Multiple factors including socioeconomic status and access to health care have combined to erode Black men’s health.
One weekend afternoon two decades ago, Otis Brawley threw on a pair of gym shorts and a t-shirt and started cleaning his garage. It was a welcome bit of downtime from a demanding schedule as a senior investigator at the National Cancer Institute, an aide to then-Surgeon General David Satcher, and a staff physician at the Naval Hospital in Bethesda.
A Montgomery County police officer spotted Brawley in the garage and called for reinforcement. The police questioned him, and Brawley ended up handcuffed, face-down on the ground. Only after he produced his driver’s license with the address of the house they were standing in did the police back off.
“This is the price of being Black in America,” says Brawley, MD, a cancer expert and now a Bloomberg Distinguished Professor.
Black men too often pay this price with their lives in fatal police encounters. But there’s another price: their health, which is eroded by multiple societal factors over their lifespan. In aggregate, Black men have lower average life expectancy and higher rates of chronic conditions like diabetes and kidney disease than white men.
Brawley, who has appointments in Epidemiology at the Bloomberg School and in Oncology at the School of Medicine, directs a broad interdisciplinary research effort looking at cancer disparities. These stem from a complex mix of factors, including socioeconomic status, access to health facilities, medical distrust, neighborhood and environmental factors—and, of course, race.
Brawley emphasizes, however, that there are very few biological differences between people of different ethnic or racial backgrounds. Rather, race operates on a social level, showing up in how Black men are perceived and treated—from violent encounters with law enforcement to the slights of colleagues and the paternalism of doctors who second-guess Black patients. Race also operates on a structural level, undergirding centuries of marginalization that leave many Black Americans with less access to healthy food, safe neighborhoods, educational and professional opportunities, and quality health care.
Black men also have a lingering distrust of the medical system. Men typically go much less frequently to the doctor than women—and this is especially common for Black men, says Roland Thorpe, Jr., PhD, MS, a Health Behavior and Society professor and the founding director of the Program for Research on Men’s Health.
“The first time we go to the doctor, we’re in the ER, because we didn’t go get the annual check-ups,” Thorpe says.
Thorpe is the principal investigator of the Black Men’s Health Project, a longitudinal study launched two years ago in conjunction with Tulane University researchers. The study—the first to focus exclusively on the health of Black men—will recruit 10,000 Black American men and follow them for at least 20 years. A questionnaire asks about issues particular to the lives of Black men. Thorpe and future scholars will use this dataset to glean insights such as how microaggressions and masculinity relate to cardiovascular risk.
“We have a lot of psychosocial factors that are known as key determinants of Black men’s health,” he says.
With participants from all over the U.S., the study will gather the nuanced experiences of Black men across a range of social and geographic milieus.
This is important because place has long been recognized as a key determinant of health outcomes, affecting the quality of housing, the availability of healthy food, or the adequacy of local medical facilities. In the U.S., it has been inextricably bound with race due to practices such as redlining, which denied home mortgages to would-be Black homeowners and concentrated Black residents in neighborhoods with lower property values. Not only do Black neighborhoods lack full-service supermarkets or well-resourced hospitals, they are also more likely to expose residents to threats such as hazardous waste or abandoned buildings that attract vermin and crime.
When people conflate these place-based attributes with the people living in these neighborhoods, it can lead to unhelpful assumptions about the role of race in health, says Darrell Gaskin, PhD ’95, MS, a Health Policy and Management professor and director of the Johns Hopkins Center for Health Disparities Solutions. Recognizing the impact of living in an under-resourced or marginalized neighborhood, says Gaskin, changes “thinking about race as a risk factor because of who the person is” to understanding that “race in these United States so much determines where you live, where you work, where you play, the context you’re in,” he says.
For example, several of his studies found that while under-resourced hospitals consistently had higher mortality rates, Black and white patients treated in the same hospital had similar outcomes. “You don’t see within-hospital differences in mortality rates,” Gaskin says. “It’s not the person, but the context, which creates the problem.”
Like Brawley, Gaskin has had his own close encounters with law enforcement, including an incident in which police pulled him over, and officers emerged from six cruisers and approached him with their guns drawn. (His temporary license plates had been stolen off of his new car and they presumed he was a criminal.)
“The indignity that one must endure—if you don’t express that rage … you start to internalize it, so it’s not a wonder that people struggle with high blood pressure and have higher rates of stroke, because you’re constantly on alert,” Gaskin says, citing writer James Baldwin’s description of being a “relatively conscious” Black man in America is “to be in a rage almost all the time.”
Marino Bruce, PhD, MSRC, MDiv, a professor and director of the Program for Research on Faith, Justice, and Health at the University of Mississippi Medical Center, has had to negotiate this sensation in his own life many times, including in academia—from coming out of the library and having a campus policeman ask him to produce his student ID on his very first day at Davidson College, to the invisibility he sometimes still experiences as a Black scholar in a scientific field.
“I’m aware of a physical reaction during such interactions,” Bruce says. “I can feel my blood pressure going up … your breathing changes—what you’re trying to do is remain calm.”
Bruce, who is also an ordained Baptist minister, is examining the role that faith and spirituality can play in improving health outcomes and dealing with stress. In one study, he found that risks for mortality for individuals who attended religious services at least once per week were 45% less than for individuals who did not attend church at all. He believes that when people connect to something larger than themselves, especially a faith practice founded on principles of compassion, forgiveness, and tolerance, they may become less reactive to stressors over time.
“You also learn to cope with difficult situations. If you’re mindful, and remember the difference between feeling and thinking, you can think your way through them. This process can be beneficial to your health,” Bruce says.
Cornerstone institutions in Black communities, churches have historically pooled and distributed economic, political, and social resources. They have also “affirmed African American men and provided them with leadership training and opportunities,” Bruce notes.
Janice Bowie, PhD ’97, a Bloomberg Centennial Professor and chair of the School’s DrPH Program, is also researching the role of faith and spirituality in health outcomes and quality of life. While physicians may hesitate to ask about a patient’s spiritual practice, they should be sensitive to whether it may benefit a patient to have a hospital chaplain or someone from their faith pray with them ahead of a surgery, for example.
“For many people, their faith is what sustains them in their recovery,” Bowie says. “Sometimes when people are feeling very down about a clinical outcome or a diagnosis, their faith and their relationship with their faith community can be therapeutic.”
Bowie also believes strongly that research must include community representatives from the outset. That so much of the current research is being led by Black men gives her hope that the solutions and findings will resonate with their intended beneficiaries.
“I see promise for Black men, when Black men are leading those studies, designing those studies, and when they’re engaging participants with them in delivering that work,” Bowie says.
It also means that researchers are set to learn much more about how structural racism shapes Black men’s lived experience, the allocation of critical resources, and the “weathering” effect on their bodies. As Thorpe notes, it’s about time.
“I think we need to directly deal with the issue of racism,” he says. “We’ve been skirting it for 401 years.”
