结构性种族主义、高血压和黑人健康之间的联系

高血压. 结构性种族主义.

What do they have in common?

研究人员表示，这是造成美国黑人和白人成年人在心脏和大脑健康方面存在差距的两个最大因素. And they are inextricably linked.

Studies show high blood pressure, 也叫高血压, 对成年黑人尤其是女性的影响比同龄白人更早、更剧烈. 到55岁时， 研究显示 四分之三的黑人成年人已经患上了这种疾病，而白人男性和白人女性的这一比例分别为一半和40%.

未经处理的, 高血压会导致一系列致残和潜在致命的慢性疾病, 包括心脏病, 中风, 痴呆, 肾脏疾病, sexual dysfunction and loss of vision.

Behind these elevated risks, 研究人员说, 一个复杂的负面影响网络是否源于结构性种族主义的多代影响.

钱德拉杰克逊, 他是国家环境健康科学研究所的研究员和流行病学家, 认为结构性种族主义是“社会通过相互加强的住房制度助长种族歧视的所有方式”, 教育, 就业, 工资, 好处, 信贷, 媒体, health care and criminal justice.

"These patterns and practices 反过来 reinforce discriminatory beliefs, values and the maldistribution of health-promoting or harming resources,她说. 这是, 他们创造了物质和社会环境，使白人家庭更容易健康成长，而黑人家庭更难健康成长.

例如, decades of discriminatory lending, 被注销, 把黑人家庭隔离在资源更少、长期暴露于环境危害更大的社区, such as unclean drinking water and noise and air pollution, 杰克逊说.

这些社区也往往缺乏高质量的卫生保健设施和提供者, grocery stores that sell healthy and affordable foods, or open spaces where adults can exercise and children can play, 她说. 歧视性的就业和教育制度导致更严重的贫困，造成财政紧张, housing and food insecurity, strained relationships and less access to good health insurance.

所有这些，再加上种族歧视的日常侮辱，都增加了压力. 那, 反过来, may be associated with increased blood pressure, 奥古斯丁·康说, an investigator at Brown University School of Public Health in Rhode Island. "All these factors set up the perfect storm for disease."

总体而言，黑人男性和女性的压力水平高于白人. But studies show Black women, who experience the compounding effects of both race and gender discrimination, 与此同时，人们还不得不“更努力地工作”，以克服这种双重偏见, pay a particularly high price with their health starting early in life. Black women have a shorter life expectancy than white women, in part due to higher rates of heart disease.

压力还会使控制心脏和大脑健康风险因素(如高血压)变得更加困难.

Kang led a study that found Black women with high blood pressure 经历过高水平压力的人基本上不太可能服用药物或采取降血压的行为，如锻炼或健康饮食.

“生活方式因素在控制血压方面非常重要，”他说. “社会和环境因素对饮食和体育活动造成了额外的障碍, which accounts for a lot of the health disparities we see today."

克服这些障碍被证明是具有挑战性的，但并非总是不可逾越的.

例如, 加州凯撒医疗机构针对高血压的一个项目消除了黑人和白人成年人在控制方面的差异. The program used electronic health records to track blood pressure, 增加了医生与病人之间的信息交流，降低了血压药物的价格，使其更容易负担和获得.

"In well-organized health systems, we're doing a better job of monitoring and controlling blood pressure,”医生说。. 约翰Ayanian, 他是位于安娜堡的密歇根大学医疗政策与创新研究所所长. 但是美国.S. has a fragmented health care system."

Ayanian领导了一项研究 showing disparities in blood pressure 除西部地区外，全国各地的黑人和白人都在享受医疗保险优惠, where the Kaiser health plans had eliminated those differences. 他的研究还显示，在全国范围内，黑人成年人参加表现不佳的医疗计划的比例过高.

"We cannot rely just on the efforts of individuals and doctors," he said. "You need a well-functioning health care delivery system."

Asking people to improve their diet when they don't have access to healthy foods, to exercise when they don't have access to safe or affordable spaces, 在负担不起降压药的情况下服用降压药——同时也无法确保获得高质量的全民卫生保健——将永远无法成功消除卫生不平等, 博士说. 纽约康奈尔健康公平中心的创始人兼联合主任莫妮卡·萨福德说. She also is chief of general internal medicine at Weill Cornell Medical College.

"We can't leave it up to individuals. 这不是他们的错. The system is set up to fail them. … The system is not fair, equal and equitable."

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