The Embodiment of Race: Health Disparities in the Age of Epigenetics (WP-08-01)
Christopher Kuzawa and Elizabeth SweetThe role of genetic and environmental influences on race-based health disparities has been a source of heated debate among the public health and clinical medical communities. In this paper, Kuzawa and Sweet review new evidence for developmental and epigenetic origins of common adult metabolic diseases, and argue that this field sheds new light on the origins of racial health disparities. African Americans not only suffer from a disproportionate burden of adult chronic diseases like hypertension, diabetes, and cardiovascular disease, but they also have higher rates of the perinatal health disparities that are now known to be the antecedents of these conditions. There is extensive evidence for a social origin to prematurity and low birth weight in African Americans, working through pathways such as the effects of discrimination on maternal stress physiology. In light of the inverse relationship between birth weight and adult metabolic diseases, there is now a strong rationale to consider developmental and epigenetic mechanisms as links between social and environmental factors and adult race-based health disparities in conditions like hypertension, diabetes, and cardiovascular disease. Their model builds upon classic social constructivist perspectives by highlighting an important set of mechanisms by which social influences can become embodied, having durable and even transgenerational influences on the most pressing U.S. health disparities.