Archive for September, 2010|Monthly archive page

When the Boughs Break

In disparities, medicine, public health on September 15, 2010 at 4:04 pm
Judging by the date of my last blog, it’s evident that school is in full-swing. Actually, med school is a lot of fun! Consuming, but fun!

I just finished attending an extra credit lecture for my Foundations in Medicine course in which we had a discussion based on the viewing of Unnatural Causes…is Inequality Making us Sick? – Episode 2:When the Boughs Break.  The documentary explores the phenomenon of African-American women at every socioeconomic level having higher rates of pre-term birth and infant mortality than white women who haven’t even finished high school or Black immigrants. The basic findings were that it’s not genetic and not socioeconomic (in fact, being a higher educated Black woman increased your risk instead of lowering it).  The general idea discussed is that birth outcomes are affected by the negative impact of racism over a lifespan and that racism in America is an addedsource of stress for people of color, leading to poorer health outcomes.  That’s the basic synopsis.  I’d highly recommend watching the documentary if you can get your hands on it. It was an eye-opener for many of my classmates.
I learned about the study discussed during the video this summer in one of my public health courses (Social & Behavior Aspects of Global Health).  At the time, the study was briefly touched upon, highlighting the possibility that operating under a lifelong level of elevated stress hormones is detrimental to overall health.  However, the course did not nearly go into as much detail as this film.  I was literally holding back tears at certain points during the film, telling myself, “this can’t be life.”  Nothing stated here struck me as new – I’ve always been one of few (if not the only) Blacks in a given environment (exception being college). As such, I have been aware of my race every day of my life since I can remember, and have had many struggles and obstacles because of it.  However, something about this film really struck a nerve in me.
Perhaps it is that I am older and have more life experience and feel that I have fought to carve out a good future for myself.  Now I finally feel that I have full ownership of my life.  It is frustrating to think that no matter what I do to shift things in my favor, certain things that I think I should have a significant handle on are out of my control.  Furthermore, according to this film, by working to put myself in a high socioeconomic level will actually have adverse affects on my life.  Coupled together, frustration, anger, and sadness abound within me.
I fully believe the Life Course Perspective, that the accumulation of this chronic life stressor of race is a determinant of health.  Unless we were able to do away with racism and prejudices, I don’t really see that stressor going away.  Therefore, I suppose it would be in my best interest to implement some coping mechanisms to deal with it, rather than to just sit back and accept it.  Easier said than done.  How do I take time and energy to calm myself down or cheer myself up sometimes multiple times a day when time is becoming an increasingly more precious commodity?  As one of three Black students in my class, I am all too aware of my race every day.  I play well with my peers and like most of them.  But even the ones I am closest with from time to time slip up and say something offensive about other Black people, or interact with me based on assumptions about the few other Black people they’ve had close interactions with over their life spans, or just interact with me differently than they do others.  I won’t even talk about the bad classmates…  To be honest, at times being here has been lonely – and one I don’t see improving over the course of my career. How does one stop ignorant comments and prejudiced actions of others? I have no problem fighting off verbal attacks, but how am I supposed to fight back against the subconscious physiological effects of these offenses?
As I sit and reflect on all the issues brought up in this film, and other underlying concerns triggered by this viewing, I am left with a series of unanswerable questions.  So, what am I to do? Right now, I feel it best to stay on my course to become a physician who will work to help study and, hopefully eliminate, some ethnic health disparities.  But, once again, I am left with a question that can’t be answered: what good will my future research be if it all boils down to the influence of a lifelong battle with racism yielding subconscious physiological consequences?
Aside: I am very happy I am pursuing the MPH degree – the MD is incomplete to developing a forward-thinking physician capable of making lasting societal change.  These questions might not yet be answerable, but at least they’re being asked, right?