Racism's Effect on Health, and the Heartbreak of Being a Black Parent Right Now: California's Surgeon General Speaks

The coronavirus pandemic and the recent killing of George Floyd have brought longstanding racial inequities into sharp focus. One of those disparities concerns the high rate of coronavirus transmission among people of color. To talk about the intersection of race and health, KQED’s Brian Watt spoke last week with California Surgeon General Dr. Nadine Burke Harris, who is known for her pioneering work on the role that childhood stress and trauma play on the wellness of minority populations.  Here are excerpts from the interview, edited for length and clarity.

Brian Watt: You wrote in Medium recently that you are often asked what it is about black and brown people that makes us vulnerable to the coronavirus, and that the question infuriates you. But I think people need to hear your answer.

Dr. Nadine Burke Harris: There have been decades of science that demonstrate our experiences and our environments shape our biology. If the experiences are nurturing and enriching, that activates a pathway of wellness and resilience. But if those experiences are threatening or adverse, they increase our risk of early disease and death.

As a black woman, I understand that when you are repeatedly exposed to dehumanizing, traumatizing experiences, these things literally get under our skin and change our biology. And they increase our risk for disease. And so when we are asking the question why it is that we see black and brown people dying at a higher rate from COVID-19, we have to keep in mind that in addition to more people of color being in front-line jobs, they have greater underlying health conditions, and this is part of the reason why.

Watt: What can public health officials do to change that?

Burke Harris: Those are some of the big questions we’re asking. One of the pieces is making sure we are raising awareness and reaching out to communities of color so that they are tested early. A recent study from Sutter showed that black folks with COVID-19 were more likely to be tested in the emergency room or in the hospital, meaning after they’ve developed some pretty severe symptoms. And we know that the earlier someone is tested and is identified as having COVID-19, the better their survival rate.

So one of the really important things is to make sure that our black and brown communities understand that if you are even remotely concerned that you’ve been exposed,  free testing is available and you should get tested as early as possible.

Watt: Public health officials have told us not to gather, but for the last couple of weeks, tens of thousands of people have been marching and protesting. Does this concern you?

Burke Harris:  Of course it concerns me from a public health perspective. I’m certainly very, very worried about the health of the protesters. We recognize that COVID-19 is a scary pandemic and it is killing people. But we also have to recognize that racism is killing people. We have to attack both. We can’t just attack the pandemic and not attack the other endemic disease of American society, which is racism.

Watt: For the people who might want to go out into the streets but have been trying to heed the calls to stay away from where lots of people are gathering, what can they do?

Burke Harris: The good news is that protests are not the only way; there is a very important role that all of us can play in dismantling structural racism. Every single one of us, in our own sphere of influence, whether it’s working with our employer or with our school groups, can look at our policies and practices. Racism is embedded in racist policies. I think every single black and brown person has experienced this themselves.

An incredibly important thing is to vote. Or better yet, run for office. Get involved, because ultimately lasting change is going to come when we change the systems, the policies, the practices in a much deeper way.

Watt: In your role as surgeon general, can you describe what you’re doing to change the health inequities in California?

Burke Harris: One of the things I’m really pleased about is that California has launched a first-in-the-nation effort to train physicians, to train health care providers on how to recognize and respond to the impact that trauma has on health.

The name of the initiative is ACEs Aware, and it’s really focused on the science of how adverse childhood experiences can lead to a biological response called the toxic stress response. This toxic stress response can lead to long-term harms in terms of increased risk of heart disease, stroke, cancer, etc.

Although the traditional adverse childhood experiences criteria don’t include discrimination — because the CDC research was done in a population that was majority Caucasian — the science demonstrates that discrimination and racism are also  risk factors for developing the toxic stress response rate.

So as part of this effort of helping doctors recognize how to identify and respond to the toxic stress response, we are also including a recognition of the role of discrimination, so that we in health care can be a very important part of the solution.

Watt: I am the father of two half-Asian, half-black children, and I really struggle with how I want to explain this moment to them. We’ve heard a lot of black parents express the fear they have for their children.  As a mother of four black sons, do you have fear for your children?

Burke Harris: Of course I do. My God, I think it is a horrible rite of passage for every black parent to have to have “the talk” with their children, and particularly with my husband and I having four black boys. It is particularly salient, and It’s heartbreaking. Honestly, I have been tearful in this process. It’s been very, very difficult.

Watt: I look at my children and, like, they have too much of this cute invincibility right now for us to think they could be in a difficult altercation with law enforcement. And I get overcome and don’t want to ruin that. And yet I feel like, right now, I have to do something.

Burke Harris: It is so wrenching, because our kids are so adorable and so beautiful and so cute, and you look at them and realize it doesn’t matter how cute they are — by nature of the racist attitudes that infect our nation, they are at risk.

And that is what I am anguishing over, because I see how beautiful they are. I see how cute they are, how handsome they are. And I also know that racist attitudes don’t care how cute your kid is.