It started with this model of doctor-patient communication, and although language was a big factor, it grew from there. Gradually it expanded to all racial and ethnic populations, realizing that sometimes the results are better than the general ones.

WebMD: His institute funded a study showing that racial and ethnic disparities cost the US. up to 451 billion dollars a year. Break that.

Pérez-Stable: Most of the costs to societies come from premature death: people dying too soon and losing their productivity in their work and in their community with their family. The average American woman lives to be 80, and men 2 to 3 years less, so one gets an idea of ​​where we should be.

When people are sick and can no longer work or their work is limited, that takes a toll. Presumably, with proper intervention, they could have worked another 5 or 10 years. Someone with high blood pressure does not control it and suffers a stroke at age 60; He is still in the prime of his working life. They may be thinking about retiring, but they will continue to work and will not be the same retiree after a major stroke.

There are also genes that increase the risk of certain cancers. The breast cancer gene is probably the most famous. But in reality there is a gene that protects against breast cancer, discovered only in women of indigenous origin in Latin America.

WebMD: Their work shows that environmental and living conditions affect how genes are expressed. Can you explain how it works?

Pérez-Stable: This is the field of social epigenomics. It is evolving. The concept of epigenome implies changes that occur in the gene due to external factors. Where this has been studied the most includes cardiovascular health, asthma, maternal health and a little bit in cancer.

For example, if you are under five years old and you are very stressed (because there is a dysfunctional family, maybe lack of food, maybe violence in certain contexts), these adverse events change your epigenome in a way that maybe 30 years later. You will contract a disease. That’s a hypothesis.

WebMD: Explain how the Community Participation Alliance (CEAL) that you helped spearhead addressed disparate COVID-19 outcomes in underserved communities.

Pérez-Stable: A study was conducted in the summer of 2020 to test the Moderna vaccine. After about the first month, 90% of the study volunteers were white. Dr. Francis Collins (former director of the NIH) said we cannot allow this.

We all discuss strategies. From those first conversations CEAL was born. We wanted to create an infrastructure to activate the community. Initially it was “participate in this clinical trial,” because we didn’t know what the outcome was going to be. Once the vaccine came out in December (2020), we had to convince everyone to get vaccinated.

We saw how badly things were going for black communities, Latinos, American Indians, and Native Hawaiians/Pacific Islanders. Deaths were two to three times the average, but we saw that by fall 2022 death rates had decreased across the board and gaps had been reduced or eliminated. It was a success.

We are in the midst of a transition, but CEAL will continue as an infrastructure for community engagement and partnering community organizations with academic researchers to make a difference in the health of those communities. We now have 21 teams across the country.

WebMD: You talked about some results being better. One of his areas of study shows that African Americans who engage in unhealthy behaviors are more resistant to depression than whites and most Latinos. What factors could be at play?

Pérez-Stable: The fact that African Americans are diagnosed with less depression, and indeed fewer suicides, has been known for a long time. Latinos are in the middle. In reality, they are not as tall as white people, but not as short as black people either.

Among Puerto Ricans, using the (Hispanic Community Health Study/Latino Study) we saw a trend: that chronic stress did not lead to more depressive symptoms, but it did lead to more unhealthy behaviors. But Mexican-Americans did not fit this model at all. (Two-thirds of Latinos in the United States have Mexican backgrounds.) The stress made them more depressed and they did not adopt more unhealthy behaviors to cope with it.

It was not gender specific because the sample size was not large enough and we could not say anything about Cubans or Central Americans.

WebMD: Another focus for you is how Latino heritage and adaptation to American culture impacts smoking behavior. Can you expand?

Pérez-Stable: I am also Cuban. In Cuba, smoking was much more common. In the United States, Latinos smoke at lower rates. Again, the US data is driven by Mexicans. The pattern among Cuban Americans and Puerto Ricans is heavier smoking and higher rates. I think that’s pretty consistent.

Well, Mexicans and Central Americans – and curiously Dominicans – smoke at much lower rates.

In general, it will also be influenced by social mobility. In general, women, as they become more acculturated, are more likely to smoke and men are less likely to smoke. The traditional gender role of women in Latin American culture may be functioning as a protective factor against cigarettes and alcohol. That is a hypothesis.

For men in the United States there is a social environment in which smoking is not always as fun as it was in Latin America. We see the same thing with Chinese men who immigrate to the US. There were high rates of smoking when they were in China. When they arrived in the US, their smoking rates dropped dramatically.