Racial discrimination and health effects: Current research and new areas of study By Farah Qureshi As the deaths of Michael Brown, Eric Garner, Tamir Rice and Freddie Gray have captured headlines and sparked protests across the United States over the past year, there has been a renewed discussion about how structural issues of racial inequity influence various domains of life, including law enforcementeconomic opportunityeducational achievement and indicators of health.
Abstract Perceived discrimination has been studied with regard to its impact on several types of health effects. This meta-analysis provides a comprehensive account of the relationships between multiple forms of perceived discrimination and both mental and physical health outcomes.
In addition, this meta-analysis examines potential mechanisms by which perceiving discrimination may affect health, including through psychological and physiological stress responses and health behaviors.
Perceived discrimination also produces significantly heightened stress responses and is related to participation in unhealthy and nonparticipation in healthy behaviors. These findings suggest potential pathways linking perceived discrimination to negative health outcomes.
A number of comprehensive literature reviews find substantial evidence—from both laboratory and community studies— for the harmful health effects of discrimination across a range of mental health outcomes including depression, psychological distress, anxiety, and well-being e.
Perceived discrimination has also been linked to specific types of physical health problems, such as hypertension, self-reported poor health, and breast cancer, as well as potential risk factors for disease, such as obesity, high blood pressure, and substance use see, e.
However, none of the prior reviews of the association of discrimination to health document the quantitative nature of this relationship. The meta-analysis we present enables deeper insights than past reviews by systematically examining the strength of the evidence for the effect of discrimination on multiple health outcomes.
In addition, we tested the strength of our discrimination model in which we identify specific pathways by which health is likely to be affected. We also systematically examined whether these relationships vary on the basis of gender or race and ethnicity.
One way to understand the experience of discrimination is that it is a stressor that can broadly impact health.
Although most stressful experiences do not increase vulnerability to illness, certain kinds of stressors—those that are uncontrollable and unpredictable—are particularly harmful to health, and these characteristics are common to discrimination experiences see D.
Along these lines, recent research on the psychological implications of perceiving discrimination applies a stress and coping framework e.
Similarly, physical health outcomes linked to discrimination have also been characterized as a stress response e. These models conceptualize discrimination as a social stressor that sets into motion a process of physiological responses e.
Ambulatory blood pressure studies indicate that perceived racism may influence cardiovascular disease risk through its effects on nocturnal blood pressure recovery Brondolo et al. General perceived discrimination i. These findings are important because numerous studies have found that exaggerated cardiovascular responses to stress are a marker or mediator for coronary heart disease and hypertension e.
As with other forms of cumulative stress, perceived discrimination may lead to wear and tear on the body because chronic over- or underactivity of allostatic systems produce allostatic load e.
The implication, when applied to the health domain, is that dealing with experiences of discrimination may leave individuals with less energy or resources for making healthy behavior choices.
Despite the large number of studies examining the relationship between discrimination and health, several questions have remained unanswered. The negative impact of discrimination on mental health outcomes is widely supported, but the evidence is not as clear for the relationship between discrimination and physical health.
The main purpose of our meta-analysis was to determine the strength of these relationships and, when possible, to test pathways by which perceived discrimination may affect health. Furthermore, distinctions have been made between the predictive utility of measuring perceived discrimination by self-reported life-time history of discrimination or reports of the past 12 months and whether major events are more influential on health than more chronic, everyday experiences.
These issues were addressed through the use of meta-analysis on the available literature and supplemented by research synthesis for the literature that did not qualify for the meta-analysis.
We also explored several potential moderator effects. Modeling the Perceived Discrimination—Health Relationship The model shown in Figure 1 illustrates three pathways through which discriminatory experiences may affect mental and physical health. First, perceptions of discrimination could have a direct effect on health Path a.
The relationship between perceived discrimination and mental and physical health can also be partially mediated through stress responses to a discriminatory event, such as the psychological responses of decreased positive emotion and increased negative emotion Path b.
If an individual perceives discrimination on a regular basis, these stress responses should be activated more often, potentially leading to a consistently negative emotional state.
Chronic, heightened physiological stress responses, such as cardiovascular reactivity and cortisol responses, are also included in this pathway. Experiences of discrimination may contribute to health problems then via Path c through allostatic load developed by heightened stress responses and negative emotional states.
Another mediating mechanism we tested in our model is the role of health risk behaviors Path d that may emerge as possible coping mechanisms when discrimination is experienced. As represented by Path e, these activities can have detrimental effects on physical health, contributing to increased risk of multiple major disease outcomes.
We also examined several variables that have been identified in the literature as potential moderators of these pathways.This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health.
Perceived discrimination is one such pathway and the paper reviews the. While categorization activates stereotypes and prejudice, the links to discrimination are not as direct. There are a number of factors that influence when discrimination is more or less likely to occur. of Discrimination: Racial Discrimination in Employment, Housing, Credit, and Consumer Markets ).
Furthermore, perceived discrimination may lead to diminished effort or performance in education or the labor market, which itself factors, racial attitudes being only one. Where. To assess discrimination in health care, reliable, valid, and comprehensive measures of racism/discrimination are needed.
The purpose of this review is to update and summarize the published literature on measures assessing individuals’ perceptions of racism/discrimination in their environment. Most studies of perceived discrimination have been cross-sectional and focused primarily on mental rather than physical health conditions.
We examined the associations of perceived racial and gender discrimination reported in adulthood with early life factors and self-reported physician-diagnosis of. First, we examined whether early life factors (e.g., birth weight, parental SES) as well as adult social and behavioral factors (e.g., adult education, BMI) predicted reports of racial discrimination and gender discrimination separately.