Terry DAVIS didn't know he was having a stroke, much less that, as an African American male, he had a three to four times greater risk of suffering one than a white man. When a transient ischemic attack, or mini-stroke, hit nearly a year ago, he was 49. He woke up early, felt a little slackness on his right side, a little slowness in his speech. He was dizzy and headachy. A professional tennis teacher, he canceled the day's lessons and, thinking more sleep was what he needed, went back to bed.

His wife, Carrie, still feels guilty that she got a little annoyed with his lethargy that day. "I thought, 'Snap out of it. Help me get the kids going,' " she says.

Davis is fine now. But the stroke scared him for his future, and those of his four sons, ages 8, 16, 18 and 21. These days, they all keep a more watchful eye on one another's health habits.

 

Statistically, black males in America are at increased risk for just about every health problem known. African Americans have a shorter life expectancy than any other racial group in America except Native Americans, and black men fare even worse than black women. Some of it can be chalked up to poverty, the most powerful determinant of health, or to lifestyle factors. But even when all those factors are accounted for in studies, the gap stubbornly persists. Now researchers are beginning to examine discrimination itself. Racism, more than race, may be cutting black men down before their time.

It is possible, they believe, that the ill health and premature deaths can be laid -- at least in part -- at the feet of continuous assaults of discrimination, real or perceived. "We have always thought of race-based discrimination as producing a kind of attitude," says Vickie Mays, psychologist and director of the UCLA Center on Research, Education, Training and Strategic Communication on Minority Health Disparities. "Now we think we have sufficient information to say that it's more than just affecting your attitude. A person experiences it, has a response, and the response brings about a physiological reaction."

The reaction contributes to a chain of biological events known as the stress response, which can put people at higher risk of cardiovascular disease, diabetes and infectious disease, says Namdi Barnes, a researcher with the UCLA center. That protective response includes the release of cortisol, often called the stress hormone. It increases blood pressure and blood sugar levels and suppresses the immune system. Those are all good things when it comes to fleeing a wild beast or a suspicious sound in a dark parking lot. But for many African Americans, these responses may occur so frequently that they eventually result in a breakdown of the physiological system.

"This whole phenomenon of cumulative biologic stress is real," says Nicole Lurie, director of the Rand Center for Population Health and Health Disparities.

Racism, Davis says, is something a black man lives with, although these days, teaching tennis to, mostly, wealthy white people,he doesn't often feel its sting. "Sometimes there's stress, but you've got to keep on living," he says.

Still, the Compton native has troubling memories of being pulled over by police as a young man for no apparent reason, and worries that such things could still happen to his boys. "When I was a kid, we never went through Culver City," he says. "They'd watch you go in, sometimes stop you. I don't want my kids getting stopped because of the color of their skin. They're good boys."

Having survived a childhood of poverty, with eight siblings, an alcoholic father and a churchgoing mother who kept the family centered and straight, the thought of sudden illness at this comfortable point in his life didn't enter his mind. Although neither Davis nor his wife thought the 6-foot-3, 250-pounder who plays tennis for a living could be seriously sick, a day after the first symptoms, an MRI showed that he had suffered a mini-stroke. He was lucky. A transient ischemic attack is a kind of low-level warning that conditions are ripe for a more serious stroke unless the patient follows medical advice, most typically blood-thinning drugs, improved diet and exercise.

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Death comes sooner

The shorter life expectancy of black men has been an inflexible truth since slavery. The gap has slowly narrowed throughout the last century, and the most recent improvement is attributed to lower accident and homicide rates, along with life-sustaining treatments for AIDS, all of which afflict a greater proportion of black men.

Still, heart disease, stroke, hypertension, diabetes, obesity and most cancers strike black men sooner, and cut them down more often, than white men. And the higher incidence of disease among black men is set against a backdrop of an increased incidence of poverty, which carries with it a multitude of health problems.

Violence, including accidents and homicide, lays its claim on black men early. Homicide is the leading cause of death for black men ages 15 to 34, followed by unintentional injuries. (For white men those ages, unintentional injuries are the leading cause of death, followed by suicide.) In every decade that follows, for every leading cause of death, the rates of disease for black men are disproportionately high. Once they become sick, they are more likely to suffer worse consequences and die sooner of the disease.

It adds up to an average life span for black men that is 6.2 years less than for white men, and 8.3 less than the national average, 77.8 years, for all races and both genders.

The major culprit in the black-white mortality gap is cardiovascular disease. The death rate from heart disease is about 30% higher among blacks than whites, according to the Centers for Disease Control and Prevention. The prevalence of diabetes is about 70% higher, and diabetes significantly increases the risk of heart disease.

High blood pressure is the leading risk factor for heart disease in African Americans, and some researchers have speculated that the cause is genetic. About half the people in the world are salt sensitive, but about 80% of African Americans are salt sensitive. That means that a diet high in salt is more likely to result in high blood pressure. But blacks living in African countries have few blood pressure problems, casting doubt on a genetic link. "Salt sensitivity is completely related to potassium intake," says Dr. Karol Watson, cardiologist and co-director of preventive cardiology at UCLA. "And that's related to fruit and vegetable intake." More veggies equals less salt sensitivity.

But fresh produce is hard to come by in poor neighborhoods.