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 enforcement, economic opportunity, educational achievement and indicators of health.
Despite heightened public awareness, non-white Americans continue to have overwhelmingly different views about the prevalence and impacts of racial and ethnic discrimination. Gallup polling over many decades reveals persistent differences in perceptions, with Pew Research Center survey data and analysis largely confirming these trends. A 2013 Pew survey, conducted on the 50th anniversary of Martin Luther King’s “I Have a Dream Speech,” found that only about a third of whites believe blacks are treated less fairly by the police, while 70% of blacks said they believed police are less fair to them. Regarding treatment in the courts, the numbers similarly diverged, with roughly two-thirds of black respondents (68%) but only a quarter of whites (27%) saying blacks are not treated as fairly in the justice system.
A growing body of public health research has been dedicated to studying the impact of experiences of racial discrimination on outcomes ranging from mental disorders such as depression and anxiety, to chronic illnesses such as heart disease and breast cancer. Studies have consistently found that experiencing discrimination is associated with poorer health outcomes overall, but findings on the specific factors have been mixed. Much depends on the health problem in question as well as different approaches to studying these issues, highlighting the need to further understand existing controversies in the field.
In a 2015 paper published in the Annual Review of Clinical Psychology, “Self-Reported Experiences of Discrimination and Health: Scientific Advances, Ongoing Controversies, and Emerging Issues,” Tené T. Lewis of the Rollins School of Public Health at Emory University, Courtney D. Cogburn of the Columbia University School of Social Work, and David R. Williams of the Harvard T.H. Chan School of Public Health examine what current research has shown; inconsistencies in methodologies that may influence observed results, and future directions for study in areas that have been historically neglected.
Key points highlighted in the review include:
- While many interpreted the election of Barack Obama as being indicative of a new “post-racial” America, discrimination based on race or ethnicity continues to be a persistent experience for people of color in the United States across numerous domains, including housing, community policing, and health care treatment.
- Experiences of discrimination are a form of stress that can have serious implications for mental and physical health, ranging from depression, anxiety and post-traumatic stress disorder to all-cause mortality and hypertension. Research has also found discrimination to be associated with, “silent indicators of poor health and premature aging,” like allostatic load and cortisol dysregulation.
- Controversies in the field are focused primarily on how experiences of discrimination are recorded and measured in scientific studies. Concerns around how discrimination is defined (broadly compared to specifically racially motivated), perception bias (the fact that certain types of people may be more or less likely to perceive experiences as discriminatory), and the intersection of different forms of discrimination, all present challenges to public health studies.
- Perception bias can present in two forms: a minimization bias (perceiving less discrimination than is truly present), and a vigilance bias (perceiving more discrimination). Minimization can exist when the cost of reporting discrimination is high, if experiences are unclear and nuanced, or it can simply be the result of denial. Vigilance, on the other hand, can be the product of prior personal or cultural experiences, and has been related to improved feelings of self worth. Overall, it is not clear which forms of perception bias are more common in the population; however, the authors note that it is important to interpret study findings cautiously, and also to consider the extent to which studies have addressed anger-related personality characteristics found to be associated with both discrimination and poor health.
- To address the question of whether racially discriminatory experiences are unique compared to unfair treatment broadly, researchers typically employ a two-stage approach to asking about discrimination: They first inquire about unfair treatment and then follow-up with a question regarding whether that experience was due to one’s race or ethnicity. For example, this approach was used in a 2008 study by Chae and colleagues published in the American Journal of Public Health, where the authors found that 74% of Asians reported discrimination while 62% reported racially motivated discrimination, leading to the conclusion that both are conceptually distinct.
- Where multiple types of discrimination are at issue, the authors note that “individuals frequently occupy more than one socially disadvantaged status and these statuses may interact to shape their experiences.” While researchers are beginning to consider new ways to study these intersections empirically, more research needs to be done to understand how different forms of discrimination may interact.
- An understudied area remains the impact of chronic discrimination. Most research in the past was based on one-time events, and therefore does not capture “chronic stressors, traumatic stressors and macrostressors…[that] span the life course, often beginning early in life and continuing throughout old age.” While macrostressors like natural disasters, economic recessions and terrorist attacks have received some attention in public health literature on discrimination, little is known about the population health impacts of traumatic events like race riots and widespread police brutality.
- Emerging areas of research include: Digital discrimination, the impact of “vigilance and anticipatory stress” that can harm health, and resources that may buffer individuals from negative health impacts, such as religious involvement, mindfulness practice and emotional support.
- Promising approaches that have been associated with improved outcomes include: Value affirmation interventions “designed to enhance an individual’s sense of adequacy and self-worth”; and forgiveness strategies aimed at “emotion-focused coping, and community-based racism countermarketing.” In a 2014 evaluation of the Racism Still Exists campaign in New York City by Naa Oyo Kwate of Rutgers University, greater community awareness of racism was associated with reduced psychological distress.
Lewis and colleagues conclude that the “overwhelming body of research on discrimination and health indicates that self-reported experiences of discrimination are an important risk factor for poor mental and physical health.” However, to adequately address these disparities, “significant inroads need to be made in order to dismantle the institutional policies, structures, and processes that underlie societal inequality and race-related discrimination. As research documenting the adverse effects of discrimination on health continues to grow, these efforts will become critically important as a means of improving health in societies shaped by racism and other forms of discrimination.”
Keywords: African-American, Hispanic, Latino, civil rights, discrimination, racism