Racial and ethnic disparities in health: examining the contexts that shape resilience and risk.

Race, ethnicity, and social class differences in the prevalence and effects of cardiovascular risk factors have been observed in many studies. Understanding the drivers of these differences is critical to efforts aimed at reducing racial disparities in health. Two articles in this volume of Psychosomatic Medicine contribute to our understanding of the underlying mechanisms driving racial disparities in health. The first article confirms the deleterious effects of psychosocial stressors on neuroendocrine function and suggests that the effects of stress on cortisol patterning are worse for Black and Latino individuals than for White individuals. The second meta-analysis article indicates that, in comparison to Whites, Black individuals display higher levels of high frequency heart rate variability, a measure of parasympathetic activity that may be an indicator of potential resilience to stress. To interpret these effects, it can be useful to move beyond assessments of phenotype and to consider the psychosocial context in which people live and assessments of risk are made. The psychosocial context includes variables and processes that influence the type, timing, and frequency of stress exposure, and the levels of background stress. Ultimately, these variables may create race and class differences in the underlying mechanisms that contribute to the development of different risk factors for adverse health outcomes such as cardiovascular disease, diabetes, and cancer. This editorial describes the relevance of incorporating the variables associated with psychosocial context when building new models in the next generation of research on health disparities.