Estifanos Zerai-Misgun, a black Brookline, Mass., police officer, pulled up in an unmarked car and greeted his superior, a white lieutenant. He wasn't prepared for the response by the lieutenant, who said, as he gestured at the vehicle, Who would put a black man behind one of these?
I was shocked, the officer later told a Boston news station about the experience. It was one of several derogatory racial comments he would hear on the job. It got so bad that he and a black colleague walked away from the force in 2015.
The statements they'd heard were offensive and at times threatening in the moment, but they also made the men fear for their safety at work in a broader sense: The black officers weren't sure that the white colleagues who were so willing to antagonize them would back them up if they were attacked on patrol.
Even if Mr. Zerai-Misgun and his colleague were never directly physically harmed, the experience probably took a toll on their bodies. Perceptions of discrimination like those the officers experienced, as well as those that are less direct, may make us sick. And in the current political environment, with its high-profile expressions of racism, sexism, anti-Semitism, Islamophobia, homophobia and xenophobia, along with widely covered acts of hate and bigotry, countless Americans are at risk of this type of harm.
Take Mr. Zerai-Misgun as an example. Chances are, in reaction to each instance of perceived discrimination, he had a stress response. His blood pressure increased, his heart rate went up, and his brain sent a signal to release cortisol. We know this because in 2008, researchers studied the effects of discrimination on blood pressure. Black and Latino study participants recorded their interactions with perceived racism and were outfitted with blood pressure monitors. The results were striking. While blood pressure normally dips at night, those who said they'd experienced racism were more likely to have blood pressure that did not and this has been strongly linked to increased mortality . Over time, this high blood pressure hardens our arteries, increasing the risk of a clot forming in our hearts or brains.
In 2015, researchers examined the effect of discrimination on cortisol, a natural hormone that helps the body deal with stressful situations. They followed black and white children in Maryland, measuring their perceived racial discrimination starting in seventh grade and for 20 years thereafter. When study participants were in their early 30s, researchers calculated their cortisol levels. Perceptions of discrimination consistently predicted slower declines in cortisol level throughout the day, which is associated with obesity, depression, decreased immune function, cancer and death.
More than 700 studies on the link between discrimination and health have been published since 2000. This body of work establishes a connection between discrimination and physical and mental well-being. With all of these effects, it is no wonder that more than 100,000 black people die prematurely each year .
These days, it's nearly impossible to avoid headlines about things like the white nationalists and neo-Nazis who marched in Charlottesville, Va., and the recent spike in expressions of identity-based hate and harassment. Our commander in chief has said he wants to ban transgender people from our military and Muslim people from our nation, and he pardoned the former sheriff Joe Arpaio, in a sign of approval of Mr. Arpaio's notorious racial profiling of Latinos in Arizona.
In this climate, it makes sense that so many people report having personally experienced discrimination. In recent polls, about half of black respondents and a third of Hispanic respondents reported that they'd experienced unfair treatment because of their race in the past month. About half of Muslims reported discrimination in the past year. Even if one denies that these self-reported instances constituted actual discrimination, it is this perception of discrimination, in and of itself, that is linked to poor health.
Worse, we know that racism doesn't have to be experienced in person to affect our health taking it in the form of news coverage is likely to have similar effects. After all, studies have shown that when television viewers observe scenes depicting racism, their blood pressure remains elevated long after the scenes are over. That means it's reasonable to believe that every time we see a TV news segment or even get a notification on our phones about an event, statement or policy that we believe represents discrimination, our bodies pay the price.
We shouldn't need the specter of disease to denounce hatred in all its forms. Racism, bigotry, sexism, anti-Semitism, Islamophobia, homophobia, xenophobia, should have no place in our society. But the illness associated with discrimination adds injury to insult and magnifies the suffering of these times.
Douglas Jacobs is an internal medicine resident at the Brigham and Women's Hospital and Harvard Medical School.