Race, Traumatic Brain Injury (TBI), and the Big Game: How Racism Makes TBI Worse for People of Color

With the Big Game coming up, we’re working with our friends at LoveYourBrain to raise awareness about racial disparities in the causes and consequences of traumatic brain injury (TBI), and what we can do about it.

But before we dig into that, let’s take a look at what a TBI actually is.

What Is A TBI?

A traumatic brain injury (TBI) is a bump, blow, or jolt to the head that disrupts brain functioning. Concussions are the most common form of TBI.

• 2.8+ million adults and children in the US sustain a TBI every year—that’s one every 11 seconds
  • 2.2 million are treated for TBI in emergency departments
  • 280,000 are hospitalized
  • 64,000+ die (that’s 175 deaths every day)
• 5.3 million Americans live with a TBI-related disability

Falls are responsible for about half of all TBI-related hospitalizations (they are a major factor for young children and adults over 65), but auto accidents, contact sports, and assaults are other common ways that people may get a TBI.

Impacts of TBI

TBI results in chronic, complex, and often debilitating health issues for millions of people worldwide every year. Effects can include

• Changes to memory, focus, and mood/behavior regulation
• Problems with balance, dizziness, and motor skills
• Visual changes, headaches, and chronic pain
• Anxiety, depression, and other mental-health challenges
• Social isolation, increased loneliness, and suicide

These effects can be short lived, or they may last weeks, months, or even years. Treatment, which could include both physical and mental-health therapy, can help those who’ve had a TBI begin to heal.

Racial Disparities and TBI

TBI does not affect all people equally—there are big racial disparities in the causes, risk, medical care, and health outcomes.

• People of color are more than 2 times as likely as white people to die from a TBI
• American Indian/Alaska Natives have the highest rate and number of TBI-related deaths overall
• Black people are significantly more likely to incur a TBI from violence compared to white people
• Black and Latinx people are less likely than white people to receive followup care and rehabilitation
• People of color are more likely to have poor psychosocial, functional, and employment-related outcomes

Racial Disparities and the Healthcare System

Very few studies have directly investigated these startling disparities—and that needs to change.

The truth is that, whether it’s for a TBI or some other health issue, Black and Brown people are less likely than white people to have access to medical facilities and insurance due to systemic racism.

Research has also shown that doctors routinely fail to provide appropriate treatment to people of color who report experiencing pain. Not only that, but studies indicate that racial disparities are present even when it comes to treating children:

• Black children are 34% less likely to receive a concussion diagnosis when compared to white children.
• Among those who received a diagnosis, Black children are 3.8 times more likely to obtain a concussion from assault than from sports.

Football and the Brain

The Big Game is coming up, which makes this conversation about racial disparities and TBI even more important—70% of active, and 60% of retired, professional football players are Black.

A recent study led by a Boston University neuropathologist, found that 99% of 202 deceased former pro football players’ brains showed signs of neurodegenerative disease. Scientists believe that this disease is caused by repeated TBI.

Professional players, of course, aren’t the only ones at risk of TBI. Researchers additionally found that 48 of 53 brains of former college players also showed signs of CTE. So did seven of eight who played professional football in Canada and nine of 14 semiprofessional players.

What Is Race Norming?

For many years, the top pro football league in the US employed a "race norming" dementia test to determine whether Black players would qualify for payouts in a brain-injury settlement.

What does that mean? Basically, the test operated under the assumption that Black players have lower cognitive function than white players, so they had to show a sharper decline to be eligible for the money.

Former players campaigned to force the league to reverse course, but the almost unbelievable truth is that “race norming” is used throughout the US healthcare system, in everything from cardiology to oncology. Race norming relies on racial stereotypes—it embeds race-based assumptions in diagnostic tools and algorithms that often result in Black patients receiving inadequate care. And when it comes to healthcare, this kind of ingrained bias and racism is a matter of life or death.

TBI Treatment Programs Work

The good news is that LoveYourBrain's research has shown that when TBI rehabilitation programs are available and integrate racial-justice strategies, the BIPOC (Black, Indigenous, people of color) community experiences improved:

• cognition
• resilience
• emotion regulation
• community connection
• overall health outcomes

It's Time to End Racism in TBI

TBI has a huge impact on millions of people and their families every year. Systemic racism makes TBI even more challenging for people of color.

We must include the BIPOC community in TBI research. And we need more intersectional programs and resources to fight racial injustice in TBI—and in the healthcare system overall.

Learn more about LoveYourBrain and its free programs, and be part of the work to help fight racial injustice in TBI.