pituitary-adrenal axis activity, leaving individuals' unable to effectively cope and respond to social adversities during adulthood (i.e., the Biological Embedded Model). 33,34 In a 20-year longitudinal study of Black and White Americans followed from ages 12 to 32, discrimination during adolescence predicted more dysregulated cortisol activity outcomes than did discrimination during adulthood, and such effects of discrimination were more pervasive for Black Americans than their White American peers. 35 Unfortunately, when scholars have examined ethnic/racial disparities in DNAm profiles, their empirical studies have primarily focused on aging samples and cross-sectional approaches.…”