Whether it's microaggressions at work, racial profiling, or the ever-present fear of police violence, Black people face stressors that many others never even consider.

This stress is not just psychological; it has real, measurable effects on the body. The human response to stress involves the hormone cortisol, which helps regulate our "fight-or-flight" response. While cortisol is beneficial in short bursts, chronic exposure to stress—such as the unrelenting stress of racism—keeps cortisol levels elevated, contributing to severe health problems. From hypertension to diabetes, Black people disproportionately suffer from chronic illnesses linked to stress, making the impact of racism not just a social issue, but a public health crisis.

Understanding Cortisol and Its Role in the Body

Cortisol is produced by the adrenal glands and plays a critical role in managing stress. When faced with a stressful situation, the body releases cortisol to help with energy regulation, inflammation control, and maintaining blood pressure. However, when stress is prolonged and unrelenting, cortisol levels remain elevated, leading to a range of health problems, including:

• Hypertension (High Blood Pressure) – Black Canadians are 1.8 times more likely to have high blood pressure than white Canadians.
• Obesity – Chronic stress contributes to weight gain, particularly around the abdomen, increasing the risk of heart disease.
• Diabetes – Black individuals are nearly twice as likely to develop Type 2 diabetes due to the effects of prolonged stress and systemic barriers to healthcare.
• Cardiovascular Diseases – Studies show that racism-related stress contributes to the early onset of heart disease in Black populations.
• Anxiety and Depression – Constant exposure to racial discrimination has been linked to higher rates of mental health conditions, which often go untreated due to stigma and lack of culturally competent healthcare.
• Weakened Immune System – Chronic stress suppresses immune function, making the body more susceptible to infections and diseases.

The Link Between Systemic Racism and Cortisol

While stress is a normal part of life, the stress faced by the Black population is persistent and systemic. It stems from policies, societal norms, institutional structures and procedures, and everyday experiences that reinforce discrimination. Some daily stressors that elevate cortisol levels in members of the Black community include:

• Being followed in stores based on racial profiling
• Facing barriers to career advancement due to workplace discrimination
• Watching or hearing about police brutality and racial violence
• Experiencing microaggressions, such as comments about hair, skin tone, speech patterns, or intelligence
• Worrying about how to prepare children for encounters with law enforcement
• Feeling unsafe in predominantly white spaces.

Each of these experiences on their own might seem minor, however together, they create a chronic state of stress that takes a cumulative toll on physical health. This constant state of hypervigilance—always being on guard—ensures that cortisol levels remain elevated, setting the stage for long-term health problems.

A Personal Perspective: A Life of Hypervigilance

I was recently in conversation with “David”, a 44-year-old Black man living in Toronto, Canada. A successful engineer and leader in his field, David has spent decades climbing the corporate ladder. Despite his accomplishments, he constantly feels the need to prove himself twice as much as his white colleagues.

“It’s exhausting,” he admitted. “I measure every word I say in meetings, making sure I don’t sound too assertive because I have often been misinterpreted as aggressive. It’s like walking a tightrope every single day.”

David’s hypervigilance doesn’t end at the office. On his drive home, he remains acutely aware of every police car that passes. “It’s not paranoia—it’s survival,” he said. “I’ve seen it happen too many times. I think, ‘Am I going to be pulled over for looking suspicious?’ My heart pounds every time those flashing lights come on behind me, even though I’ve done nothing wrong.”

Once he’s home, the stress doesn’t fade. Instead, it lingers. Like many Black men, David finds himself scrolling through social media, bombarded with images and headlines about police brutality and racial injustice. “By the time I get home, I should be able to unwind, but I can’t,” he shared. “My mind races, my body tenses, and I just can’t fully relax. It’s like I’m always bracing for something to happen, and that kind of stress—it’s not sustainable.”

The weight of this constant alertness takes a toll—not just mentally, but physically. This isn’t just about emotions or feeling uncomfortable—this kind of chronic stress has real health consequences. “The constant vigilance and pressure keep me on my toes, often feeling anxious, even when at home”, David said. “It’s no surprise that I am being treated for high blood pressure. It’s not just me; this is something my friends and I talk about all the time. It is experienced by Black men everywhere. We’re always on guard, and that takes a toll on the body and the mind.”

David’s reality is not unique. It is a shared experience among Black professionals; Black men in particular. The burden of proving their worth, staying safe, and defending their existence is a persistent and exhausting weight—one that society must acknowledge if change is ever to come.

To reduce the health impacts of chronic stress on Black individuals, change must occur on multiple levels. Healthcare professionals must be trained to recognize the unique stressors that affect Black patients and clients. This includes acknowledging the physiological effects of racism and providing care that is both informed and empathetic.

Culturally relevant mental health services, such as therapy that addresses racial trauma, are essential in helping members of the Black community manage stress in healthy ways.

Social connections buffer against stress. Creating safe spaces and brave places for Black individuals to share experiences, find mentorship, and build community can reduce the physiological effects of chronic stress.

The reality of being Black in a world structured by systemic racism is a heavy burden—one that exacts a severe toll on the mind and body. Chronic stress and elevated cortisol levels are not abstract concepts; they are real health risks that lead to life-threatening conditions. By acknowledging this, advocating for systemic change, and prioritizing culturally competent healthcare, we can begin to break the cycle. Systemic racism must be addressed through policy reforms in education, policing, hiring, workplaces, and healthcare. Racial equity is not just a moral issue; it is a public health imperative.