Race or Racism? Researchers Study Racial Disparities in Neurological Diseases 

December 15, 2022

headshot of Larry Charleston, IV, MDWhile Black Americans suffer a disproportionate number of neurological diseases and resultant deaths, the reason is not due to biological differences in the races but to racism, a recent article coauthored by a College of Human Medicine professor concluded. 

“I would say a lot of these disparities are the result of a history of racism and discrimination,” said Larry Charleston IV, MD, the study’s second author and director the College of Human Medicine’s Headache and Facial Pain Division. “If we don’t understand that, then we’re doing our profession a disservice, and we’re doing our patients a disservice.” 

The article, Black Patients Matter in Neurology: Race, Racism, and Race-Based Neurodisparities, was based on a literature review of previous studies of neurological disease disparities and was published in the journal Neurology. 

A history of racism rooted in slavery and perpetuated by “discriminatory practices, such as unequal drug law enforcement and differential incarceration rates, systemic disenfranchisement, and discriminatory lending practices” have contributed to what the authors called “neurodisparities.” 

“To date, many neurologists have neglected racism as a root cause of neurologic disease, further perpetuating the problem,” they wrote. 

“Poverty and low socioeconomic status remain the largest determinants of health,” the article said, “and understanding America’s racist history is crucial to understanding contemporary neurodisparities.” 

Black Americans on average suffer worse outcomes from many neurological diseases, including stroke, epilepsy, Parkinson’s disease, dementia, and headache, the article said. 

“Race is actually a social construct,” said Charleston, a neurologist. “It’s not race per se; it’s racism.” 

Poverty, unemployment, food insecurity, lack of adequate health insurance, and inconvenient access to medical care all are a result of racism and contribute to inferior neurological outcomes, he said. As an example, he cited redlining, which relegated many Black Americans to lower income, urban neighborhoods. 

“Where are these medical specialties located?” he asked. “A lot of them are not in these current and historically redlined areas.” 

Black patients often are underrepresented in studies of neurological diseases, Charleston said, adding that “Black researchers in general are significantly less likely to be awarded NIH (National Institutes of Health) grants. That’s a huge problem for many reasons. Also, one key to academic promotion is research.” 

Neurologists should be aware of their implicit biases and work to improve their cultural sensitivity, he said. Medical schools should recruit and train more students underrepresented in medicine to increase the number of Black neurologists, the authors advocated. 

The article grew out of a conversation between Charleston and Nathaniel Robbins, MD, the article’s first author and an assistant professor of neurology at the Dartmouth Geisel School of Medicine. Researchers from the Harvard Medical School, the University of Pennsylvania Perelman School of Medicine, and the Brooklyn Law School also worked on the literature review. 

“It was a collaborative effort among people who really want to make a difference,” Charleston said. 

The bottom line, he added, is that racism – not race – causes neurodisparities. 

“We’re all part of the human race,” he said.