Does Discrimination Affect Your Health? Short Answer: Yes.

There have been many, much-needed discussions about race and race relations in the US recently. Like, a lot. Even Beyoncé and the U.N. have gotten involved. Epidemiologists have too. Actually, we’ve been interested in the topic, and its effects on health, for quite some time. This, despite the fact that the scientific community hasn’t always been on the right side of history.

Anyway. Way back in 2007, a group of researchers conducted a cross-sectional study to determine whether or not experiences of racial discrimination affect individual health outcomes, in this case hypertension (a.k.a., high blood pressure). Specifically, they aimed to compare the odds of hypertension among persons reporting never perceiving racial discrimination with those who reported perceiving nonracial discrimination (e.g., ageism, sexism); whether or not the frequency of perceived racial or nonracial discrimination modified observed associations with hypertension in a dose-response manner; and whether these associations differed by gender. Their study population was a cohort of African-Americans living in Pitt County, North Carolina who had previously participated in the Pitt County Study, originally initiated in 1988. They called their study, “Cross-Sectional Association between Perceived Discrimination and Hypertension in African-American Men and Women: The Pitt County Study.” For the record, epidemiologists are really bad at naming stuff.

In this study, participants were asked to give frequency ratings (5 being “almost every day” and 0 being “never”) to a series of statements that measured perceptions of how they were treated in society. Participants were asked to choose the most important reason for this discrimination from either “age, gender, height or weight, shade of skin color, or other.” Diastolic blood pressure was then measured by a trained technician with a digital device. This is great, because do you know your diastolic blood pressure off the top of your head? Yeah. Me either.

So, what did our researchers discover? That 89% of African-American men and 85% of African-American women participants reported experiencing discrimination during their lifetime. They also found that men were more likely than women to attribute this discrimination to race (57% of men to 42% of women). Further age-adjusted analysis showed that women who did perceive any type of discrimination experienced a greater risk of hypertension that grew with the amount of discrimination they experienced. In men, however, the pattern stood on its head. The more men perceived discrimination, the lower their risk of hypertension.

Let’s talk about why this study is important. More African-American men and women develop hypertension than any other racial/ethnic group, and they develop it a lot earlier. Which isn’t good, because hypertension is a huge risk factor for a number of very serious health outcomes, most notably heart attack and stroke. And while we do understand many risk factors for hypertension, the link between hypertension and stress is not always as clear. For example, the American Heart Association indicates that poorly managed stress may cause bad health behaviors, such as overeating, but admits that we do not truly understand the effects of chronic stress on our health.

What our study and the current conversations about race have in common is an investigation of the potential effects of systemic racism on the health and wellness of African-Americans. Individuals, communities, and policy makers would do well to join in the present conversation to determine how best to remedy the huge amount of discrimination African-Americans in this study, and in this country, face on a daily basis, and to further investigate the detrimental effects this discrimination may have on African-American women in particular.

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*Note this post was originally completed in 2016 under the title “Does Discrimination Affect Your Health?” to fulfill a grad school course assignment.

The Case of the Red Vespa

“Do one thing a day that scares you.”

The above quote has been variously attributed to Eleanor Roosevelt, Ralph Waldo Emerson, and Kurt Vonnegut. Turns out it was first published in a June 1997 essay by Mary Schmich, a columnist for the Chicago Tribune. The essay went viral before viral was a thing, and now we all quote this trite piece of advice at each other during graduations, weddings, and the like.

Hm. Turns out Mary won a Pulitzer in 2012. Go Mary.

Anyway.

I’m not one to be intimidated easily. I’ve lived in some pretty awesome places, traveled somewhat widely, and have zero problems voicing my opinion. As I’m sure this blog proves. The only things that really scare me are hypodermic needles and aggressive Chihuahuas, and I make a point of avoiding both in every day life. So when I moved to Austin, TX, I figured I would have no problem re-adapting to a driving culture with the purchase of a Vespa.

Of course I wanted the most obnoxious colored Vespa money could buy, and, through the generosity of my parents, I procured a bright red S150 that I promptly named ‘Madeline.’ She’s lovely, and my parents are the best. But I let her sit in my parking lot (covered and alarmed, thank you) for about three months before I got my shit together enough to ride her anywhere but said parking lot.

I’m still not sure what exactly kept me from just getting it together and riding the damn thing, though I do know fear was a large part of it. So were the countless pieces of bureaucratic red tape one has to cut through to receive a Class M certification on their driver’s license in the great state of Texas. But that’s not that point.

I think the biggest deterrents were the colossal difficulties I had readjusting to Texas in general, and adjusting to Austin in particular. I saw this episode of my life as a “return to my Texas roots,” and naïvely believed that moving here would feel more like coming home than moving halfway across the country to a place that should feel like home but didn’t.

Not that home was so great to begin with. I love my family, dearly, truly, deeply, but if they were not living in Texas, I would never step foot in this state again. As much as I love Tex-Mex and cheap margaritas, I would give it all up to escape the deeply entrenched sexism, bigotry, and Bible-thumping that makes this great state the cesspool of white male privilege it is.

Unfortunately, I remembered this after I moved here to finish grad school. After the arduous process of transferring from my previous (actually very good) grad program. After dragging my poor boyfriend away from his friends and comfortable job so that we could move in together and he could support me financially. (This shitty thing aside, I promise that I am, otherwise, a very good girlfriend. And the job he found in Austin – after I carefully revised his résumé – is WAY better than the one he had in D.C., thanks.) And after traumatizing my cat with about five separate moves over the course of one summer.

Yes, after all that, after moving heaven and earth and making what is probably the most adult decision I’ve ever made in my life, I found myself nearly incapable of getting out of bed one Tuesday morning. And the morning after that. And the morning after that.

I started having to negotiate with myself to take showers, and forgot to wash my hair for days on end. This likely had something to do with our apartment’s lack of hot water, but the effects on my personal hygiene were still pretty gnarly. I work from home and would often stay in bed all day, but then hid it from my boyfriend by getting dressed right before he arrived home. I had a panic attack during an exam and left several questions blank. I gained weight. I had to force myself to attend classes. I started demanding that my boyfriend pick me up in the evenings after an altercation with a sexist douchebag on a bus resulted in me yelling at him for his inappropriate behavior.

It all came to a head one morning at 4:00 a.m., when I woke up with a cockroach nestled in the curve of my collarbone. There was a lot of shrieking and a lot of tears. A month later, we managed to break our lease and move out of that apartment.

Many people wouldn’t consider my behavior during this time abnormal. And I completely understand that. But, as I said earlier, I’m not usually one to be so affected by, really, anything. I’ve lost my home in a hurricane, weathered another one in a powerless East Village, and made jokes about my dad’s two tours of active duty with the Marine Corps, and six subsequent years as a private security contractor, while he was still in Iraq. All in all, I’d say that I’m usually pretty well adjusted for a spoiled little white girl.

But things got better after we moved. And have kept getting better. Slowly.

And still the Vespa sat in my parking lot, a small, red, silent rebuke. Reminding me that I was lazy. I was ungrateful. I was useless. I was afraid.

Three weeks ago, I got into a fight with my mother about the Vespa, and whether she and my dad should reclaim and sell it, since I obviously was never going to use it. I walked away from her mid-sentence. We later apologized to each other, and I explained that I thought I might be suffering from a depressive episode.

Two weeks ago, I waited at the DMV for two hours to update my license. A week ago, I finally ordered my helmet. It’s red with black polka dots and looks like a lady bug. It came in last Thursday, and I finally rode my Vespa on Monday. I was shaking like a leaf, and begged my boyfriend to ride behind me in his car (though he didn’t have to be at work for another hour). I parked in a parking space I didn’t have a permit for, and had to move my Vespa onto the street in between classes. In my haze of fear and confusion, I forgot that motorcycles park for free on the streets in Austin, and unnecessarily paid for my parking. I still have the parking slip in one of the Vespa’s pockets. I think I’ll keep it there. Just because.

Because, I’m ok. I was ok. I am ok. Because I am very certainly falling head over heels for my Vespa, and the independence it’s brought back to my life. Because I feel like a total badass walking into a store or a classroom in my leather jacket and boots, with my lady bug helmet hanging by my side. Because I now have countless opportunities to execute the just-took-off-my-helmet hair flip. Because I can actually feel the wind whip around me as I accelerate on my way to class. Because I faced my fear, and because I have conquered it.

Why Every Woman Should Own a Tube of Red Lipstick

Every woman* should own a tube of red lipstick. Even if she never uses it, she should have it, sitting on a shelf or in the depths of her make-up bag. She should know, without a doubt, that it is always there for her when she needs it. Which, if she’s lucky, may be never. If she’s like me, it’s all the time.

Buying and keeping a tube of a well-chosen red lipstick is perhaps one of the most important things a woman can do for herself. It should never be done for a man; they’re generally rather divided on the subject, but they do seem to stare at us lot when we wear it. Regardless, red lipstick is not something one puts on for anyone else, red is a color a woman reserves for herself.

To clarify, we women need not share the same idea of “red.” Your red may be the velvety color of wine, or the soft hue of a rose petal. It may be the spicy, shiny red of a chili pepper or the bright enamel of cherry candy. It may be deep like blood or hard like a Corvette. Myself, I lean towards the sharp, full red of an English teacher’s felt-tipped correction pen – jarring, brash, and indignant all at the same time.

But your red should speak to you while showing the world your heat and your edge and your hate. It should show them your undeniable strength despite your beautiful vulnerability. It should reek of sex and inaccessibility. It should give you confidence while putting them a little on edge. Your red should be your warpaint, your secret source of comfort, your confidence when you have none. That tube in your bag is a physical representation of that little voice in your head reminding you that they don’t matter anyway.

So go to a make-up store. A nice one. Try on all of the reds you can find, and spare no expense on the one you fall in love with. Use it every day or forget about it entirely, but always know that it’s there, that you once cared enough about yourself to buy it, and that you can put it on anytime you need it.

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*Please note that, for the purposes of this post, the term “woman” applies to any and all who identify as female, prefer female pronouns, or simply enjoy wearing lipstick.

Review of Data Ethics: The New Competitive Advantage

In their 2016 book Data Ethics: The New Competitive Advantage, authors Gry Hasselbalch and Pernille Tranberg define privacy as the “space to think and feel without being watched,” and assert that it is “a prerequisite for individuals’ ability to act individually and freely.” Without this ability, neither innovation nor democracy would be possible, as individuals have been proven to act differently if and when they feel they are being observed. This is becoming more and more apparent in the current digital atmosphere. Online consumers, the authors claim, have unknowingly been engaging in hundreds, if not thousands, of silent transactions every time they accessed online services in the past decade. Millions of visitors to sites such as Facebook, Google, and Amazon have exchanged free use of these platforms for hundreds of thousands of data points, the “exhaust” generated by activities as simple as liking a post, searching for an answer, or purchasing a new vacuum. This exhaust, as the authors call it, includes what time the user was online, how long they were online, what they did while they were on the site, their location when they did it, what time they could generally be expected to do it, etc. While these platforms assert that data points have been used primarily to understand how users interact with an online platform and drive targeted improvements, they have also been sold to second and third parties, in many cases without the consumers’ knowledge or consent. And while this silent exchange of data for services has long been either ignored or accepted by Internet devotees, many are beginning to push back.

Hasselbalch and Tranberg note that Internet users of all ages and backgrounds are becoming increasingly concerned with their online privacy. The steady rise of commercial online privacy services such as ad blockers, encryption services, and VPN providers, along with reference to the global outcry that followed Edward Snowden’s revelations about the United States NSA cyber surveillance activities, are offered as conclusive proof of their assertions. Further support for this argument are the recent data breaches, hacking activities, and cybersecurity threats that have kept online privacy in the global spotlight. Rather than accepting the free – and in many cases, permanent – exchange of personal activity data for online services, consumers are demanding ethical practices that preserve their personal privacy and ensure the security of their data.

The authors claim that this transition has been lead by the European market, where personal privacy is considered a human right that should be built into online platforms from the ground up. Called Privacy by Design (PbD), this methodology involves a number of technical safeguards such as the purposeful injection of “noise” to fully anonymize large datasets, the storage of user data on separate servers and/or in separate locations, and allowing users the ability to permanently delete their data upon request, among others. These security features are built into the platform from the ground up, rather addressed after a serious data breach has already occurred. The authors state that in some cases, the data are so well anonymized that providers claim they could not match it to an individual even if they wanted to.

In the public health sector, these ethical approaches are extremely important. As the authors astutely note, the United States Health Insurance Portability and Accountability Act only applies to patient data that is in the hands of medical professionals or insurance companies. It does not apply to platforms, apps, or wearables that generate large amounts of sensitive data on countless individuals. Instead, the United States sees all individuals as consumers who may or may choose to exchange their privacy for online services. This approach is particularly disturbing, however, as online privacy policies, which communicate a company’s policies governing privacy and consent on their platform, are often unnecessarily long and intentionally opaque because they are written by and for lawyers, not consumers. Furthermore, they often do not specifically address what a company can and will do with consumer data once they receive it, or how and whether a consumer can request that it be deleted in the future.

While many Americans are doubtless willing to exchange some information for some services, it cannot be expected that the majority will see their personal health conditions and choices as digital currency. Hasselbalch and Tranberg are optimistic in their projections, stating that market pressure from these concerned consumers, and a more privacy-conscious European market, will eventually push and pull global privacy standards forward with the weight of their economic force. They claim that data ethics, and the return to privacy it promises, will be the new competitive advantage.

My own projections are not so cheery, however. I do believe that data ethics can and should be built into the foundation of every platform, website, and online study that attempts to measure, report on, or promote public health. I also fear that it will take more than economic pressure to make this an industry standard, particularly for well-established monoliths like Facebook or Amazon. Namely, I fear that there are more damaging data breaches in our future.