Genetics, lifestyle aren't biggest predictors of health for Black women. Here's what is

When Carolyn Williams Francis enters a room and realizes she is the only Black person there, her heart rate increases, her blood pressure rises and her body goes into fight or flight mode.

That response can harm the East Side resident's long term health, but it's not a choice or even something she can control, said Yvette Cozier, a senior epidemiologist at Boston University who has been studying Black women's health for nearly 30 years.

"It's our natural human instinct to look at the environment that we're walking into because that's what we're instinctively meant to do," said Cozier, who is an investigator on Boston University's Black Women's Health Study, which began in 1995. "We are survivors."

Being the sole Black woman in a situation takes a social and physiological toll on the body and mind, she said.

"In the back of your mind, it makes you start to doubt yourself and your capabilities and it is stressful," said Williams Francis, who said she feels this way even after running her own business, Williams Interior Designs, for 39 years because she remains a minority in a field of white men.

The consequences can be devastating, Cozier said.

Black women are more likely than other racial and ethnic groups to die from cardiovascular disease, hypertension, stroke, lupus and several cancers, according to the Boston University study. They are also twice as likely as white women to develop diabetes over age 55 and have uncontrolled blood pressure.

Those poorer health outcomes are caused in part by the stress due to centuries of racism and other race-related inequalities, such as the fact that Black women are more likely than their white counterparts to live in higher-poverty, dangerous neighborhoods with fewer resources and less likely to have access to healthy food and health insurance, Cozier said.

It can happen to white women and women of other races, too, Cozier said, but the frequency and intensity is worse for Black women, and that makes a huge difference when it comes to their health.

The research by Cozier and her colleagues at Boston University is ongoing and is the largest and longest-running U.S. study focused entirely on Black women's health. It includes 59,000 women across the nation.

The study found that racism and other stressors may be stronger predictors of poor health than a person's individual choices or genetics, meaning Black women's health is often out of their hands.

There is a concept called "weathering" that is used to explain this phenomenon, said Dr. Kamilah Dixon, an associate professor of obstetrics and gynecology at Ohio State University Wexner Medical Center and the department's vice chair of diversity, equity and inclusion.

"It's the idea that the experience of being a Black woman in this country inherently leads to stress, which then leads to poorer health outcomes," Dixon said.

Studies show that even women who recently immigrated to the U.S. have better health outcomes than a Black woman who has lived here for years, Dixon said.

"It's just the experience of being Black in this country," she said. "It's rooted, unfortunately, in systemic racism."

Sexism can also play a role in women's health outcomes, Cozier said, though the Black Women's Health Study doesn't directly measure its impact.

Because a lot of inequities are systemic, society has to change as a whole, Cozier said.

It's important to bring in new leaders, young changemakers, fresh ideas and keep looking ahead when it comes to systemic change and creating equity, she said.

Boston Mayor Michelle Wu is one such example, Cozier said. One of Wu's goals includes investing city money in underfunded neighborhoods, many of which are historically Black. More efforts need to be aimed at helping Black people own homes, Wu's website states, something that has been out of reach for many due to a practice known as redlining that denied homeownership to Black people and others beginning in the 1930s and later, influenced discriminatory practices in other areas.

Education is also important. Ohio State provides health education and has programs to help women, especially those who are pregnant, get resources to lessen the impact of what are called "social determinants of health" or the non-medical factors that influence health such as where you are born, grow, work, live, and age, Dixon said.

On an individual level, how women cope with race-related and other stressors can impact their health outcomes, Cozier said. For example, women who say their religious beliefs help them deal with stress have lower blood pressure, she said. When women confront racism or share their experiences with others, their outcomes also improve.

Williams Francis, 63, said she copes with job and racism-related stress by confiding in those she trusts, exercising, meditating and praying.

Though Williams Francis isn't a part of the study, she said she and others in her family have suffered from health issues that seem to hit Black women harder than others.

Her twin sister Carla Bailey died last year after a battle with breast cancer, and she had struggled with a congenital heart condition before that.

And Williams Francis has had two heart stents put in to prevent having a heart attack.

She attributes the need for those interventions in large part to the stress, and the aftereffects of that stress, that has come with being a pioneering Black woman entrepreneur in a white man dominated world the past four decades.

"I do have a lot of stress with our business because I feel sometimes, we are discriminated against in two ways: one, because we're a small business; two, because we're an African American woman-owned business," Williams Francis said. "Clients do treat me a little bit differently than my counterparts."

Her counterparts also treat her differently, she said, by underestimating her. As a consequence, Williams Francis said she tries to make every project perfect to set the record straight and pave the way for other Black-owned businesses.

Experiences like Williams Francis' aren't an anomaly for professional Black women, Cozier said.

"(People think) if you're educated, you're not going to experience racism, but actually being an educated Black woman means that you are more likely to be in the room where you are the only," Cozier said.

Cozier's advice to Black women coping with stressors that impact their health is to look back as well as ahead.

"Look toward the generation that came before," she said. "Those women survived. Those women brought joy to their families. Those women navigated and they thrived, and they laid a foundation for me as I can lay the foundation for my own children."

dking@dispatch.com

@DanaeKing

This article originally appeared on The Columbus Dispatch: Racism impacts Black women's health more than genetics, lifestyle