How Racism In Early Life Can Affect Long-Term Health

OPINION: Excessive adversity activates biological responses that can lead to lifelong problems of physical and mental wellbeing

By Jack P. Shonkoff

The scientific evidence is crystal clear: early experiences literally shape the architecture of the developing brain. This widespread understanding is leading to increased public support for universal pre-school to improve school readiness for all children and to create the conditions for children facing adversity. But here’s something that is less known to the public: Because the brain is connected to the rest of the body, early experiences affect all of our biological systems, for better or for worse, starting in the uterus and through all of the crucial years that Follow.

This broader message sends an important wake-up call: We all need to start paying more attention to the science that explains how excessive adversity can undermine lifelong health and early learning. Knowing this can help us better understand why people of color in the United States are at greater risk of developing chronic diseases and aging prematurely than white people.

With growing evidence of the early causes of inequalities in both physical and mental health, a sole focus on brain development and learning contrasts with just one dimension of the ubiquitous racism-related inequalities that can be found in American society sign off. Case in point: Although the gaps in academic achievement between black and white children have decreased by 30 percent to 40 percent since the 1970s, reducing racial differences in health has been more of a challenge. For example, premature births and low birth weight, which are associated with a higher risk of later cardiovascular disease and diabetes, occur at an approximately 1.5 to 1.6 times higher rate in non-Hispanic blacks compared to non- Hispanic whites – and those loopholes have existed for decades.

More and more scientific evidence tells us that the foundations for lifelong health are laid in the prenatal phase and early infancy. Factors that promote positive outcomes include supportive relationships, safe physical environments, and adequate resources to meet basic needs such as food and shelter. Take away those protective factors or add the weight of excessive hardship or threats outside of the family and you tip the scales in the direction of greater risk for trouble later on.

Despite the critical impact of these early years, long-term results are neither inevitable nor biologically predetermined. Of course, physical and mental health are affected by our genetics, but the likelihood that problems will actually develop is greatly influenced by the environment in which we live. Policies, conditions and resources that eliminate inequalities and ensure healthy conditions for young children as early as possible will help build a healthier society. Put simply, racism, not race, is the root of persistent inequalities in physical and mental wellbeing.

Race is a social invention. All humans, regardless of skin color, share 99.9 percent of the same genome. Residential segregation – one of the many converging consequences of systemic racism, personal discrimination and poverty – creates significant inequalities in exposure to air pollution, other environmental toxins and violence in the neighborhood, as well as inequalities in access to nutritious food, stable housing and quality education Health care. Black and white differences in premature births are well documented and are associated with discriminatory stress regardless of socioeconomic status. Black children are three times more likely to lose their mother than white children by the age of 10.

How Can The Effects Of Adversity Due To Racism In Early Childhood Affect Lifelong Health? One answer lies in the particular sensitivity of young, developing bodies to the physiological effects of a stressful environment. We all know what stress feels like physically, and science explains the source of those sensations.

Put simply, racism, not race, is the root of persistent inequalities in physical and mental wellbeing.

Jack P. Shonkoff

When we are confronted with an acute challenge or threat, stress response systems are activated in our body. Blood pressure and heart rate increase. Stress hormones such as cortisol are increased. The immune system triggers an inflammatory response in preparation for wound healing and fighting infection. Metabolic systems mobilize blood sugar to drive the “fight or flight” response. Once the threat has been overcome, the stress response (which can be lifesaving) returns to baseline. However, if the level of adversity remains high over a long period of time (e.g. due to chronic discrimination or poverty), continuous activation of the stress reaction can cause wear and tear in the body, which leads to “toxic stress” and a variety of health problems.

For example, excessive inflammation can affect multiple organ systems and increase the likelihood of developing heart and autoimmune diseases. Prolonged spikes in blood sugar can lead to insulin resistance, obesity, metabolic syndrome, and diabetes. Once we understand the biology of adversity and resilience, we can see that excessive activation of stress in early life does not lead to inevitable illnesses, but increases the risk of problems later, many of which include the pre-existing conditions that accompany more severe disease, Covid19. The high prevalence of these diseases among people of color may therefore explain some of the marked racial / ethnic differences in hospitalization and mortality rates in the pandemic.

Much of the public debate about disparity in health outcomes has centered on unequal access to health care, unequal treatment in the health system, and the impact of lifestyles and ownership in adulthood. But science tells us that preventing or mitigating the effects of negative experiences and exposures in early childhood could be as important to long-term health as the conditions we live in as adults and the medical care we receive.

A better understanding of how the synergistic pressures of systemic racism, interpersonal discrimination, and intergenerational poverty can be built into the body can be a powerful tool on the way to a healthier and more just world. Science tells us that the path must begin in the earliest years of life.

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Jack P. Shonkoff is a pediatrician, professor of child health and development, and director of the Center on the Developing Child at Harvard University.

This article originally appeared in Knowable Magazine, an independent journalistic company owned by Annual Reviews. Sign up for the newsletter.

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