Racism and Its Impact on Clinical Research

Although the American healthcare system has experienced tremendous advances over the last few decades, it's become clear that novel technologies don't reach everyone equally. As a result, we now see growing disparities related to both life expectancy and access to evidence-based medical care acrossdemographic groups. In particular, this negatively impacts Black adults in the United States, particularly when it comes to heart health.

Regardless of metric or health condition, Black adults seem to be getting later care, suboptimal care presenting with more severe disease, and overall worse health outcomes than white Americans, points out Dr. Stephen Juraschek, Research Director of the Hypertension Center at Healthcare Associates at Beth Israel Deaconess Medical Center (BIDMC).

How Does Racism Impact Health Disparities?

Whether structural, systemic, or individual, racism contributes to health disparities and overall health in general. Though difficult to study completely, racism creates both acute and chronic health effects. Dr. Juraschek notes that chronic exposure to racism and related stress, such as microaggressions and macroaggressions, adversely impacts Black patients by worsening their health issues over time.

"The constant wear and tear of stress on the body, known as allostatic load, has been shown to really impact the health of people and gets worse with age, essentially," says Ruth-Alma Turkson-Ocran, PhD, an instructor of medicine at BIDMC and Harvard Medical School. "We see that regarding cardiovascular disease risk, Black people who say, yes, they've had more instances of discrimination throughout their lifetime would be more likely to have diabetes, high cholesterol, or hypertension."

Dr. Juraschek, who co-authored the research paper Recruitment of Black Adults into Cardiovascular Disease Trials, notes that despite 55% of Black adults having a hypertension diagnosis, they remain greatly underrepresented in National Institutes of Health-funded cardiovascular clinical trials. His research shows that the majority of clinical trials didn't specify targets for Black enrollment, didn't meet existing targets, and lacked concrete plans to include Black participants.

Working Towards a Solution

Both Dr. Juraschek and Dr. Turkson-Ocran agree that race is directly related to health outcomes and that achieving health equity needs to start with examining structural racism as well as various social determinants of health. For example, statistics show that when compared to non-Hispanic white individuals, Black Americans tend to earn less, regardless of their level of education.

When it comes to improving research studies and clinical trials for Black Americans, specifically, Dr. Juraschek believes that protocol planning documents promote inclusivity. The documents, which are now required for all trial publications, force researchers to think about the following questions:

• Did I set a goal for racial inclusion?

• If I did set a goal for racial inclusion, did I meet that goal?

• Did I use best practices in order to achieve that goal?

• What was my plan for tracking the achievement of that goal?

• Did I engage community advisors and consultants?

• Did I attempt to make our communications accessible?

• How is diversity reflected in our research team?

Dr. Juraschek also points out that there have been many documented cases of abuse against Black adults from both researchers and medical institutions throughout the years which has created lasting trust issues for the Black community. To advance health equity, both Dr. Juraschek and Dr. Turkson-Ocran believe the medical community must find a way to make reparations. One way to do so, Dr. Turkson-Ocran suggests, might involve communicating directly with Black community members to ask them about what can be done to regain and maintain their trust in order to improve healthcare for all.

"If we ignore disparities and focus more on the next technology that can only benefit a decreasing subset of the population, we're not going to advance population health. We're not going to improve life expectancy in this country," cautions Dr. Juraschek.

If you're concerned about your heart health, don't wait to speak to your primary care doctor or seek out a cardiologist.