How Tackling Racism Could Reduce Chronic Illness
Imagine living in a neighborhood without parks, struggling to find healthy food, facing job discrimination, and fearing medical systems that have failed your family before. Now imagine that this daily stress doesn’t just wear on your mood—it wears on your body’s cells, your immune system, even your DNA.
That’s the unsettling reality laid out in a groundbreaking new review published in the International Journal of Environmental Research and Public Health. It pulls together decades of science to show that racism isn’t just a social injustice—it’s a biological one.
A Framework Rooted in History and Reality
The research team, led by scholars from Johns Hopkins, UCLA, and the University of Houston, starts by reframing how we think about health disparities. For too long, we’ve blamed poor health outcomes among racial and ethnic minorities on lack of access to care or personal behaviors like diet or exercise.
But this misses the bigger picture.
Structural racism—baked into housing, education, policing, and healthcare—has created environments where stress is constant, access to health-promoting resources is scarce, and trust in institutions is thin. These are the social determinants of health (SDoH)—the root conditions that shape everything from what’s on your dinner plate to how long you live.
And when those conditions are inequitable, they set off a chain reaction.
Stress as a Silent Killer
Let’s break it down: The body is built to handle stress, for a short time. A jolt of adrenaline or cortisol can help you escape danger or prepare for a challenge. But when stress becomes chronic, the body’s systems start to break down.
And racism is a chronic stressor.
People from minoritized communities face stress not just from one-off incidents but from daily microaggressions, systemic barriers, and policy-level disadvantages. This kind of stress, researchers argue, leads to a phenomenon called weathering—a term coined to describe the premature aging of the body due to sustained adversity.
Over time, the constant activation of the stress response damages cells, disrupts hormones, and weakens the immune system. It shows up in blood pressure, inflammation, and even shortened telomeres—protective DNA caps that fray as we age.
The Science: From Racism to Disease
What’s truly striking is the depth of biological evidence behind this argument. The review highlights several biological pathways affected by racism-driven stress:
- HPA Axis Dysregulation: Chronic stress overactivates the hypothalamic–pituitary–adrenal (HPA) axis, leading to harmful surges of cortisol and adrenaline.
- Inflammation and Oxidative Stress: Racism is linked to inflammation and immune dysfunction, conditions that underlie diseases like diabetes, heart disease, and cancer.
- Epigenetic Changes: Experiences of discrimination may switch genes on or off, influencing how the body handles future stressors.
- Telomere Shortening: Repeated exposure to racism has been associated with biological aging at the cellular level.
One study cited found that the bodies of people who report frequent racial discrimination show higher levels of inflammatory markers and signs of cellular distress. Another showed reduced glucocorticoid sensitivity—the body’s ability to regulate stress hormones—in those exposed to ongoing discrimination.
In short, racism is not just “in your head.” It’s in your blood, your brain, and your genes.
A New Public Health Mandate
The authors argue that current health policies and interventions fall short because they ignore racism as a biological risk factor. The U.S. healthcare system, they write, remains “in denial or unaware of the role of racism and its biologic impact.”
Their proposed solution? A new theoretical model that puts racism—not race—at the center of how we understand health disparities. This model connects three layers of influence:
- Socioenvironmental: Where people live, work, and play—including exposure to pollution, lack of healthcare, and unsafe neighborhoods.
- Psychosocial: The mental toll of daily discrimination, anxiety, and marginalization.
- Behavioral: Coping behaviors, from smoking and overeating to spiritual resilience.
All of these interact to trigger cellular stress systems—and ultimately disease.
What Can Be Done?
This isn’t just an academic exercise. The study outlines concrete steps to intervene at multiple levels:
- Policy solutions like equal school funding, housing vouchers, and healthcare expansion.
- Medical reforms like training providers to understand the impacts of racism on health.
- Community investments like creating green spaces and food access in underserved areas.
- Psycho-social strategies like trauma-informed care, mindfulness, and community healing practices.
Ultimately, the researchers call for a shift from treating symptoms to treating systems.
What’s Next?
The science is clear: racism is a health hazard. But recognizing this is just the beginning. Future research must dig deeper into how different forms of racism—individual, institutional, and internalized—affect health. And interventions must work not just at the bedside, but at city halls, school boards, and legislative chambers.
Because if we want everyone to live a long and healthy life, we need to dismantle the barriers that have been killing people slowly, cell by cell.
Join the Conversation
- How have social or environmental factors shaped health in your community?
- Do you think healthcare providers are prepared to address racism as a health issue?
- What would it look like to treat structural racism like any other public health emergency?
