When we talk about COVID19 and health disparities, we must also talk about the Social Determinants of Health. The Social Determinants of Health are the conditions under which people are born, grow, live, work, and age. The factors that strongly influence a person’s health include access to medical care, access to healthy foods, of which there are many food deserts and food insecurity in low-income and minority areas, environment, which can include access to clean water and clean air, socioeconomic status (SES), employment, and social support networks.
Social Determinants of Health and Racism
The Social Determinants of Health are intricately tied to racism. Racism is not merely negative attitudes or treatment from one person to another. Racism has deep historical roots in American society, sustained through institutional policies and practices, whereby people of color are routinely and systematically treated differently than whites. Examples of racism include harsh judgement and treatment, few choices, not being able to hail a cab, getting poor service in stores and restaurants, being treated unfairly at work, being treated unfairly by police and law enforcement, being followed around in stores because of racial stereotypes, etc. We must be mindful of the poverty, the redlining, gentrification, food deserts, environmental and institutional racism that lead to chronic diseases and underlying health conditions.
Believe it or not, there is a biological fallout from living with racism and oppression. One could say that an underlying health condition that is not listed in a person of color’s medical record is… racism. Racism is not only a public health issue, it’s a personal health issue. Racism causes chronic stress. Racism is a chronic health condition. The daily, chronic stress and threats of racial discrimination creates a state of biological imbalance that leaves certain groups of people more susceptible to chronic disease. When stressors like racism or disadvantages in SES trigger the sympathetic nervous system, which controls our fight-or-flight responses, the behavior of our genes are altered and cortisol and epinephrine are produced. This leads to complex biochemical events that turn on genes, which may result in poor health outcomes. African Americans may be vulnerable to COVID-19 because many suffer from the underlying health conditions caused by chronic stress, including asthma, diabetes, high blood pressure, obesity.
Racism and discrimination are chronic stressors that people of color have no control over.
When you feel stressed – or even if your body simply perceives a situation as stressful – your adrenal glands release cortisol, your body’s “stress hormone”.
Your adrenal glands also release cortisol when your blood sugar level drops too low, another perceived threat to your well-being.
While cortisol is important for your body’s functions, too high of levels due to stress can cause problems.
High levels of cortisol can:
- Create an imbalance in your hormones and brain neurotransmitters, possibly leading to poor sleep, anxiety, and moodiness
- Impact your blood sugar, blood pressure and cholesterol levels, and immune function
- Increase fat storage (a telltale sign of a cortisol excess can be an increase in fat storage around your mid-center)
Your adrenals perform other jobs, too. They regulate many bodily functions, including metabolism, and they release hormones essential for your physical, mental and emotional well-being.
Let’s do a deep dive into this… Chronic stress releases hormones called cortisol and epinephrine, which increases blood pressure, heart rate, and inflammation over time, thus the body is in a constant state of the fight-or-flight response. Both have protective and damaging effects on the body. In the short run, the fight-or-flight response is essential for adaptation and survival, and serves to protect one from a health threat. Yet, over longer periods of time, cortisol and epinephrine can cause inflammation and speed-up disease processes. If someone feels under threat for long periods of time, his/her health may suffer significantly from chronic inflammation. For example, “driving while black” and the daily threat of worrying about being killed by police takes a toll on the health of black lives both locally and nationwide. The tension of never totally relaxing, of always being on guard, is disabling. The daily, chronic stress of those threats lead to high blood pressure, diabetes, asthma, obesity, and even PTSD and autoimmune diseases.
For many people in racial and ethnic minority groups, living conditions contribute to underlying health conditions and make it difficult to follow steps to prevent getting sick with COVID-19 by sheltering-in-place, access to masks, etc. or to seek treatment if they do get sick. Many of the essential workers and service-industry jobs, these high touch professions, are held by people of color. These jobs include front-line workers, bus-drivers, home health care workers, factory workers, etc. They’re vulnerable because of underlying health conditions, and they’re vulnerable because of increased risk of exposure. They simply cannot stay home and shelter in place, and those that live in multigenerational households find it almost impossible to self-isolate.
*For more information on health disparities in general, and to illustrate the impact of health disparities, please watch “Unnatural Causes: Is Inequality Making Us Sick?” https://unnaturalcauses.org. This is a 7-part documentary series that explores racial and social inequalities in health.
The environment in which we live is a major determinant of our health and wellbeing. Clean air, water, soil, plants, food supplies, and even our community environment which includes the Social Determinants of Health, are essential for our personal health. In my blog’s Environmental Health Series, we will continue to talk about the environment and try to answer the question, “What is an unhealthy environment and how does it get under the skin?” The environment’s effect on our health is complicated, but there are ways that we can prevent and reduce toxic exposure.
Stay tuned as we examine Disparities in Care During the COVID-19 Pandemic…
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I really wanted to talk about this topic today because your natural health and wellness is important. You can adopt healthy lifestyle practices that improve your health and enrich your life, which can in turn improve the lives of those close to you. You have the power to break the cycle of poor health, including chronic disease, so that you can leave a legacy of health to your loved ones.
I use lifestyle medicine as the first line of treatment, before medications, to treat lifestyle-related chronic diseases. Lifestyle-related chronic diseases include diabetes, hypertension, obesity, and some cancers, just to name a few. Lifestyle practices, such as eating a whole-food plant-based diet and regular physical activity, can help you lose weight, and maybe reverse some chronic diseases (if you suffer from them). In certain cases, these approaches may even outperform pharmaceutical therapy.
Tools for COVID-19 Prevention
COVID-19 vaccines are safe, effective, and free. Get the vaccine: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/
While COVID-19 cases continue to soar, better masks will help protect against transmission. The CDC says a NIOSH-approved N95 provides the most protection. Well-fitting surgical masks and KN95 masks offer the next best protection, followed by cloth masks with multiple layers. I recommend this Face Mask NIOSH N95 w/o Valve.
CDC recommends washing hands with soap and water whenever possible because handwashing reduces the amounts of all types of germs and chemicals on hands. But if soap and water are not available, using a hand sanitizer with at least 60% alcohol can help you avoid getting sick and spreading germs to others. I recommend TriDerma Moisturizing Hand Sanitizer.
Choose a face shield that wraps around the sides of your face and extends below your chin or a hooded face shield. This is based on the limited available data that suggest these types of face shields are better at preventing spray of respiratory droplets. I recommend Shield U PPE Headgear and Face Shield.
An oximeter may be useful for monitoring oxygen levels if a person has a light case of COVID-19 and is treating it at home.
Please talk with your doctor about any complementary health approaches, including supplements, you use. Let me know what you think in the comment section below.
PS. I am always asked what tools and resources I recommend to help you reach YOUR health goals. Here is the ever-growing, always updated list for you.
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