TEDMED 2016
David R. Williams: How racism makes us sick
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Why does race matter so profoundly for health? David R. Williams developed a scale to measure the impact of discrimination on well-being, going beyond traditional measures like income and education to reveal how factors like implicit bias, residential segregation and negative stereotypes create and sustain inequality. In this eye-opening talk, Williams presents evidence for how racism is producing a rigged system -- and offers hopeful examples of programs across the US that are working to dismantle discrimination.
David R. Williams - Public health sociologist
David R. Williams asks: What if we decided to tackle the striking levels of early death and poor health that are due to the color of one's skin? Full bio
David R. Williams asks: What if we decided to tackle the striking levels of early death and poor health that are due to the color of one's skin? Full bio
Double-click the English transcript below to play the video.
00:13
An article in the Yale Alumni Magazine
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told the story of Clyde Murphy,
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a black man who was a member
of the Class of 1970.
of the Class of 1970.
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Clyde was a success story.
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After Yale and a law degree from Columbia,
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Clyde spent the next 30 years
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as one of America's
top civil rights lawyers.
top civil rights lawyers.
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He was also a great husband and father.
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But despite his success,
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personally and professionally,
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Clyde's story had a sad ending.
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In 2010,
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at the age of 62,
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Clyde died from a blood clot in his lung.
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Clyde's experience was not unique.
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Many of his black classmates from Yale
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also died young.
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In fact, the magazine article indicated
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that 41 years after graduation from Yale,
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the black members of the Class of 1970
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had a death rate
that was three times higher
that was three times higher
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than that of the average class member.
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It's stunning.
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America has recently awakened
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to a steady drumbeat
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of unarmed black men
being shot by the police.
being shot by the police.
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What is even a bigger story
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is that every seven minutes,
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a black person dies prematurely
in the United States.
in the United States.
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That is over 200 black people
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die every single day
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who would not die if the health
of blacks and whites were equal.
of blacks and whites were equal.
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For the last 25 years,
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I have been on a mission
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to understand why does race
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matter so profoundly for health.
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When I started my career,
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many believed that it was simply
about racial differences
about racial differences
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in income and education.
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I discovered that while
economic status matters for health,
economic status matters for health,
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there is more to the story.
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So for example, if we look
at life expectancy at age 25,
at life expectancy at age 25,
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at age 25 there's a five-year gap
between blacks and whites.
between blacks and whites.
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And the gap by education
for both whites and blacks
for both whites and blacks
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is even larger than the racial gap.
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At the same time,
at every level of education,
at every level of education,
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whites live longer than blacks.
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So whites who are high school dropouts
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live 3.4 years longer
than their black counterparts,
than their black counterparts,
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and the gap is even larger
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among college graduates.
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Most surprising of all,
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whites who have graduated from high school
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live longer than blacks
with a college degree
with a college degree
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or more education.
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So why does race matter
so profoundly for health?
so profoundly for health?
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What else is it
beyond education and income
beyond education and income
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that might matter?
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In the early 1990s,
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I was asked to review a new book
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on the health of black America.
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I was struck that almost every single one
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of its 25 chapters
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said that racism
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was a factor that was hurting
the health of blacks.
the health of blacks.
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All of these researchers
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were stating that racism was a factor
adversely impacting blacks,
adversely impacting blacks,
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but they provided no evidence.
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For me, that was not good enough.
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A few months later,
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I was speaking at a conference
in Washington, DC,
in Washington, DC,
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and I said that one
of the priorities for research
of the priorities for research
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was to document the ways
in which racism affected health.
in which racism affected health.
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A white gentleman stood in the audience
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and said that while he agreed
with me that racism was important,
with me that racism was important,
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we could never measure racism.
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"We measure self-esteem," I said.
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"There's no reason
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why we can't measure racism
if we put our minds to it."
if we put our minds to it."
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And so I put my mind to it
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and developed three scales.
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The first one captured
major experiences of discrimination,
major experiences of discrimination,
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like being unfairly fired
or being unfairly stopped by the police.
or being unfairly stopped by the police.
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But discrimination also occurs
in more minor and subtle experiences,
in more minor and subtle experiences,
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and so my second scale,
called the Everyday Discrimination Scale,
called the Everyday Discrimination Scale,
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captures nine items
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that captures experiences
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like you're treated
with less courtesy than others,
with less courtesy than others,
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you receive poorer service
than others in restaurants or stores,
than others in restaurants or stores,
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or people act as if they're afraid of you.
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This scale captures
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ways in which the dignity and the respect
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of people who society does not value
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is chipped away on a daily basis.
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Research has found
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that higher levels of discrimination
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are associated with an elevated risk
of a broad range of diseases
of a broad range of diseases
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from blood pressure to abdominal obesity
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to breast cancer to heart disease
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and even premature mortality.
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Strikingly, some of the effects
are observed at a very young age.
are observed at a very young age.
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For example, a study of black teens
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found that those who reported higher
levels of discrimination as teenagers
levels of discrimination as teenagers
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had higher levels of stress hormones,
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of blood pressure
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and of weight at age 20.
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However,
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the stress of discrimination
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is only one aspect.
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Discrimination and racism
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also matters in other
profound ways for health.
profound ways for health.
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For example, there's
discrimination in medical care.
discrimination in medical care.
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In 1999, the National Academy of Medicine
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asked me to serve on a committee
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that found, concluded
based on the scientific evidence,
based on the scientific evidence,
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that blacks and other minorities
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receive poorer quality care than whites.
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This was true for all kinds
of medical treatment,
of medical treatment,
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from the most simple
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to the most technologically sophisticated.
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One explanation for this pattern
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was a phenomenon
that's called "implicit bias"
that's called "implicit bias"
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or "unconscious discrimination."
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Research for decades
by social psychologists
by social psychologists
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indicates that if you hold
a negative stereotype
a negative stereotype
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about a group in your subconscious mind
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and you meet someone from that group,
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you will discriminate against that person.
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You will treat them differently.
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It's an unconscious process.
It's an automatic process.
It's an automatic process.
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It is a subtle process, but it's normal
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and it occurs even among
the most well-intentioned individuals.
the most well-intentioned individuals.
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But the deeper that I delved
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into the health impact of racism,
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the more insidious the effects became.
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There is institutional discrimination,
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which refers to discrimination
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that exists in the processes
of social institutions.
of social institutions.
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Residential segregation by race,
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which has led to blacks and whites living
in very different neighborhood contexts,
in very different neighborhood contexts,
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is a classic example
of institutional racism.
of institutional racism.
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One of America's best-kept secrets
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is how residential segregation
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is the secret source
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that creates racial inequality
in the United States.
in the United States.
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In America, where you live
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determines your access to opportunities
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in education, in employment,
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in housing and even
in access to medical care.
in access to medical care.
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One study of the 171 largest
cities in the United States
cities in the United States
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concluded that there is not even one city
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where whites live
under equal conditions to blacks,
under equal conditions to blacks,
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and that the worst urban contexts
in which whites reside
in which whites reside
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is considerably better than the average
context of black communities.
context of black communities.
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Another study found
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that if you could eliminate statistically
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residential segregation,
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you would completely erase
black-white differences in income,
black-white differences in income,
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education and unemployment,
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and reduce black-white differences
in single motherhood
in single motherhood
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by two thirds,
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all of that driven by segregation.
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I have also learned
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how the negative stereotypes
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and images of blacks in our culture
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literally create and sustain
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both institutional
and individual discrimination.
and individual discrimination.
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A group of researchers
have put together a database
have put together a database
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that contains the books,
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magazines and articles
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that an average college-educated
American would read over their lifetime.
American would read over their lifetime.
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It allows us to look within this database
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and see how Americans
have seen words paired together
have seen words paired together
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as they grow up in their society.
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So when the word "black"
appears in American culture,
appears in American culture,
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what co-occurs with it?
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"Poor,"
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"violent,"
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"religious,"
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"lazy,"
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"cheerful,"
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"dangerous."
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When "white" occurs,
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the frequently co-occurring words
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are "wealthy,"
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"progressive,"
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"conventional,"
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"stubborn,"
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"successful,"
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"educated."
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So when a police officer
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overreacts when he sees
an unarmed black male
an unarmed black male
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and perceives him
to be violent and dangerous,
to be violent and dangerous,
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we are not necessarily dealing
with an inherently bad cop.
with an inherently bad cop.
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We may be simply viewing
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a normal American
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who is reflecting
what he has been exposed to
what he has been exposed to
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as a result of being raised
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in this society.
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From my own experience,
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I believe that your race
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does not have to be
a determinant of your destiny.
a determinant of your destiny.
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I migrated to the United States
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from the Caribbean island of Saint Lucia
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in the late 1970s
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in pursuit of higher education,
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and in the last 40 years,
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I have done well.
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I have had a supportive family,
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I have worked hard,
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I have done well.
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But it took more for me to be successful.
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I received a minority fellowship
from the University of Michigan.
from the University of Michigan.
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Yes. I am an affirmative action baby.
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Without affirmative action,
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I would not be here.
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But in the last 40 years,
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black America has been
less successful than I have.
less successful than I have.
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In 1978, black households
in the United States
in the United States
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earned 59 cents for every dollar
of income whites earned.
of income whites earned.
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In 2015,
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black families still earn 59 cents
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for every dollar of income
that white families receive,
that white families receive,
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and the racial gaps in wealth
are even more stunning.
are even more stunning.
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For every dollar of wealth
that whites have,
that whites have,
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black families have six pennies
and Latinos have seven pennies.
and Latinos have seven pennies.
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The fact is,
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racism
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is producing a truly rigged system
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that is systematically disadvantaging
some racial groups in the United States.
some racial groups in the United States.
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To paraphrase Plato,
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there is nothing so unfair
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as the equal treatment of unequal people.
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And that's why I am committed
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to working to dismantle racism.
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I deeply appreciate the fact
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that I am standing on the shoulders
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of those who have sacrificed
even their lives to open the doors
even their lives to open the doors
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that I have walked through.
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I want to ensure
that those doors remain open
that those doors remain open
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and that everyone
can walk through those doors.
can walk through those doors.
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Robert Kennedy said,
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"Each time a man" --
or woman, I would add --
or woman, I would add --
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"stands up for an ideal
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or acts to improve the lot of others
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or strikes out against injustice,
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he sends forth a tiny ripple of hope,
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and those ripples can build a current
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that can sweep down the mightiest walls
of oppression and resistance."
of oppression and resistance."
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I am optimistic today
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because all across America,
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I have seen ripples of hope.
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The Boston Medical Center
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has added lawyers to the medical team
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so that physicians can improve
the health of their patients
the health of their patients
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because the lawyers are addressing
the nonmedical needs their patients have.
the nonmedical needs their patients have.
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Loma Linda University
has built a gateway college
has built a gateway college
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in nearby San Bernardino
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so that in addition
to delivering medical care,
to delivering medical care,
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they can provide job skills
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and job training
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to a predominantly minority,
low-income community members
low-income community members
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so that they will have the skills
they need to get a decent job.
they need to get a decent job.
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In Chapel Hill, North Carolina,
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the Abecedarian Project has figured out
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how to ensure that they have lowered
the risks for heart disease
the risks for heart disease
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for blacks in their mid-30s
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by providing high-quality day care
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from birth to age five.
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In after-school centers
across the United States,
across the United States,
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Wintley Phipps and the US Dream Academy
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is breaking the cycle of incarceration
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by providing high-quality
academic enrichment and mentoring
academic enrichment and mentoring
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to the children of prisoners
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and children who have
fallen behind in school.
fallen behind in school.
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In Huntsville, Alabama,
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Oakwood University,
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a historically black institution,
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is showing how we can improve
the health of black adults
the health of black adults
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by including a health evaluation
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as a part of freshman orientation
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and giving those students
the tools they need
the tools they need
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to make healthy choices
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and providing them annually
a health transcript
a health transcript
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so they can monitor their progress.
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And in Atlanta, Georgia,
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Purpose Built Communities has dismantled
the negative effects of segregation
the negative effects of segregation
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by transforming a crime-ridden,
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drug-infested public housing project
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into an oasis of mixed-income housing,
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of academic performance,
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of great community wellness
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and of full employment.
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And finally,
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there is the Devine solution.
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Professor Patricia Devine
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of the University of Wisconsin
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has shown us how we can attack
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our hidden biases head on
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and effectively reduce them.
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Each one of us
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can be a ripple of hope.
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This work will not always be easy,
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but former Supreme Court Justice
Thurgood Marshall
Thurgood Marshall
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has told us, "We must dissent.
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We must dissent from the indifference.
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We must dissent from the apathy.
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We must dissent from the hatred
and from the mistrust.
and from the mistrust.
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17:11
We must dissent
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because America can do better,
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because America has no choice
but to do better."
but to do better."
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Thank you.
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(Applause)
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ABOUT THE SPEAKER
David R. Williams - Public health sociologistDavid R. Williams asks: What if we decided to tackle the striking levels of early death and poor health that are due to the color of one's skin?
Why you should listen
Dr. David R. Williams has played a visible national leadership role in raising awareness levels about health disparities and identifying interventions to address them. The author of more than 400 scientific papers, Williams developed the Everyday Discrimination Scale, which is currently one of the most widely used measures to assess perceived discrimination in health studies. He was ranked as the world's most cited black scholar in the social sciences in 2008, and Thomson Reuters ranked him as one of the world's most influential scientific minds in 2014.
Williams is currently the Norman Professor of Public Health at Harvard's T. H. Chan School of Public Health and Professor of African and African American Studies and of Sociology at Harvard University. He holds an MPH degree from Loma Linda University and a PhD in Sociology from the University of Michigan.
David R. Williams | Speaker | TED.com