As we age, our cells accumulate damage. Over time, the damage can lead to disease, disability, or death.
Yet time does not affect everyone’s cells equally. Some public health practitioners argue that time should be considered one of the social determinants of health.
“Aging and racism is not about Black people who are old,” says Linda D. Oakley, PhD, RN, the Louis J. and Phyllis Clark Jacobs Professor in Mental Health at the University of Wisconsin–Madison School of Nursing.
“The connection between aging and racism is that aging happens faster” for Black people, she explains. “There’s an extra biological load that comes from the social environment. We call it aging, but it’s also morbidity, mortality, decreased life expectancy.”
Racism harms Black people throughout their lives. Fetuses are impacted by the stressors on pregnant people. Children and young adults navigate challenging educational systems. Adults experience workplace discrimination. At every age, Black people face additional barriers to accessing housing, healthcare, nutrition, and social and community resources.
“You’re banging against structures that are very stressful and you internalize them,” says Oakley. As a result, biological age—as measured by accumulated cellular damage—becomes older than actual chronological age.
Healthcare providers who understand this impact of racism can better care for Black patients.
“People are not nervous because you’re wearing a white coat with a stethoscope,” says Oakley. “They know that if you’re Black in a healthcare situation, it’s a little more risky, it’s a little less predictable.”
“Nurses need to know if you’re getting different vital signs or functional behaviors, Black patients may be trying to be invisible,” to limit potential structural threats, she explains. “Or they’re trying to be the most relaxed, funny, jovial, nonthreatening person, even if they’re dying of cancer. That’s exhausting.”
Some 55 percent of U.S. Black adults have hypertension, which is among the highest rates for any group worldwide. Black people are more likely to have severe hypertension and to develop the condition at younger ages.
“This premature aging of Black populations is through the autonomic [nervous] system,” says Oakley. “That is how you get increased hypertension and inflammatory health conditions. It’s how you get increased diabetes and obesity. Those impacts have changed health in this country.”
Oakley and her colleagues are working to promote health and well-being in Black communities.
“Our goal is to develop, test, and implement a real-world health promotion strategy that can improve cardiovascular health by supporting healthy responses to the structural, chronic stressors that Black communities face,” she says.
Under the name “Nurses 4 Black Well-Being,” Oakley and her colleagues are talking to Black people in Madison about their stressors, sources of strength, and ways of practicing self-care.
“Our data suggest that high levels of peace that reduce self-directed anger may increase self-acceptance and well-being in ways that might promote cardiovascular health,” says Oakley.
One person they talked to is especially skilled in regulating her response to stress.
“She was in her 80s, and she was the hippest, coolest, healthiest woman we’ve seen,” says Oakley. “And she could tell you exactly why she is, too. She doesn’t let people ‘pull down her face,’ as she described it. She doesn’t let people upset her. She doesn’t let the world upset her. She’s going to age based on her number of years, not her encounters with people who make her feel bad.”
That woman shows that it’s possible to reduce or avoid the negative health impacts of racism.
“As a psychiatric nurse, I’m pretty sure she is using directed attention to self-regulate,” says Oakley.
“That’s what our project is about, to help remind Black people that you can regulate the daily chronic stress that ages you prematurely. If you understand that as a nurse, then you can help your patient understand that. And if we can regulate stress, health outcomes will be better. We can achieve health equity.”
–Diane Farsetta; photography by Todd Brown