结构性种族主义之间的联系, high blood pressure and Black people's health

高血压. 结构性种族主义.

他们有什么共同点?

Researchers say they are two of the biggest factors responsible for the gap in poor heart and brain health between Black and white adults in the United States. 它们有着千丝万缕的联系.

研究表明高血压, 也叫高血压, affects Black adults – particularly women – earlier and more dramatically than their white peers. 到55岁时， 研究显示 3 of 4 Black adults have already developed the condition compared to about half of white men and 40% of white women.

未经处理的, high blood pressure can lead to a range of disabling and potentially fatal chronic illnesses, 包括心脏病, 中风, 痴呆, 肾脏疾病, 性功能障碍和视力丧失.

这些风险升高的背后, 研究人员说, are a complex web of negative influences stemming from the multigenerational impacts of structural racism.

钱德拉杰克逊, a research investigator and epidemiologist with the National Institute of Environmental Health Sciences, considers structural racism as the "totality of ways in which societies foster racial discrimination through mutually reinforcing systems of housing, 教育, 就业, 工资, 好处, 信贷, 媒体, 医疗保健和刑事司法.

“这些模式和做法反过来又强化了歧视性信念, 促进健康或危害健康的资源的价值和分配不当,她说. 这是, they create the physical and social environments that make it easier for white families to grow up healthy and harder for Black families to do so.

例如, 几十年的歧视性贷款, 被注销, have kept Black families segregated in neighborhoods with fewer resources and greater chronic exposure to environmental hazards, 比如不干净的饮用水和噪音以及空气污染, 杰克逊说.

These neighborhoods also tend to lack quality health care facilities and providers, 杂货店出售健康和实惠的食品, 或者是成年人可以锻炼，孩子们可以玩耍的开放空间, 她说. Discriminatory 就业 and 教育al systems result in higher levels of poverty that create financial strain, 住房和粮食不安全, 紧张的人际关系和较少获得良好的医疗保险的机会.

All of this – along with the daily indignities of racial discrimination – increases stress. 那, 反过来, 可能与血压升高有关, 奥古斯丁·康说, 他是罗德岛布朗大学公共卫生学院的研究员. “所有这些因素都为疾病创造了完美的风暴."

Overall, Black men and women report higher levels of stress than their white counterparts. 但研究表明，黑人女性, 谁经历了种族和性别歧视的复合效应, along with the chronic stress of having to "work harder" to overcome this dual bias, 他们在生命早期就开始为健康付出特别高的代价. 黑人妇女的预期寿命比白人妇女短, 部分原因是心脏病的发病率更高.

Stress also makes it harder to manage heart and brain health risk factors such as high blood pressure once they take hold.

Kang领导的一项研究发现 患有高血压的黑人女性 who experienced high levels of stress were substantially less likely to take medication or practice blood pressure-lowering behaviors such as exercising or eating a healthy diet.

"Lifestyle factors are incredibly important in managing blood pressure," he said. "There are social and environmental factors that present an added barrier to diet and physical activity, 是什么导致了我们今天看到的健康差异."

Overcoming these barriers has proven challenging – but not always insurmountable.

例如, a program targeting high blood pressure at Kaiser Permanente in California eliminated differences in control among Black and white adults. 该项目使用电子健康记录来追踪血压, increased doctor-patient messaging outside of office visits and lowered the price of blood pressure medication to make it more affordable and accessible.

“在组织良好的卫生系统中, 我们在监测和控制血压方面做得更好了,”医生说。. 约翰Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor. 但是美国.S. 医疗保健系统支离破碎."

Ayanian领导了一项研究 显示出血压的差异 among Black and white Medicare Advantage enrollees persisted in every region across the nation except in the West, 凯撒医疗计划消除了这些差异. His research also showed Black adults were disproportionately enrolled in lower-performing health plans nationwide.

“我们不能仅仅依靠个人和医生的努力，”他说. “你需要一个运转良好的医疗保健系统."

当人们无法获得健康食品时，要求他们改善饮食, 在没有安全或负担得起的空间时进行锻炼, to take blood pressure medications when they can't afford them – while also failing to ensure access to quality universal health care – will never succeed in eliminating health inequities, 博士说. Monika Safford, founder and co-director of the Cornell Center for Health Equity in New York City. 她也是威尔康奈尔医学院的普通内科主任.

“我们不能把它留给个人. 这不是他们的错. 这个系统就是为了让他们失败而设置的. 这个制度不公平、不平等、不公正."

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