1. Mwilu, Jacinta BSN, RN


Higher disease susceptibility in populations is too often seen as a nonmodifiable characteristic.


Article Content

In nursing school, we are taught two main categories of risk factors that influence disease: nonmodifiable risk factors (such as age) and modifiable risk factors (such as smoking). Among the nonmodifiable risk factors, African American race-sometimes interchanged with ethnicity-is listed for conditions like cardiovascular disease, hypertension, stroke, and diabetes. Inclusion of African American race as a nonmodifiable risk factor ignores the potentially modifiable risk factors of racism and inequity that have played a major role in the disease vulnerability of African Americans.

Figure. Jacinta Mwil... - Click to enlarge in new windowFigure. Jacinta Mwilu

In nursing education, when race is addressed as a nonmodifiable risk factor, the implication is that there is something specific to the race that causes higher susceptibility to a disease. Framing race in this way validates the idea that the particular race should have a higher burden of disease while downplaying racism and related socioeconomic conditions as causal factors. Through this education, future nurses become conditioned to associating African American race with higher burdens of certain diseases and not investigating or addressing the true underlying causes.


But race is a social construct. Racial categorization of human beings is for convenience and does not reflect the far more complex realities presented by human biology, history, and social experience. Despite this, African American race is included in most nursing textbooks in the United States as a nonmodifiable risk factor on a par with objective criteria like age. This could imply that the genes accounting for phenotypic variations in the skin color and hair texture used in the social categorization of race are linked to the genes that affect health. But this is not true.


In addition, when we link African American race to disease burden in the United States, we attribute this association to all people socially categorized as African American. This includes the African who recently immigrated to the United States as well as the African Americans who belong to multiple generations in this country. In a 2020 study in the Journal of the American Heart Association by Turkson-Ocran and colleagues that compared cardiovascular disease risk factors among African Americans and African immigrants, recent immigrants from Africa were found to have significantly lower cardiovascular risk.


Such research raises the question of why descendants of African American slaves have a higher risk of cardiovascular disease. While close attention has been paid recently to the influence of social determinants of health on disease risk, nursing education too often continues to depict race as a nonmodifiable factor. This ignores the robust evidence correlating exposure to chronic stressors such as discrimination, racism, and segregation with the increased burden of hypertension, depression, cancer, and cardiovascular disease among African Americans. As such, the disease burden is less of a race issue and more of a racism issue.


The understanding of race as a nonmodifiable risk factor poses a challenge to the nurses who double as educators, limiting them from exploring other individual and environmental factors. An African American nursing student who receives this kind of education may be led to believe that disease vulnerability is due to their race and never consider the role of racism and social determinants of health. Continuing to teach that race is a nonmodifiable risk factor is not only scientifically incorrect, but also a form of conditioning that reinforces racial biases in students' minds and in their future nursing careers. I hope we can change this narrative in our nursing textbooks, classrooms, and clinical rotations to name racism-not the social construct of race-as the main contributor to continued racial inequities for African Americans.