Velandy Manohar, MD

Fostering Recovery By Increasing Understanding of Mental Illness


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Velandy Manohar, MD
93, Meeting house road
Haddam, CT 06438
[email protected]

Racism & Health - Disparities

Racism and Health : Prof. David R. Williams Interviewed on 60 Minutes - An Informative Stark and Disturbing transcript from 60 Minutes broadcast 04 18 21 follows.

https://scholar.harvard.edu/davidrwilliams/dwilliam/publications/racism-and-health

Citation:

Williams, D. R. (2004). Racism and Health. In K. E. Whitfield (Ed.), Closing the Gap: Improving the Health of Minority Elders in the New Millennium. . Washington, DC, The Gerontological Society of America.

I.

https://www.cbsnews.com/news/60-minutes-disease-black-americans-covid-19-2021-04-18/

Racism’s corrosive impact on health of Black Americans.

Bill Whitaker reports on how decades of research show that racism is adversely affecting Black Americans' health in several different ways.

2021Apr 18 CORRESPONDENT Bill Whitaker

When the Centers for Disease Control declared last week that racism is a serious public health threat in America, it acknowledged something that researchers have found for decades: on nearly every measure of health, African Americans are more prone to serious disease and premature death.

The coronavirus pandemic has provided devastating evidence of this: Black Americans have died of COVID-19 at twice the rate of Whites, and so far are being vaccinated at a dramatically lower rate.

Poverty and unequal access to high-quality health care play a role in these disparities, but this is not a matter of genetics. Harvard researcher David Williams has spent his career showing what the CDC now recognizes: racism itself can be a killer.

Professor David R. Williams: Imagine a fully loaded jumbo jet with 220 passengers and crew taking off and crashing today. And the same thing happened every day next week and every day next month and every day for the rest of the year. That's exactly what is occurring when we say there are racial disparities in health in the United States. Over 200 Black people dying prematurely every single day.

Professor Williams has demonstrated that the health of Black Americans suffers whether they are rich or poor, well-educated or not. Black women with college degrees are more likely to see their babies die as infants than White women who didn't finish high school. Another stark example? The 1970 graduating class at Yale.

Bill Whitaker: The Black graduates were three times more likely to die prematurely than their White classmates--

Professor David R. Williams: That's correct. I mean that's the magnitude of some of the racial disparities in health we see.  

Bill Whitaker: Just to make this abundantly clear. A Black man or woman-- with a college degree, making a lot of money, is less well off, health-wise, than a White man or woman in the same category, under the same circumstances?

Professor David R. Williams: Absolutely.

David Williams' research shows that even when treated in the same health care settings, Black Americans are less well-cared-for than Whites.

Professor David R. Williams: One researcher coined the term "weathering" to describe what is happening to African Americans. Imagine a drop of water falling from the rooftop of this building to the concrete sidewalk below. If the water drips today, it's no big deal. But if day in, day out, week in, week out, year in, year out there is a constant drip, drip, drip of water, the sidewalk, the concrete below would become weathered. It becomes eroded by the constant exposure to adversity. And so what the research is suggesting, that all of these stressors are weathering African Americans in the same way.

Michelle Thomas: I can't change the color I am. And I can't change the color my kids are. And I can't, you know, change the way people see us.

Michelle Thomas is a single mom raising six kids in Atlanta. She has felt the drip, drip, drip of all of racism's "stressors."

Michelle Thomas:  You see the Confederate flag being flown. You see people driving by are calling you the N-word. And you're just walking down the street. I don't know any other race that actually say they have to have a talk with their kids about how to handle yourself when you're in the street or how to handle yourself around a police officer or how to handle yourself when you go shopping in a store. Make sure your hands are not in your pocket. 

She points to a particularly painful moment in 2019 when her teenage son Jerome, who is on the autism spectrum, was stopped and handcuffed by Atlanta police who said he fit the profile of a robbery suspect.

Michelle Thomas: I'm like, "If you talked to him for a little while, you would know for a fact that my son had had autism. But you didn't get a chance to know my son. You just assumed that he was the criminal. And that broke my heart.

Bill Whitaker: What was the impact on your son? What did it do to him?

Michelle Thomas: He was, like, "Mom, did I do something wrong?" And I'm, like, "No baby. You did nothing wrong. It's just your skin." And he's, like, "Well, you think this is gonna happen to me again?" And -- you know, I had to say. And I'm, like, "Yes. Nine-- nine times out of ten this is gonna happen to you plenty of times in your lifetime."

Shirley Franklin: People are really tired of these two Americas. They want to do something different.

Shirley Franklin served two terms as mayor of Atlanta, and then as board chair of purpose-built communities, an organization trying to improve health outcomes for African Americans by investing in Black neighborhoods.

Bill Whitaker: Dr. Williams told us that there is a 20 to 25-year gap in life expectancy based on the communities we live in. That's a remarkable number.

Shirley Franklin: The life expectancy numbers are startling and they are horrific. 

One of the places where Franklin's group is trying to change those numbers is historic South Atlanta, the neighborhood of about 2,000 people where Michelle Thomas and her kids now live.

Shirley Franklin: We determined that there were three key pillars. One is community wellness and community health with a sense of community spirit. Another is accessible affordable housing. And the third is education.

Professor David R. Williams: If we can improve the living conditions of individuals, we actually can improve their health. Let me give you an example of a study that was done years ago.  Where they took African Americans, who lived in public housing and randomly, by the flip of a coin, some of them remain in -- public housing, and some of them were given a voucher where they could go and find housing in areas of lower levels of poverty than where they currently were. Research shows ten to 15 years later those African Americans who moved to a better neighborhood had lower rates of obesity-- and lower diabetes risk. No health intervention. You just changed their neighborhood.

In my Testimony supporting the passage and enactment of HB 6662- An act declaring Racism as a Public health Crisis… that I submitted on March 26,2021 to the House Appropriations Committee I have provided specific information on the “Place Matters concept” in section 3 a-h. Prof. Raj Chetty https://www.brookings.edu/blog/social-mobility-memos/2018/01/11/raj-chetty-in-14-charts-bigfindings-on-opportunity-and-mobility-we-should-know/ This is an important foundational link. Velandy Manohar, MD

A crucial factor in that equation is access to healthy foods. For years, South Atlanta – like many Black neighborhoods - was what's known as a food desert, with no nearby grocery store. Katie Delp, whose neighborhood nonprofit works with former Mayor Franklin's group, says she tried to convince grocery chains to open a store.

Bill Whitaker: You approached, every major supermarket chain to ask them if they would build a supermarket -- in the neighborhood, and they all said no?

Katie Delp: They all said no.

Bill Whitaker: Why?

Katie Delp: The community does not have enough disposable income for a large supermarket. So it doesn't work for their model.

So Delp and her colleagues decided to build a smaller one of their own. In 2015 they opened Carver Market with Community Grounds, a coffee shop, in the same building.

Bill Whitaker: Do you remember your reaction the first time you saw or walked into Carver Market?

Michelle Thomas: Yeah. I was blown away. Like, it has a cafe here and there's a -- grocery store. I'm, like, "Wow." And I'm, like, "This area is a food desert. And we got somethin' like th--" I was, like, "Thank God. Amen." I was so happy.

Bill Whitaker: Just the things you're saying, to be able to walk into a store and get fresh vegetables and fruits, and have a coffee shop, that's something many Americans just take for granted. And that's not something that is available to everybody.

Michelle Thomas: Yes. It's not. And it's sad. And it should be.

Professor David R. Williams: To have grocery stores that provide affordable access to high quality foods is a good thing from a health and nutrition point of view. But in addition to that, it provides employment opportunities. And really-- a job is a good health-enhancing strategy.

That has been precisely Michelle Thomas's experience in South Atlanta.

Bill Whitaker: You didn't just wanna shop at Carver Market.

Michelle Thomas: No. I wanted to be a part of Carver Market. "How can I apply? How can I get started?"

Bill Whitaker: What was your first job?

Michelle Thomas: My first job was a barista.

Bill Whitaker: So what is your job now?

Michelle Thomas: I'm assistant-- general manager of Carver Market. (LAUGH)

The health benefits that a nearby grocery store can provide have been proven in neighborhood after neighborhood. Michelle Thomas says she sees it in her own family, compared to the food-desert where she used to live.

Michelle Thomas: I could never get fresh fruit and vegetables the same day that I needed them. With Carver Market, I can actually just walk down the street like five blocks and I have fresh vegetables, fresh fruit. And that's the point. You want to give your kids something healthy. 

Even with all the progress in South Atlanta, there's fresh trauma, too. Last June, Rayshard Brooks was shot and killed by an Atlanta police officer just a half-mile from the Carver Market. In the unrest that followed, the market was vandalized. But that wasn't the whole story.

Katie Delp: One thing that struck me the morning-- after the vandalism is that we had neighbors everywhere, you know, sweeping up glass, scrubbing off graffiti-- boarding up windows.

Michelle Thomas: We came together. You wouldn't believe how many neighbors came together. And if you see that many people, you know you're at a good place.

That same week, Michelle Thomas and her neighbors held a peaceful march that drew a stark contrast to the violence. They painted murals over graffiti and started bike rides to occupy neighborhood kids idled by the pandemic. And recently, more than 400 neighborhood residents got a COVID vaccine during a one-day pop-up clinic.

Michelle Thomas: We're more than just a neighborhood. We're more than just people. We're a family. And once-- you have a family, hey, you have everything.

South Atlanta is now one of almost 30 neighborhoods around the country that are part of the purpose-built community’s network, all of them working to undo or at least mitigate the damage done by decades – centuries, really – of segregation and racism.

Bill Whitaker: If you're working community by community, this is gonna take a long time to reach your goals. I mean, people are clamoring for change right now.

Shirley Franklin: It took 400 years to get into this desperate situation. So your question about whether we do it one at a time-- doesn't sit too well with me. Because we didn't get here overnight. And it's gonna take some, it's gonna take some time to get out of this dilemma.

Produced by Rome Hartman and Sara Kuzmarov. Field producers, Miles Doran and Cristina Gallotto. Associate producer, Emilio Almonte. Edited by Michael Mongulla.

© 2021 CBS Interactive Inc. All Rights Reserved.

 

II.

https://nihrecord.nih.gov/2021/03/05/housing-segregation-central-cause-racial-health-inequities

Housing Segregation a Central Cause of Racial Health Inequities

BY ERIC BOCK

Structural racism in the housing system is a fundamental cause of racial health inequity in the United States, said Dr. David Williams during a recent NIMHD/NINR Joint Directors’ Seminar on the Science of Structural Racism.

“We will not make the progress we would like to make in reducing health inequities if we don’t address it,” said Williams, professor of African and African American studies at Harvard University and the Florence and Laura Norman professor of public health and chair of the department of social and behavioral sciences at Harvard’s T.H. Chan School of Public Health. 

Structural racism—also known as institutional or systemic racism—is a societal system that “categorizes and ranks populations and groups, devalues and disempowers some groups,” he explained. It “leads to the development of negative attitudes and beliefs, prejudice and stereotypes, differential treatment and discrimination by both individuals and societal institutions.” 

Residential segregation, or “the physical separation of the races by forcing residents into different areas,” is one of the most prominent examples of structural racism. The system was developed in the South and expanded to the North. He said it has been “locked in place” since 1940. 

Historically, the segregation of African Americans has been unique. While other groups are segregated depending on income levels, segregation is higher for African Americans at all income levels. But not by choice. 

“Studies show African Americans show the highest preference for residing in integrated areas [compared to] any other group,” he said. 

Williams compared segregation to toxic emissions produced by an industrial plant in a neighborhood. Both are often imperceptible and cause illness and death. When they appear, valuable resources such as quality schools, safe playgrounds and housing, good jobs, clean air and water, transportation and health care, all disappear.

Structural racism in the housing system is a fundamental cause of racial health inequity in the United States, said Dr. David Williams during a recent NIMHD/NINR Joint Directors’ Seminar on the Science of Structural Racism.

“We will not make the progress we would like to make in reducing health inequities if we don’t address it,” said Williams, professor of African and African American studies at Harvard University and the Florence and Laura Norman professor of public health and chair of the department of social and behavioral sciences at Harvard’s T.H. Chan School of Public Health. 

Structural racism—also known as institutional or systemic racism—is a societal system that “categorizes and ranks populations and groups, devalues and disempowers some groups,” he explained. It “leads to the development of negative attitudes and beliefs, prejudice and stereotypes, differential treatment and discrimination by both individuals and societal institutions.” 

Residential segregation, or “the physical separation of the races by forcing residents into different areas,” is one of the most prominent examples of structural racism. The system was developed in the South and expanded to the North. He said it has been “locked in place” since 1940. 

Historically, the segregation of African Americans has been unique. While other groups are segregated depending on income levels, segregation is higher for African Americans at all income levels. But not by choice. 

“Studies show African Americans show the highest preference for residing in integrated areas [compared to] any other group,” he said. 

Williams compared segregation to toxic emissions produced by an industrial plant in a neighborhood. Both are often imperceptible and cause illness and death. When they appear, valuable resources such as quality schools, safe playgrounds and housing, good jobs, clean air and water, transportation and health care, all disappear.

In my Testimony supporting the passage and enactment of HB 6662- An act declaring Racism as a Public health Crisis… that I submitted on March 26,2021 to the House Appropriations Committee. https://www.cga.ct.gov/asp/menu/CommDocTmyBillAllComm.asp?bill=HB-06662&doc_year=2021

I have provided specific information on the “Place Matters concept” in section 3 a-h. Prof. Raj Chetty https://www.brookings.edu/blog/social-mobility-memos/2018/01/11/raj-chetty-in-14-charts-bigfindings-on-opportunity-and-mobility-we-should-know/ This is an important foundational link. Velandy Manohar, MD

In the 100 largest metropolitan areas in the U.S., studies show two-thirds of all African American children, 58 percent of Latino children and 53 percent of indigenous American children live in low-opportunity neighborhoods. Almost two-thirds of non-Hispanic whites and Asian kids live in high- or very high-opportunity neighborhoods. 

“There are striking differences in access to opportunity at the neighborhood level,” Williams said. 

Residential segregation is just one aspect of systemic racism. Other examples include immigration and border policy, political participation, the criminal justice system, workplace policies and home mortgage discrimination.

Acts of interpersonal racism also adversely affect health, he noted. Everyday discrimination, such as being treated with less courtesy and respect or receiving poorer service, predicts adverse health outcomes that have enormous health consequences, such as higher levels of type 2 diabetes, heart disease, breast cancer, poorer sleep and obesity. 

People who experience these little indignities are biologically older than their chronological age, Williams said. Some research studies found African Americans are biologically 7.5-10 years older than non-Hispanic whites who are the same chronological age based on their physiology.  

“One of the consequences of this is the earlier onset of diseases and greater severity of diseases,” he said. 

Going forward, Williams said public health researchers must better understand how poor neighborhoods and substandard housing lead to stress. They also need to identify exposure to non-traditional stressors, such as the viewing of traumatic videos of persons being beaten, arrested or detained or being shot by police, that adversely affect health. 

“Addressing segregation will not be easy,” Williams said. “There are deep fears of segregation and its impact on the United States.” 

Williams indicated that although there are not many success stories, there is the Purpose-Built Communities model that shows it is possible to create mixed-income housing that addresses all of the challenges faced by poor communities simultaneously, and markedly improve public safety, education, employment and child care.

Associate Editor: Carla Garnett
[email protected]

Writers:[email protected] [email protected]

III. A.

Racism and Health

https://scholar.harvard.edu/davidrwilliams/dwilliam/publications/racism-and-health

Citation:

Williams, D. R. (2004). Racism and Health. In K. E. Whitfield (Ed.), Closing the Gap: Improving the Health of Minority Elders in the New Millennium. . Washington, DC, The Gerontological Society of America.

III. B.

SELECT RECENT PAPERS

·Miles to go before we Sleep: Racial Inequities in Health

·The Intergenerational Transmission of Discrimination: Children’s Experiences of Unfair Treatment and Their Mothers’ Health at Midlife

·Racism and Health: Evidence and Needed Research

·Understanding How Discrimination Can Affect Health

·Stress and the Mental Health of Populations of Color: Advancing Our Understanding of Race-Related Stressors.

·Civil rights as determinants of public health and racial and ethnic health equity: health care, education, employment, and housing in the United States

III. C

25 HIGHLY CITED PUBLICATIONS

·Discrimination and Racial Disparities in Health: Evidence and Needed Research

·Prevalence and Distribution of Major Depressive Disorder in African Americans, Caribbean Blacks, and Non-Hispanic Whites

·Measuring multiple dimensions of religion and spirituality for health research: Conceptual background and findings from the 1998 General Social Survey

·Racial/Ethnic Variations in Women's Health: the Social Embeddedness of Health

·Religious Involvement, Stress and Mental Health: Findings from the 1995 Detroit Area Study

·Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health

·The Prevalence, Distribution, and Mental Health Correlates of Perceived Discrimination in the United States

·Racism as a Stressor for African Americans: A Biopsychosocial Model

·Race and Health: Basic Questions, Emerging Directions

·Race, Socioeconomic Status, and Health: The Added Effects of Racism and Discrimination

·Measuring Social Class in U.S. Public Health Research: Concepts, Methodologies, and Guidelines

·Racial Differences in Physical and Mental Health: Socioeconomic Status, Stress, and Discrimination

·U.S. Socioeconomic and Racial Differences in Health: Patterns and Explanations

·Religion and Psychological Distress in a Community Sample

·Socioeconomic Differentials in Health: A Review and Redirection

·Racism and Mental Health: The African American Experience

·Understanding and Reducing Socioeconomic and Racial/Ethnic Disparities in Health

·Racial/Ethnic Discrimination and Health: Findings from Community Studies

·The Health of Men: Structured Inequalities and Opportunities

·Social Sources of Racial Disparities in Health

·The Concept of Race and Health Status in America

·Forgiveness and Health: Age Difference in a U.S. Probability Sample

·The Social Determinants of Health: Coming of Age

·Race, Socioeconomic Status and Health: Complexities, Ongoing Challenges and Research Opportunities

·Socioeconomic disparities in health in the United States: what the patterns tell us

III. D

DR. WILLIAMS' DOWNLOADABLE PUBLICATIONS PRE-2006

http://www.isr.umich.edu/williams/

 

III. E.

 

THE SOUTH AFRICAN STRESS AND HEALTH STUDY (SASH)

·The South Africa Stress and Health Study: Rationale and Design

·Multiple Traumatic Events and Psychological Distress: The South African Stress and Health Study

·Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study

·Perceived Discrimination, Race and Health in South Africa: Findings from the South Africa Stress and Health Study

·Lifetime Prevalence of Psychiatric Disorders in South Africa

·Social determinants of psychological distress in a nationally-representative sample of South African adults

·Prevalence and correlates of non-fatal suicidal behavior among South Africans

·Non-fatal Suicidal Behavior among South Africans: Results from the South Africa Stress and Health Study

·The Impact of the Truth and Reconciliation Commission on Psychological Distress and Forgiveness in South Africa

·Physical Violence against intimate partners and related exposures to violence among South African men

·DSM-IV Personality Disorders and their Axis 1 Correlates in the South African Population

·Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa

·The South African Stress and Health Study (SASH): A Foundation for Improving Mental Health Care in South Africa

·Twelve-Month Treatment of Psychiatric Disorders: South African National Probability Household Survey

·Intermittent Explosive Disorder in South Africa: Prevalence, Correlates, and the Role of Traumatic Exposures

·The mental health impact of AIDS-related mortality in South Africa: A national study

·The South African Stress and Health (SASH) study: A scientific base for mental health policy

·The South African Stress and Health Study (SASH)

·Mental health service use among South Africans for mood, anxiety and substance use disorders

·Patterns of substance use in South Africa: Results from the South African Stress and Health study

·The epidemiology of major depression in South Africa: Results from the South African Stress and Health study

·Life stress and mental disorders in the South African Stress and Health study

·Race and Psychological Distress: The South African Stress and Health Study

·Perpetration of gross human rights violations in South Africa: Association with psychiatric disorders

Perceived discrimination and mental health disorders: The South African Stress and Health study

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