Minority Health Conference focuses on societal stresses that harm marginalized populations

By Rachel Crumpler

Food access. Housing. Education. Job security. Climate change.

These and other nonmedical factors that shape where people are born, live and work have become known as social determinants of health. And though they are not related to the health care system, they arguably have an even bigger impact on people’s health outcomes, well-being and daily life.

a pie chart showing five categories of social determinants of health included in Healthy People 2030 — Credit: Healthy People 2030

In recent years, the public health community has increasingly recognized how these factors influence people’s health and contribute to gaping health disparities. That’s why Healthy People 2030, the nation’s objectives for improving health and well-being, makes addressing social determinants of health a key focus.

In North Carolina, state health leaders took a leap: They launched a first-in-the-nation project, the Healthy Opportunities Pilot, in 2022 using the state’s Medicaid program to try to address people’s non-medical health needs by providing things like healthy food boxes and by paying someone’s first month’s rent.

The Minority Health Conference, a student-led conference in its 45th year at Gillings School of Global Public Health at UNC Chapel Hill, honed in on this topic Friday with the theme: “The Building Blocks to Well-Being: Connections between Health & Stress.” More than 900 people — close to 700 in person and another 230 online — spent the day learning about the role of social determinants of health, particularly the mental and physical stresses related to them, and the disproportionate short- and long-term impacts they have on disadvantaged populations of all ages.

“Stress can physically take root in our bodies, impacting our risk for chronic diseases and influencing not only our lives, but those of our families and communities,” said Raven Walters, co-chair of the Minority Health Conference, who helped coordinate the event. “With this in mind, promoting equity related to social determinants of health becomes even more essential to public health practice.”

Influence in early childhood development

Iheoma U. Iruka, founding director of the Equity Research Action Coalition at the Frank Porter Graham Child Development Institute at UNC Chapel Hill, spoke at the conference. She said children are being shaped by their environment and surroundings from their very beginnings.

The first 1,000 days of life is when children are developing neural pathways based on what they observe and feel. It’s a particularly sensitive period of development that many people underestimate, Iruka said.

“People think children live in a bubble,” Iruka said. “You go home, you go to school — that’s it. But kids actually feel the world — whether it’s police violence, the political unrest. Kids begin to feel what their families feel, like I know when I’m highly stressed, when I’m feeling something, and me and my husband are kind of talking through it, my kids are hearing it. They feel what we feel. They feel the community. They feel that tension. They literally internalize that.”

For example, Iruka said political forces such as book bans that have occurred across the country send damaging messages to children.

“Imagine telling the kid: ‘That book that’s about you, about your people, about your community, is not worthy. We’re gonna ban it.’ That tells a child what is worthy and what is not,” she said. “That quickly tells you a story. That’s actually dehumanizing and is actually not healthy.”

Ongoing racism, bias and discrimination are harming the lives of young children — killing them softly, Iruka argued.

She’s seen her own daughter affected. At age 3, Iruka said she was shocked when her daughter came home from school and told her “Mom, I don’t know if I really like this skin I have.”

Iruka had worked to instill self-love and a fondness for Black culture in her child since birth, but she said that was overpowered by bias in society and exposure to various forms of racism that children can internalize at a young age.

Children get through their days, but navigating the environment changes them and damages them. Iruka also added that there’s a link between racial discrimination and adverse childhood experiences. Adverse childhood experiences, or ACEs, are traumatic events such as witnessing domestic violence, experiencing abuse or neglect or even seeing a loved one sent to jail or prison. Research has shown that these experiences put people at risk of greater physical and mental health challenges as they grow older.

Research also shows that racial and ethnic discrimination is almost seven times as common among children with three other ACEs compared to those with no other such events.

Children need to be protected from the harm of these societal stressors, Iruka said, and one of the most crucial buffers against societal trauma is knowing they have a safe, supportive caregiver or adult.

“They’re part of a larger family system. They’re part of a larger community,” Iruka said.

She continued that policymakers need to consider what they’re doing not just from the perspective of a child, but from that of a family.

“If the family is doing well, the child will be just fine,” she argued.

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Factors get under the skin

Chantel Martin, a professor in the Department of Epidemiology in the Gillings School, also spoke about how exposures in the social and physical environment become biologically embodied — or get under the skin — to impact health outcomes.

Despite decades of advancements and improvements in medicine and technology, Martin said, Black Americans continue to have worse health outcomes across every stage of life — from birth outcomes to premature mortality. Additionally, she said Black adults have the physiological profiles of white adults who are six to ten years older.

In effect, she said, Black adults are aging faster.

Such disparities exist even when individuals’ behaviors are similar, Martin explained, indicating that more is at play. For example, Black women and white women with the same educational attainment die at vastly different rates and ages. One stark contrast: The pregnancy-related mortality of a white woman with less than a high school diploma is lower than the mortality of a college-educated Black woman.

“The health benefits of education and social support are not equal,” Martin said. “For Black women, achieving higher levels of education and having more social support alone does not translate to better health.

“For me, this speaks to the context and the environments in which Black women are having to navigate to achieve this higher level of education that may be unhealthy. That navigating these spaces are exposing Black women to other things or other stressors like racism, discrimination, microaggressions, gendered racism due to the intersection of being both Black and a woman.”

Environmental contexts — ones that create and reinforce stressful conditions — are vital to understanding health differences, Martin argued. Neighborhoods with violence, poverty, political disenfranchisement, environmental toxins and other conditions can lead to biological stress responses that affect health outcomes.

The effects can occur even before birth, Martin said, citing her own research looking at whether exposure to police-reported violent neighborhood crime in Durham during pregnancy affected the health of the child after delivery. Based on the findings, Black and Hispanic people were exposed to violent crime every one and a half to two weeks during their pregnancy, while White women were exposed once every couple of months. For every one additional violent crime in the neighborhood, early childhood blood pressure increased among Black children.

Furthermore, Martin explained how biological stress responses affect the aging process. Chronological age is the measure of time on the calendar since birth, but more accurate to the aging process is a person’s biological age measured by cardiovascular activity, metabolic function, how people’s genetic makeup gets expressed physically and other stress markers. Biological aging can occur at different rates for different groups due to various contexts, conditions and exposures, Martin said.

Based on data from Detroit neighborhoods, Martin and other researchers found that individuals living in areas with higher social disorder and increased poverty were likely to have more than two more years’ worth of additional aging in their bodies.

Navigating stress

As public health researchers and leaders work to address health inequities, they also recognize that doing that work can, itself, be a stressful load to carry.

“It gets hard doing this work,” Martin said. “Recognizing the structures and the people with power, and the things that are going on to try to prevent us from doing this work and discredit the work and discourage us from doing the work, it gets tiring. I get tired.

“Sometimes I want to throw my hands up and be like, ‘Nothing’s going to change!’ But I know that’s not true because we have history to show us that things will change and can change.”

Walters and Ciera Thomas, the lead student organizers of the event, hoped the day’s conference prompted attendees to take a moment of self-reflection about their own social determinants of health and stressors.

“I hope [the conference] will spark critical conversations about how we as public health practitioners can collaborate with others, both within public health and across disciplines to promote access to the social determinants of health and reduce the negative impacts of stress and, overall, build a better future for us all,” Thomas said.