Epidemiologist Takes a “Slow-Cooker” Approach to Structural Racism and Health Equity
Since before John R. Pamplin II was born, psychiatric epidemiologists have described, investigated, and debated the relationship between race and mental health. As a graduate student at the Columbia Mailman School—he earned a Master of Public Health in 2014 and a PhD in 2020—Pamplin homed in on the role of social stress. “I came to public health to study racial health equity based on the things I saw in my family and my experiences in the world around me,” he says. “Through my training, I’ve been able to develop a more sophisticated understanding of structural drivers of health. The type of intervention I want to see isn’t going to be about individual behaviors, but structural factors.”
Now an assistant professor in the Columbia Mailman School Department of Epidemiology, Pamplin works as a social epidemiologist, examining how structural racism and systemic inequity affect mental health and substance use outcomes. He investigates racial patterns in major depression, emerging racial trends in adolescent and adult suicide, and the mental and physical health consequences of the hyper-policing of Black and Brown neighborhoods. “We commonly hear this idea that race is a social construct,” says Pamplin. “It’s important to drill down on what we mean when we say that. What does it mean to have your experience in the world transposed on you based on characteristics like skin color or hair texture?”
Your dissertation investigated the Black-White Depression Paradox. What is that phenomenon?
Pamplin: We have really good evidence that exposure to stressors—particularly personal stress, socioeconomic disadvantages—increases the risk of depression. Black folks in this country have elevated rates of these stressors because of inequality, discrimination, and structural racism. Based on everything we think we know about depression, Black folks should have higher rates of depression than their white counterparts. Yet for 40 years, epidemiologists have consistently documented lower or equal rates of depression among Black folks.
What do you think is going on?
Pamplin: The way that we try to make sense of this relationship between racial group stress and depression might be slightly inaccurate. There are a number of pathways that lead to depression risk. I found evidence that Black folks have a lower burden of depression in all of those other pathways that don’t involve stressors, at least not how they’re typically measured. But those stressor measures get all of the attention.
What else affects whether a person develops depression?
Pamplin: One pathway is cognitive processing. When we talk about racial socialization, we’re talking about how you learn to think about your place in the world based on your racial identity, and how you experience the world. If you’re socialized with the framing that many Black folks are—that society is unfair and bad things will happen that are often out of your control—when something fundamentally upsetting happens, it’s possible that the effect that experience has on your mental well-being may differ, because you were socialized to expect it from an early age.
How did your work on policing and drug policy come about?
Pamplin: There’s a lot of co-occurrence of mental illness and substance use, so I think it’s important to remember that these outcomes are not always siloed. I started my research career very interested in the experience of racialization and why we’re not seeing more of an impact of that on depression. My work on substance use outcomes developed when instead of looking for where the effects of racialization are missing, I looked for where they may be most pronounced.
Looking at the opioid overdose crisis opened the floodgates for me. Drug policy in the U.S. has been one of the largest manifestations of structural racism for a century, centered around criminalizing drug use, and more than likely, impacting the mental health of targeted communities as well. Now we’re in an era of narratives about harm reduction, recognizing drug use as a public health issue instead of a criminal issue. I’m looking at what happens to racial equity as drug policy changes to meet this new narrative. [Read a recent op-ed by Professor Pamplin published on Thirteen.org.]
What habits of mind do you want to cultivate in your MPH and doctoral students?
Pamplin: The most impactful science requires deep, broad thinking. You can’t microwave it. You have to let it slow-cook and that can be very frustrating in a society that wants fast food. On the road to my dissertation, I went through about three research questions, because I was allowing myself the space to let the ideas evolve and letting myself follow them where they lead, back and forth through different explanations of the paradox. Even after the dissertation, allowing myself to follow the questions led me to this work now, with substance use and drug policy. Not saying that every student will (or should) come up with three dissertation ideas, but I hope they embrace that developing a worthwhile research question is a process.
How do you cope with the psychological and emotional challenges of racial health equity work?
Pamplin: Students tell us they get exhausted by the lectures on how bad outcomes are. A key aspect of my work that keeps me going is reminding myself that it's not just about highlighting that disparities exist, but trying to work towards a solution to alleviate those disparities—that provides me some solace. The bigger thing is community. As a Black person doing racial health equity work that affects Black people, there are days that are just hard. On those days I lean on my people—mentors and colleagues who have been incredibly supportive, but especially family and friends.