Page 17 - RACE HEALER Mag Volume 1 final draft
P. 17
stability, and allostasis, the variability allowing for response become overwhelming even in the most resilient among us.
to stress, are complimentary internal or “endogenous” mecha- What if in addition, we consider the additional stressors of
nisms for maintaining inner stability. The greater the allostatic economic disadvantage or differences in culture that give you
load, the more likely we are to overwhelm our system and less access to support? What impact might added stressors like
exceed our ability to overcome the burden of that cumulative discrimination based on sex or race have on factors that are
already known to predispose us to atherosclerosis, diabetes,
cardiovascular disease, depressed immune function, low birth
weight, maternal and infant mortality, and premature death?
IV. Allostatic Load & Racial
Disparities
It’s been almost two decades since the Institutes of Health
published a preliminary review “Unequal Treatment: Con-
fronting Racial and Ethnic Disparities in Health.” Since then,
research on health disparities has focused less on racism in the
current U.S healthcare system and more on the quality of care
differences. Mounting evidence supports what is with increas-
ing frequency referred to as ‘the social determinants of health’
and ‘cultural dissonance and concordance’ have been broad-
stress. ly studied as major contributors to inequities. This includes
Resiliency is our ability to withstand and recover from stress- attention to socioeconomic factors such: wealth, influence and
ors, or the sum total of all the adjustments we, as vulnerable power, including lack of health insurance and preventative and
organisms, must make to counteract stress. It represents our routine medical care. A second major issue is the patient-cli-
ability to maintain health when taxed by the total allostatic load nician ethnic concordance and how it can enhance or interfere
we experience. Humans raised in nurturing environments have with communication and compliance. However, the IOM study
greater stores and have more durable mechanisms for resilien- also pointed to personally mediated biases from healthcare
cy. This is particularly important since as long as resiliency is providers, which has received relatively less attention. It is
greater than the allostatic load, we remain in relatively good much more challenging to approach the analysis of the effect
health. Repeated stress unrelieved by such mechanisms during of institutionalized, interpersonal and internalized racism on
periods of recovery, causes the allostatic load to overwhelm health outcomes measures. Despite this fact, several good
resiliency making disease states more likely to prevail. studies have established that health disparities in cardiovascu-
lar disease and infant mortality persist even after adjustment
for socioeconomic status and health behaviors due to allostatic
III. Acute vs. Chronic Stress load and chronic life stressors.
Stressors not only range from mild to severe but from acute
to chronic which can also trigger maladaptive or dysfunction-
al responses, particularly when constant, as implied above.
Our brains and bodies are vulnerable to misinterpretation of
the degree of threat in our modern worlds and our responses
are often inappropriately triggered. In turn, the pathology of
chronic stress daily, weekly, and yearly basis over decades lead
to dangerous physiological effects. In a typical day sustained
stress that begins with an alarm clock in the morning, contin-
ues with commuter traffic, unwelcome interactions at work,
and / or challenging relationship interactions with family and
friends can result in similar amygdale hijack that not only rep-
resent maladaptive responses to threats, but sustained allostatic
load from with no provision made for periods of recovery can
Photo by Quentin Keller
