TEDMED 2016

David R. Williams: How racism makes us sick

Filmed:

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.

- 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

An article in the Yale Alumni Magazine
00:26
told the story of Clyde Murphy,
00:30
a black man who was a member
of the Class of 1970.
00:32
Clyde was a success story.
00:37
After Yale and a law degree from Columbia,
00:41
Clyde spent the next 30 years
00:45
as one of America's
top civil rights lawyers.
00:47
He was also a great husband and father.
00:51
But despite his success,
00:55
personally and professionally,
00:57
Clyde's story had a sad ending.
01:01
In 2010,
01:04
at the age of 62,
01:06
Clyde died from a blood clot in his lung.
01:09
Clyde's experience was not unique.
01:15
Many of his black classmates from Yale
01:19
also died young.
01:22
In fact, the magazine article indicated
01:25
that 41 years after graduation from Yale,
01:29
the black members of the Class of 1970
01:33
had a death rate
that was three times higher
01:36
than that of the average class member.
01:39
It's stunning.
01:43
America has recently awakened
01:46
to a steady drumbeat
01:49
of unarmed black men
being shot by the police.
01:51
What is even a bigger story
01:56
is that every seven minutes,
02:01
a black person dies prematurely
in the United States.
02:04
That is over 200 black people
02:09
die every single day
02:13
who would not die if the health
of blacks and whites were equal.
02:15
For the last 25 years,
02:23
I have been on a mission
02:25
to understand why does race
02:27
matter so profoundly for health.
02:30
When I started my career,
02:34
many believed that it was simply
about racial differences
02:36
in income and education.
02:40
I discovered that while
economic status matters for health,
02:43
there is more to the story.
02:49
So for example, if we look
at life expectancy at age 25,
02:51
at age 25 there's a five-year gap
between blacks and whites.
02:56
And the gap by education
for both whites and blacks
03:02
is even larger than the racial gap.
03:06
At the same time,
at every level of education,
03:09
whites live longer than blacks.
03:14
So whites who are high school dropouts
03:17
live 3.4 years longer
than their black counterparts,
03:19
and the gap is even larger
03:23
among college graduates.
03:26
Most surprising of all,
03:29
whites who have graduated from high school
03:32
live longer than blacks
with a college degree
03:35
or more education.
03:39
So why does race matter
so profoundly for health?
03:41
What else is it
beyond education and income
03:45
that might matter?
03:50
In the early 1990s,
03:53
I was asked to review a new book
03:55
on the health of black America.
03:58
I was struck that almost every single one
04:01
of its 25 chapters
04:04
said that racism
04:06
was a factor that was hurting
the health of blacks.
04:08
All of these researchers
04:12
were stating that racism was a factor
adversely impacting blacks,
04:15
but they provided no evidence.
04:21
For me, that was not good enough.
04:23
A few months later,
04:26
I was speaking at a conference
in Washington, DC,
04:28
and I said that one
of the priorities for research
04:31
was to document the ways
in which racism affected health.
04:34
A white gentleman stood in the audience
04:39
and said that while he agreed
with me that racism was important,
04:42
we could never measure racism.
04:47
"We measure self-esteem," I said.
04:49
"There's no reason
04:53
why we can't measure racism
if we put our minds to it."
04:54
And so I put my mind to it
04:58
and developed three scales.
05:01
The first one captured
major experiences of discrimination,
05:03
like being unfairly fired
or being unfairly stopped by the police.
05:07
But discrimination also occurs
in more minor and subtle experiences,
05:11
and so my second scale,
called the Everyday Discrimination Scale,
05:17
captures nine items
05:21
that captures experiences
05:22
like you're treated
with less courtesy than others,
05:24
you receive poorer service
than others in restaurants or stores,
05:27
or people act as if they're afraid of you.
05:31
This scale captures
05:34
ways in which the dignity and the respect
05:37
of people who society does not value
05:40
is chipped away on a daily basis.
05:43
Research has found
05:46
that higher levels of discrimination
05:50
are associated with an elevated risk
of a broad range of diseases
05:53
from blood pressure to abdominal obesity
05:58
to breast cancer to heart disease
06:02
and even premature mortality.
06:04
Strikingly, some of the effects
are observed at a very young age.
06:08
For example, a study of black teens
06:13
found that those who reported higher
levels of discrimination as teenagers
06:19
had higher levels of stress hormones,
06:26
of blood pressure
06:30
and of weight at age 20.
06:32
However,
06:37
the stress of discrimination
06:40
is only one aspect.
06:43
Discrimination and racism
06:45
also matters in other
profound ways for health.
06:47
For example, there's
discrimination in medical care.
06:52
In 1999, the National Academy of Medicine
06:56
asked me to serve on a committee
07:00
that found, concluded
based on the scientific evidence,
07:02
that blacks and other minorities
07:07
receive poorer quality care than whites.
07:09
This was true for all kinds
of medical treatment,
07:13
from the most simple
07:17
to the most technologically sophisticated.
07:19
One explanation for this pattern
07:23
was a phenomenon
that's called "implicit bias"
07:26
or "unconscious discrimination."
07:30
Research for decades
by social psychologists
07:33
indicates that if you hold
a negative stereotype
07:35
about a group in your subconscious mind
07:39
and you meet someone from that group,
07:42
you will discriminate against that person.
07:45
You will treat them differently.
07:47
It's an unconscious process.
It's an automatic process.
07:49
It is a subtle process, but it's normal
07:53
and it occurs even among
the most well-intentioned individuals.
07:57
But the deeper that I delved
08:04
into the health impact of racism,
08:07
the more insidious the effects became.
08:10
There is institutional discrimination,
08:14
which refers to discrimination
08:17
that exists in the processes
of social institutions.
08:20
Residential segregation by race,
08:25
which has led to blacks and whites living
in very different neighborhood contexts,
08:27
is a classic example
of institutional racism.
08:32
One of America's best-kept secrets
08:38
is how residential segregation
08:42
is the secret source
08:44
that creates racial inequality
in the United States.
08:46
In America, where you live
08:51
determines your access to opportunities
08:54
in education, in employment,
08:57
in housing and even
in access to medical care.
09:01
One study of the 171 largest
cities in the United States
09:06
concluded that there is not even one city
09:13
where whites live
under equal conditions to blacks,
09:16
and that the worst urban contexts
in which whites reside
09:19
is considerably better than the average
context of black communities.
09:23
Another study found
09:28
that if you could eliminate statistically
09:30
residential segregation,
09:33
you would completely erase
black-white differences in income,
09:35
education and unemployment,
09:39
and reduce black-white differences
in single motherhood
09:42
by two thirds,
09:45
all of that driven by segregation.
09:46
I have also learned
09:49
how the negative stereotypes
09:52
and images of blacks in our culture
09:54
literally create and sustain
09:57
both institutional
and individual discrimination.
10:00
A group of researchers
have put together a database
10:05
that contains the books,
10:09
magazines and articles
10:11
that an average college-educated
American would read over their lifetime.
10:14
It allows us to look within this database
10:19
and see how Americans
have seen words paired together
10:22
as they grow up in their society.
10:27
So when the word "black"
appears in American culture,
10:30
what co-occurs with it?
10:34
"Poor,"
10:36
"violent,"
10:37
"religious,"
10:38
"lazy,"
10:40
"cheerful,"
10:41
"dangerous."
10:42
When "white" occurs,
10:44
the frequently co-occurring words
10:46
are "wealthy,"
10:48
"progressive,"
10:49
"conventional,"
10:51
"stubborn,"
10:53
"successful,"
10:54
"educated."
10:55
So when a police officer
10:57
overreacts when he sees
an unarmed black male
11:00
and perceives him
to be violent and dangerous,
11:06
we are not necessarily dealing
with an inherently bad cop.
11:10
We may be simply viewing
11:16
a normal American
11:18
who is reflecting
what he has been exposed to
11:20
as a result of being raised
11:24
in this society.
11:27
From my own experience,
11:29
I believe that your race
11:32
does not have to be
a determinant of your destiny.
11:35
I migrated to the United States
11:39
from the Caribbean island of Saint Lucia
11:42
in the late 1970s
11:45
in pursuit of higher education,
11:47
and in the last 40 years,
11:51
I have done well.
11:53
I have had a supportive family,
11:55
I have worked hard,
11:57
I have done well.
12:00
But it took more for me to be successful.
12:02
I received a minority fellowship
from the University of Michigan.
12:05
Yes. I am an affirmative action baby.
12:10
Without affirmative action,
12:15
I would not be here.
12:18
But in the last 40 years,
12:22
black America has been
less successful than I have.
12:24
In 1978, black households
in the United States
12:29
earned 59 cents for every dollar
of income whites earned.
12:35
In 2015,
12:40
black families still earn 59 cents
12:42
for every dollar of income
that white families receive,
12:47
and the racial gaps in wealth
are even more stunning.
12:51
For every dollar of wealth
that whites have,
12:55
black families have six pennies
and Latinos have seven pennies.
12:58
The fact is,
13:03
racism
13:05
is producing a truly rigged system
13:07
that is systematically disadvantaging
some racial groups in the United States.
13:11
To paraphrase Plato,
13:17
there is nothing so unfair
13:20
as the equal treatment of unequal people.
13:23
And that's why I am committed
13:28
to working to dismantle racism.
13:31
I deeply appreciate the fact
13:34
that I am standing on the shoulders
13:37
of those who have sacrificed
even their lives to open the doors
13:40
that I have walked through.
13:45
I want to ensure
that those doors remain open
13:47
and that everyone
can walk through those doors.
13:51
Robert Kennedy said,
13:57
"Each time a man" --
or woman, I would add --
13:59
"stands up for an ideal
14:03
or acts to improve the lot of others
14:05
or strikes out against injustice,
14:07
he sends forth a tiny ripple of hope,
14:10
and those ripples can build a current
14:14
that can sweep down the mightiest walls
of oppression and resistance."
14:17
I am optimistic today
14:23
because all across America,
14:25
I have seen ripples of hope.
14:27
The Boston Medical Center
14:30
has added lawyers to the medical team
14:32
so that physicians can improve
the health of their patients
14:36
because the lawyers are addressing
the nonmedical needs their patients have.
14:40
Loma Linda University
has built a gateway college
14:45
in nearby San Bernardino
14:49
so that in addition
to delivering medical care,
14:51
they can provide job skills
14:54
and job training
14:57
to a predominantly minority,
low-income community members
14:59
so that they will have the skills
they need to get a decent job.
15:03
In Chapel Hill, North Carolina,
15:09
the Abecedarian Project has figured out
15:12
how to ensure that they have lowered
the risks for heart disease
15:16
for blacks in their mid-30s
15:21
by providing high-quality day care
15:24
from birth to age five.
15:27
In after-school centers
across the United States,
15:30
Wintley Phipps and the US Dream Academy
15:33
is breaking the cycle of incarceration
15:36
by providing high-quality
academic enrichment and mentoring
15:39
to the children of prisoners
15:43
and children who have
fallen behind in school.
15:46
In Huntsville, Alabama,
15:49
Oakwood University,
15:51
a historically black institution,
15:52
is showing how we can improve
the health of black adults
15:55
by including a health evaluation
15:59
as a part of freshman orientation
16:02
and giving those students
the tools they need
16:05
to make healthy choices
16:08
and providing them annually
a health transcript
16:10
so they can monitor their progress.
16:13
And in Atlanta, Georgia,
16:16
Purpose Built Communities has dismantled
the negative effects of segregation
16:18
by transforming a crime-ridden,
16:24
drug-infested public housing project
16:26
into an oasis of mixed-income housing,
16:29
of academic performance,
16:33
of great community wellness
16:35
and of full employment.
16:38
And finally,
16:41
there is the Devine solution.
16:42
Professor Patricia Devine
16:45
of the University of Wisconsin
16:49
has shown us how we can attack
16:52
our hidden biases head on
16:55
and effectively reduce them.
16:58
Each one of us
17:01
can be a ripple of hope.
17:03
This work will not always be easy,
17:06
but former Supreme Court Justice
Thurgood Marshall
17:09
has told us, "We must dissent.
17:13
We must dissent from the indifference.
17:16
We must dissent from the apathy.
17:19
We must dissent from the hatred
and from the mistrust.
17:21
We must dissent
17:24
because America can do better,
17:26
because America has no choice
but to do better."
17:29
Thank you.
17:34
(Applause)
17:35
Translated by Joseph Geni
Reviewed by Joanna Pietrulewicz

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About the Speaker:

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?

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.

More profile about the speaker
David R. Williams | Speaker | TED.com