Why Do Interracial Couples Experience Worse Health Outcomes?

A study published in the Journal of Racial and Ethnic Health Disparities earlier this year showed that in couples with only one White partner, both partners are more likely to suffer from chronic health conditions. The authors, Patricia Louie, Hana Brown, Ryon Cobb, and Connor Sheehan, established the health risk associated with interracial partnerships involving Whites through a series of comparisons that I will walk you through here. Their conclusions make a lot of sense to me given my own research on how stress gets under the skin, but I nonetheless offer an alternative explanation that the authors’ insufficient attention to repartnering left open. In other words, social stress is a quite plausible explanation of their results from a nationally representative sample of Americans, but it is not the only one.

First, the authors found that White-Black couples were more likely to suffer from multiple chronic conditions (MCC) than both White-White and Black-Black couples. If race were just a proxy for status in a society where Whites have more status, the White-Black couples would fall in between. Instead, they have the worst health. In fact, the health “penalty” associated with White-Black marriage is greater than the health penalty associated with being Black.

In contrast, Asian-Black and Hispanic-Black couples did not differ from their same-race couple counterparts (i.e., Asian-Asian, Hispanic-Hispanic, and Black-Black couples). This indicates that crossing a minority-minority racial barrier isn’t as stressful as crossing a majority-minority racial barrier. Or, as the authors put it, “a closer proximity to Whiteness may be a health risk for some minority groups.” Asian-White and Hispanic-White couples had higher odds of MCC relative to their same-race counterparts, even though Asian-Black and Hispanic-Black couples did not.

Research on how race gets under skin (impacts health) usually isn’t about the biology of race, but rather about the social stress experienced by subordinated groups. I read the paper by Louie and her colleagues last week right after finally producing a paper from my long-term collaboration with epidemiologist Edmond Shenassa about how social stress impacts birthweight. Importantly, relative social status matters—low social standing often reflects material deprivation, but being lower in the social hierarchy also decreases the likelihood of experiencing the health benefits that come with control over life and opportunities for full participation in society. In other words, the psychological disadvantage that comes with lower relative rank creates a health burden not explained by absolute rank. Through my research, I have become intimately familiar with biological evidence that health responds to relative status. It is therefore easy for me to follow the arguments Louie and her team make about how the amount of stress caused by crossing racial boundaries in intimate partnerships likely depends on exactly which racial boundaries are crossed.

Their argument differs from “status syndrome” research in subtle but important ways. Instead of considering the social position of the individuals in the couple, they theorize about how interracial partnerships involving a White person in our society can compromise the health of both partners. 

First, they argue that both partners in interracial relationships may lack support from friends and family members and experience social stigma and discrimination in their communities. 

Second, the White partner in an interracial couple sees much more of our society’s discrimination than a homogamously married White: he or she experiences discrimination as part of a couple, and he or she has an up close and personal lens on a partner’s individual experience. The authors also suggest that the health of White Americans may be more vulnerable to race-related hardships because Whites have not developed the coping resources that minority groups have. In other words, the same experience of discrimination may deliver a bigger blow to health.

Third, the minority partner is more likely to live in a Whiter neighborhood than if they were partnered within their race. This could result in more day-to-day discrimination. Even if did not, however, the harm of racist experiences could be exacerbated by lack of understanding about the experiences of racial minorities. Communities of color can provide spaces for healing and understanding when faced with these challenges; intermarried minorities are less geographically proximate to these resources that help keep stress from getting under the skin. They are also less likely to have the full understanding of their partner.

An analysis of couples, however, should consider previous partnerships as well as current ones. The authors note in their limitations section that the nationally representative National Health Interview Survey, which they used, did not have information about the duration of the coresidential relationship—this would have been good information to have because longer-term relationships confer more health benefits that shorter-term ones. So homogamous relationships might be healthier if they have been in place longer, and not because they are homogamous. 

It's also important to note that first partnerships are more likely to be racially homogamous: the health disadvantages that Louie and her colleagues found among interracial couples may reflect the cumulative stress of relationship transitions rather than reflecting racial stress. They did not separate the effect of being in an interracial partnership from being in a second or third or fourth partnership, even though the chance of intermarriage goes up in subsequent unions.

More generally, the fact that stable partnerships are positively associated with health is well enough established to argue that it should be the first hypothesis for explaining health differences between different types of unions. The arguments the authors provide for why both individuals in White-Minority partnerships experience more social stress and have a higher likelihood of multiple chronic conditions are compelling, but I will not be fully convinced until after we have data allowing us to measure health risk in interracial couples after controlling for their partnership histories.

Laurie DeRose is a senior fellow at the Institute for Family Studies, Assistant Professor of Sociology at the Catholic University of America, and Director of Research for the World Family Map Project.