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Bertha Holliday, APA's senior director for ethnic minority affairs, leads the association's efforts to increase the scientific understanding of how culture affects relationships and how ethnicity influences behaviors. A main focus for her office is to promote research that identifies behaviors that contribute to diseases that disproportionately affect the health and life span of African-Americans, as well as other ethnic minorities. Holliday, who holds a doctorate in psychology from the University of Texas at Austin, sees psychologists as instrumental in changing these behaviors and developing policies to eliminate the disparities in health care for these populations.
To mark Black History Month, the American Psychological Association spoke with Dr. Holliday about the psychological and behavioral aspects of racial and ethnic health disparities in the United States and what can be done, particularly in light of the election of the first African-American president.
APA: Research shows that there are serious disparities in health care for those of different races and ethnicities, especially among those with HIV/AIDS. What are the barriers that keep minorities from getting appropriate care, why do they exist and why might they be worse for some races? Are there psychological underpinnings to these disparities?
Dr. Holliday: Psychological factors such as fear and anxiety, a sense of helplessness and depression and perceived stress are well-known to be associated with poorer health. Psychological and emotional factors, which often interfere with healthy lifestyles, also tend to be more evident among the nation's ethnic/racial minorities. But other factors are also at the root of health disparities. For example, ethnic and racial minority persons who are underemployed, recent immigrants or institutionalized tend to have no or limited access to health insurance – and of course this limits their access to health care, especially mental health care. Recent data suggest that fewer than one in 20 Latino immigrants with a mental disorder has access to mental health services, and among those who do, 70 percent never return after an initial visit. Reactions like this among ethnic/racial minorities work against their personal health needs and have been found to be associated with numerous social and cultural factors. They may describe their symptoms differently. And interpreting what may be going on can get lost in translation by health professionals who are not aware of the cultural innuendos of that group. Health disparities are due to many different types of factors that disproportionately affect minority and poor communities, but we are working to help their current and future health care providers better understand what their needs are. What is important to remember is that we now have protocols and strategies that will encourage minorities to seek help for mental and physical problems.
APA: How is racism related to stress and poor health among African-Americans? Is discrimination a main reason for the higher rates of obesity, diabetes and heart disorders?
Dr. Holliday: Just as there are multiple causes or sources of health, there are multiple causes or sources of poor health. Being "different" in this nation continues to be "problematic" -- whether that difference is related to race, ethnicity/culture, sexual orientation/gender identity, ability/disability status or numerous other social categories that continue to be associated with stigma and disadvantage. And to be "problematic" is to experience stress, which can reach the level of psychological trauma. Of course, psychologists and other researchers have demonstrated in experiments that stress is not "just something in one's head." Stress is associated with real physical changes in the body. Stress affects heart rate, calcification, blood pressure and numerous other functions. But we also know that cultural/religious/spiritual practices, social support, meditation and exercise can lessen the effects of stress in an individual. Interventions can be designed and carefully implemented that can reduce the sources of ethnic/racial and other stigmatized group stress (i.e., patterns of behaviors, policies and procedures) within families, neighborhoods, schools, workplaces, health care facilities and other social settings. Racial stress is one of many important factors associated with higher rates of diabetes, obesity and heart disorders in racial/ethnic minorities. But given human and fiscal resources – psychologists, health providers and others, right now, can make a major impact on all of those factors.
APA: Family life is very important for achievement by black children. Is it more important for them than for children of other races/ethnicities? Is President Obama an example of how a nurturing environment can buffer a child against prejudice?
Dr. Holliday: Whose family life is most important for whose children? Who knows? In reality, our knowledge of family life is somewhat limited. We know about family process, parent-child interactions, critical life events, child-rearing practices, etc. – but we really don't know a whole lot about the richness, complexities, contradictions and power that are the totality of family life—especially as experienced by various religious, racial/ethnic and other identity–based communities. Nevertheless, one can say with a great degree of confidence, it is always a good thing for a child to have a nurturing environment. And it is always good for a child to have a parent(s) who is not only a provider, but also a protector and advocate. President Obama was certainly the beneficiary of these and numerous other social and developmental benefits. It also should be noted that the bulk of his formative childhood years was spent in locations that lacked deeply rooted social traditions of racism against blacks -- as was the case in the continental U.S.
But President Obama is also to a great degree the proverbial American "self-made man," who with little in economic resources, embarked upon a relatively solitary and focused journey in search of his identity and his own conception of his place in the world. I think this is the aspect of the man that intrigues so many.
APA: President Obama is very fit and, according to some media reports, makes a point of eating well – he even did so on the campaign trail. Will this have an effect on how African-Americans might adjust their eating and exercise habits? Can role models make a lasting difference in changing a whole groups' behavior?
Dr. Holliday: There is an African proverb: "I am because we are." I think one should consider this proverb in understanding the relationship between African-American "leaders" and the African-American "masses." Perhaps the proverb should be considered in any relationship between public leaders and the people. Of course, President Obama will have an impact on African-Americans and their behavior – just as did Martin Luther King Jr., Malcolm X, Ida B. Wells, W.E.B DuBois and other African-American icons who have accomplished things that some could not even envision, and most believed would not occur during their lifetime. But then there is the synergistic process that occurs when people begin to buy into the leader's vision, and the leader as a result feels and becomes more empowered to bring the vision to reality.
President Obama, like icons before him, will change African-Americans' and other Americans' perceptions of themselves and their sense of possibilities. But bear in mind, President Obama lays no claims to being an exercise or diet guru. He lays his hopes in being a political leader who serves the general interests of his country (and the world) and inspires people to recognize their stake in those interests. And it is in that domain that he will probably have his greatest impact on individuals and communities.
Of course, one vehicle the president will use for serving the general interests is legislation. And I am hopeful that his health care reform proposals will provide tangible benefits for ethnic minority communities. In particular, I hope that the president, his administration and Congress recognize that the elimination of health disparities is critical to the success of any health care reform efforts. It is through a focus on legislation and policy in support of the elimination of health disparities that President Obama will have his greatest impact on diet and exercise and health in ethnic minority communities.
I urge people to learn more about public policy and health disparities by looking at the February 2009 issue of my office's Communiqué Newsjournal Special Issue on "Psychological and Behavioral Perspectives on Health Disparities." Go to: www.apa.org/pi/oema
The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.