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Cardiovascular Health in Black Americans: How Important Is Resilience?

The field of positive psychology—which includes much of the early research on resilience—was founded after experiments showed that some individuals remained optimistic despite adversity. Accordingly, resilience came to be understood as the dynamic ability to maintain normal levels of function or return to psychological health after setbacks. Resilient people can replace grief with eventual gratitude, vulnerability with strength.2 Resilience has been associated with positive health outcomes such as improved quality of life and decreased depression.3 When evaluating disease risk, resilient individuals are further defined as those who evade disease despite risk factors.4 Additionally, the concept of resilience can be extended to communities that recover well from adversity.5 In assessing individual risk, data indicate that Black Americans have higher odds of developing cardiovascular disease (CVD) compared with other racial groups. A multitude of well-conducted analyses have demonstrated the persistent association of Black race with poorer CVD outcomes. Yet, fewer studies have examined the mechanisms that mitigate or prevent CVD among Black individuals. In the study by Kim et al, “Individual Psychosocial Resilience, Neighborhood Context, and Cardiovascular Health in Black Adults: A Multilevel Investigation from the Morehouse-Emory Cardiovascular Center for Health Equity Study,” the authors strive to identify mechanisms for race-based disparities in CVD.6 The authors keenly note that some Black people develop heart disease, whereas others do not, and use the concept of resilience to operationalize this heterogeneity among Black individuals. Furthermore, the authors hypothesize that Black people living in resilient neighborhoods would have better cardiovascular health. The study examines the association between individualand neighborhood-level resilience and cardiovascular health as measured by the American Heart Association Life’s Simple 7 (LS7) targets. This study fits well in the context of an evolving understanding of race in America. The year 2020 has been marked with dramatic social movements in response to race and racism. Institutional policies are being met with overdue scrutiny to determine how to implement improvements for equity. Clinicians increasingly recognize that race-based disparities do not stem inherently from race; instead, these disparities stem from the underlying social determinants of health (living conditions, access to food, access to equal pay, etc)7 and the structural racism that enables and perpetuates them. It is, therefore, critical that Circulation: Cardiovascular Quality and Outcomes