Understanding how discrimination can affect health

Abstract

Background To provide an overview of the empirical research linking self‐reports of racial discrimination to health status and health service utilization. Methods A review of literature reviews and meta‐analyses published from January 2013 to 2019 was conducted using PubMed, PsycINFO, Sociological Abstracts, and Web of Science. Articles were considered for inclusion using the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) framework. Results Twenty‐nine studies met the criteria for review. Both domestic and international studies find that experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health, including preclinical indicators of disease, health behaviors, utilization of care, and adherence to medical regimens. Emerging evidence also suggests that discrimination can affect the health of children and adolescents and that at least some of its adverse effects may be ameliorated by the presence of psychosocial resources. Conclusions Increasing evidence indicates that racial discrimination is an emerging risk factor for disease and a contributor to racial disparities in health. Attention is needed to strengthen research gaps and to advance our understanding of the optimal interventions that can reduce the negative effects of discrimination.

Gender discrimination in the United States: Experiences of women

“…However, lifetime experiences remain valid measures of discrimination, as discriminatory experiences may have long-term effects on behavior or health. 3,[11][12][13][14] Third, we note that many forms of discrimination, including sexual harassment and violence, are often under-reported-particularly on surveys administered by an interviewer, such as in this study. 35 Prior research has also found that women are often reluctant to label offensive experiences as "harassment."…”

“…[7][8][9] Evidence about the health impact of gender discrimination is supported indirectly by literature documenting the relationship between racial/ethnic discrimination and negative health outcomes. [10][11][12][13][14] These studies suggest that the experience of discrimination-be it institutional (eg, health care) or interpersonal (eg, microaggressions)-increases the body's stress response over time, and that discrimination is linked to a range of poor health-related behaviors, mental health outcomes, and physical health problems, including high blood pressure, heart disease, and mortality. [10][11][12][13][14] Experiencing gender discrimination may negatively impact women's health through parallel mechanisms, that is, through both psychological and physiological stress responses and health behaviors that lead to worse health outcomes.…”

“…[10][11][12][13][14] These studies suggest that the experience of discrimination-be it institutional (eg, health care) or interpersonal (eg, microaggressions)-increases the body's stress response over time, and that discrimination is linked to a range of poor health-related behaviors, mental health outcomes, and physical health problems, including high blood pressure, heart disease, and mortality. [10][11][12][13][14] Experiencing gender discrimination may negatively impact women's health through parallel mechanisms, that is, through both psychological and physiological stress responses and health behaviors that lead to worse health outcomes. 15,16 Research in the field also suggests that women who are racial/ethnic minorities are disproportionately exposed to discrimination and are also more likely to experience health effects of discrimination.…”

“…20,21 While older studies document gender discrimination in discrete areas of women's lives (eg, the workplace), increasing evidence about the health risks of discrimination suggests an updated examination across a broader range of areas is warranted. 2,6,14,22 The purpose of this specific study is twofold: (a) to document the prevalence of gender discrimination against women across multiple institutional and interpersonal domains, including health care, education, employment, housing, political participation, police and the criminal justice system, slurs, microaggressions, harassment, and violence; and (b) to examine the variation in discrimination experiences of racial/ethnic minority women and LGBTQ women. This study brings a public health perspective to the complexity and pervasiveness of discrimination in the United States today alongside complementary articles in this issue of Health Services Research.…”

Methodology of the Discrimination in the United States survey

“…An article by David Williams in this issue, as well as other prior research, has shown that major patterns of racism, sexism, and other discrimination can significantly harm the health and well-being of impacted populations and that self-reported discrimination is associated with worse health outcomes. [1][2][3][19][20][21][22][23][24]29 The Discrimination in the United States survey and the articles based on it extend prior work in this area by focusing on people's reports of their own and their family members' direct life experiences, rather than general perceptions of discrimination on the country; and by bringing together simultaneously these reported experiences across six groups, most of them underrepresented in much of public opinion research due to their low incidence in the population.…”