Gillings School researchers explore social drivers of chronic disease in communities of color, emphasizing the need for policies to reduce health inequities.
An individual’s disease risk isn’t just the sum of their genetics and health choices. In the United States, marginalized communities suffer disproportionately higher rates of morbidity and mortality.
Many faculty and researchers at the UNC Gillings School of Global Public Health are exploring the social drivers that increase rates of chronic disease among vulnerable and marginalized populations.
Chantel Martin, PhD, assistant professor of epidemiology at the Gillings School, is currently studying the impact of neighborhood social conditions and environmental toxins on inequalities in chronic disease risk and the underlying biological mechanisms linking neighborhood conditions to health.
Both historical and present-day policies around residential segregation have created disadvantaged neighborhoods. People residing in disadvantaged neighborhoods face limited access to economic opportunities, quality health care and healthy food choices. They also face higher levels of crime and policing and more environmental toxins. All these social factors have a profound impact on well-being and mean that no one’s health exists in a vacuum.
“Individual health is structurally patterned and embedded within contexts. An individual approach to health neglects the socio-political and economic contexts that shape health,” said Martin.
“Racism is a unique chronic stressor that can dysregulate the body’s homeostasis.”
— Anissa I. Vines, PhD
Deshira Wallace, PhD, assistant professor of health behavior, examines how various sources of stress, including racism, can affect the management of conditions like Type 2 diabetes and contribute to cardiovascular disease risk. For example, if an individual thinks that they might be stopped because of their skin color, they may feel less safe running outside and struggle to engage in the recommended physical activities to manage their diabetes.
“People are exposed to physical, social and political factors that change the calculus on how they can control their individual health,” said Wallace. “If we focus on individual health, then we are not fulfilling our public health mission to facilitate environments that reduce disproportionate risks and barriers to allow individuals to live the lives they want to live.”
Wallace’s work also explores the impact that policies, such as migration policies, have on health. Discrimination against the Latinx community can create barriers to important services like health insurance. It also makes it harder to obtain essential needs, like a driver’s license, which is often necessary to access quality health care and other services.
Anissa I. Vines, PhD, associate professor of epidemiology, also researches social drivers of health inequity but with a focus on psychosocial stressors in the lives of Black women. Her work includes the study of racism both as a chronic stressor and a determinant of other stressors on health issues, including depression and the increased incidence of uterine fibroids.
“Racism is a unique chronic stressor that can dysregulate the body’s homeostasis, or state of balance, leading to adverse mental and physical outcomes,” said Vines. “Racism operates at the individual level, but it also influences other stressors, too. For example, discriminatory practices and policies in schools and neighborhoods thwart economic opportunity and contribute to high effort coping. Because of this, racism has an intergenerational influence on determinants of health.”
Researchers at the Gillings School are hopeful that public health leaders can put these learnings into practice to positively impact public health.
“With research linking structural and institutional racism to health inequities, it’s now important to identify effective policies and multilevel interventions to reduce and, ultimately, eliminate health inequities,” said Martin.
