Luisa N. Borrell, epidemiologist: ‘In the United States, there are 197 words that disqualify you from research funding. I work with all of them’
The researcher studies racial health inequities, one of the fields the Trump administration has cut resources for
Luisa N. Borrell, 61, came to the United States intending to continue the career she had begun in dentistry, but she ultimately found a different path. She did not like Florida; in New York, she had to study again, obtain her license, and practice dentistry. She worked first in a private clinic and later in a hospital, until she realized that it wasn’t for her.
The decisive turning point came when she pursued a doctorate in epidemiology and statistics, the field to which she has dedicated the past 26 years. Her work focuses on studying health inequities according to race and place of origin, a topic she discussed in late June at the Congress of the Spanish Society of Epidemiology, which EL PAÍS attended at the invitation of the organization.
Question. At the congress, you presented your studies on alcohol consumption among adolescents. What are your conclusions?
Answer. The striking finding is that white children drink the most. The groups that drink the least are Black and Asian adolescents.
Q. Is there any explanation for this?
A. Asians metabolize alcohol less efficiently. And in the case of Black teenagers, I think it’s cultural.
Q. How do ethnicity and origin influence health?
A. Race is a very strong social and socioeconomic determinant of health in the United States. Black babies die at a rate 2.4 times higher than babies of white women. Life expectancy shows a four-year gap: 78 versus 74 in 2023.
Q. Is it purely a socioeconomic issue or is it also related to racism and discrimination?
A. It all accumulates. Socioeconomic level is linked to racism, because where you live determines educational opportunities. And you know education is the way to move up an economic rung. He who knows nothing is worth nothing. What happens if you live in a neighborhood where the school system is poor? There is a high school dropout rate; many children don’t graduate and end up on the street. Black children and Hispanic children also end up in prison. That is a way of maintaining and perpetuating inequity. Educational opportunities are highly divided depending on the group you belong to.
Q. Have you seen progress from interventions that have managed to reduce those levels, or are there areas that have become more integrated?
A. There is a lot of segregation in the United States. Although the main groups are Black, Hispanic and white, they are highly segregated and do not always live in the same neighborhoods. In California or New York, you see a lot of diversity, but in other places you see very little racial diversity.
Q. How has Trump’s presidency influenced all this?
A. It has changed a lot. I think racism has always existed in the United States. But now, since Trump in 2016, people who are racist have found a voice and feel empowered to do and say whatever they want.
Q. This racism has been institutionalized.
A. And it’s starting earlier, because children hear parents saying negative things and then replicate that at school.
Q. Are there specific diseases or health problems that disproportionately affect nonwhite people?
A. No, I think it generally affects everyone. Right now, mental health is a very serious problem, mainly among Hispanics, because of the fear people are living with: fear related to immigration and the constant sense of threat. What we are seeing is mental health problems starting to appear in children. They are depressed and don’t want to go to school. That will have many repercussions, because these are adverse events that cause trauma — especially in a five-year-old or a three-year-old. That is not forgotten.
Q. Do you think there is a solution or are you pessimistic?
A. In one sense I am pessimistic, because I think the changes we are seeing now will take a long time to reverse. And we will not return to where we were when Obama left or even when Biden left.
Q. Every year of racist backsliding takes more than a year to undo.
A. We’re talking about at least 10 years. Trump’s influence spans 10 years, because he won in 2016 and has always been present in the discourse. Even when not in the presidency, he was campaigning and promoting this far-right movement.
Q. What impact will all this have on Americans’ health?
A. It will have repercussions for at least 50 years. All the changes being made in public health institutions, the National Institutes of Health, the Centers for Disease Control and Prevention… all of that will have a huge impact for many years.
Q. What you study is exactly what Trump wants to eliminate.
A. Yes, there are 197 words that they check for in order to deny research funding. I have them all [laughs]. That prevents you from getting funds to do research on the most affected groups in society.
Q. And how do you notice that in practice?
A. They screen grant applications. They don’t even discuss them. You don’t make it to the second stage to be considered.
Q. How are you getting around this to continue researching?
A. We are using databases that still exist, because that will also change. Many databases will not be compiled in the same way. We are using what is still available and the few resources that can be used to maintain a documentation trail of inequity.
Q. So even the ability to observe that reality is at risk?
A. Exactly. Because if databases do not accurately collect information on race and ethnicity, we cannot document differences between racial or ethnic groups.
Q. You don’t think it’s a coincidence that they want to end that.
A. Not at all. This aims to destroy everything related to the diversity of the United States.
Q. How do you think this will worsen the lives of Hispanic and Black people?
A. It is already getting worse. For example, they are cutting all community programs that helped Hispanics: English as a second language, programs to help people obtain citizenship… And for Black people, they have cut many social programs. It’s interesting: people always think that the poor in the United States are Black and Hispanic. They are not. Most of the poor are white, because whites are the majority. But they don’t realize that when those programs are cut, they are affected as well.
Q. You are Hispanic and a U.S. citizen. Do you feel secure walking down the street?
A. Not entirely secure. I might resemble the description of someone they’re looking for. The problem is that, even if you have papers, it doesn’t matter. They pick you up and put you in a detention center and leave you there for three days, because they have a quota. They were supposed to take 1,500 people a day. So they took people whether they had papers or not. I think you see fewer people on the street, fewer people on the subway.
Q. You’ve also done studies in Spain, with the University of Alcalá de Henares. Do your findings there resemble what you saw in the United States?
A. In Spain, immigration — although not exactly the same as race — is an axis of inequity.
Q. What is different?
A. We do not have the universal and free access to health services that is here [in Spain]. Now, in Spain, there needs to be a campaign to promote that among the immigrant population, because many people don’t know about it or don’t feel comfortable accessing health services. If someone arrives with cancer at an advanced stage, you have to spend more money than if it is detected early.
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