In West Oakland the leading cause of death is heart disease, accounting for 27 percent of all deaths, according to the Alameda County Public Health Department. Diabetes hospitalization rates in West Oakland are three times higher than the rest of the county. In 2006, according to California Crime Statistics and Crime Data, Oakland had nearly 8,000 violent crimes, mostly split between impoverished areas in East and West Oakland. Loose ties have been drawn between the disproportionate health disparities and violence common to many urban centers. I’ve even written about West Oakland residents' personal accounts on this blog. Dr. Nadine Burke, M.D., Director of the Bayview Child Health Center, argues that these health disparities are biological. Burke says the body physically responds to stress and trauma - and that is directly responsible for adult health problems.
“When you have something that makes you really afraid, that fear response actually has effects on your body and the more times that happens the more significant those effects are,” says Burke. “When you are living in a community where that may happen quite often - or you're a child living in a household where that is happening all the time - that can be really harmful to all of the body's different systems.”
In low-income communities like Bayview/Hunters Point in San Francisco and West Oakland, children often suffer from trauma in the form of domestic violence, addiction, incarceration of a parent and many other stressors. Even children from relatively stable homes are often unable to be sheltered from the violence that is right outside their doors, as well as the stress of poverty and racism. Burke says these stresses have long-term health effects on children and those living in violent areas.
Burke says that when people are in scary or threatening situations they release two stress hormones known as adrenaline and cortisol. While these hormones play important roles in the body’s fight-or-flight response system, releasing too much over time can have serious negative health effects.
“Adrenaline can affect your heart rate, blood pressure, all the things that you think are going to be good if we are trying to fight a bear," Burke says. "And similarly with cortisol it is a long-term stress hormone so it has the effect of raising blood pressure and blood sugar. But when you have this big release of adrenaline it triggers inflammation in your body. Inflammation is what causes heart disease and chronic obstructive pulmonary disease, hepatitis and arthritis. When we think about it in terms of the families that I see in Bayview, the doses of stress that those children are exposed to is ridiculous, [it’s] absolutely toxic."
While places like West Oakland and Bayview/Hunters Point are high-density areas for violence - and therefore trauma and stress, the "Adverse Childhood Experiences Study," a collaborative study between the Center for Disease Control and Prevention and Kaiser Permanente (and the foundation of much of Burke’s research) suggests that rather than racial or class distinctions, these health problems are really about human biology.
“The interesting things about the 'Adverse Childhood Experiences Study' is that the population in which it was done was 75 percent Caucasian and 75 percent college-educated," says Burke. "And that tells us that the effect of adverse childhood experiences on health crosses race and educational level. This is just a function of how the biology of stress effects the body."
No child deserves mental or biological health disparities. Burke says she believes that we can drastically change the outcomes for children growing up in these neighborhoods if both policymakers and people in the community stop accepting violence as the norms.
“In my mind when I am looking at communities that are exposed to what I call very high doses of trauma and adversity, I think that historically our culture has wanted to say, 'Those kids: they fail in school and they get into fights and they have awful outcomes and poor communities are more likely to have high blood pressure heart disease,'" Burke says. "And we take that as conventional wisdom as if this is intrinsic to this population. I think that a lot of our community just kinda sees it as ‘that’s life’ or 'that’s just how our community is.' We accept some of these ideas as part of a community norm...I don’t accept it as a norm.”