Discrimination & health Flashcards
Brondolo, Gallo, & Myers. (2009). Race, racism, and health: Disparities, mechanisms, and interventions.
Gist: Racism is used to explain racial/ethnic differences in health comes. Racism is considered a psychosocial stressor characterized by both social ostracism & blocked economic opportunity.
Racism: “The beliefs, attitudes, institutional arrangements, and acts that tend to denigrate individuals or groups because of phenotypic characteristics of ethnic group affiliation” plus discrimination and unfair treatment. The biopsychosocial model defines stress as impacting health by directly influencing psychophysiological reactivity (e.g., blood pressure) and indirectly via engagement in risky health behaviors. Racism can also affect health care, especially through the patient-provider relationship. Interventions could focus on the perpetuators of racism & provide diversity training in the workplace or cultural competency training for health providers. another aspect of interventions could be to target specific cultural groups by exploring ethnicity-related variables (e.g., cultural beliefs, dietary habits).
Clark, Anderson, Clark, & Williams. (2013). Racism as a stressor for African Americans: A biopsychosocial model.
Gist: The authors provide a biopsychosocial model for perceived racism. Racism is defined as “beliefs, attitudes, institutional arrangements, & acts that tend to denigrate individuals or groups because of phenotypic characteristics or ethnic group affiliation”. Attitudinal racism is based on attitudes & beliefs; behavioral racism has to do with acts. There is research on intergroup racism in higher education, housing, automotive sales, etc. but little research on intragroup racism. The biopsychosocial model postulates that if racism is perceived as stressful, then there are negative consequences. Differential exposure to & coping responses following perceptions of racism may account for the within-group variability in health outcomes. Specific interventions & prevention strategies could be developed & implemented to reduce the negative impact of racism. Moderator variables may include constitutional factors (e.g., skin tone, family history of hypertension), sociodemographic factors, & psychological & behavioral factors. Mediator variables may be perceived racism, coping responses, psychological & physiological stress responses, & health outcomes.
Feagin & Bennefield. (2014). Systemic racism and US health care.
Gist: Uses systemic racism theory to assess empirical research on racial dimensions of US health care & public health institutions historically.
Systemic racism theory: details major dimensions of US racism - (1) dominant racial hierarchy, (2) comprehensive white racial framing, (3) individual & collective discrimination, (4) social reproduction of racial-material in equalities, (5) racist institutions integral to white domination of Americans of color.
Overall, institutionalized white socioeconomic resources, discrimination, & racialized framing from centuries of slavery, segregation, & contemporary white oppression limit & restrict access of Americans of color to adequate socioeconomic resources & health care & health outcomes. Dealing with continuing racial disparities in health & health care requires conceptual paradigm to realistically assess US’s white-racist roots & contemporary racist realities.
Stuber et al. (2003). The association between multiple domains of discrimination and self-assessed health: A multilevel analysis of Latinos and Blacks in four low income New York city neighborhoods.
Gist: This study looked at individual experiences of discrimination & how these affected self-assessed mental & physical health among Latinos & blacks, separately. The conceptual framework is that individual experiences of racial discrimination generate stress that then affect psychological processes that impact health. Blacks were more likely than Latinos to report experiences of both racial and nonracial discrimination. High racial/ethnic composition of a neighborhood was associated with poor physical health among blacks & poor mental health among Latinos.
Cooper et al. (2001). Relationship between premature mortality and socioeconomic factors in Black and White populations of US metropolitan areas.
Gist: The purpose of this study was to examine relationships between SES indicators & institutionalized racism on premature mortality in black & white populations in the US. The current study focuses on racism as an ecologic (rather than individual) characteristics that can influence mortality for both whites & blacks. Both median household income & income inequality predicted premature mortality. Residential segregation was also associated with premature mortality, but this relationship was stronger for blacks than for whites. When stratified by region, MSAs in the south & MSAs with higher black populations (consistent with effect of concentrated poverty).
Williams, Neighbors, & Jackson. (2003). Racial/ethnic discrimination and health: Findings from community studies.
Gist: The purpose of this article is to (1) briefly summarize population-based studies that look at discrimination & health and (2) discuss gaps in the literature. Most studies have found an association with higher discrimination relating to poorer health. Gaps in the research include: (1) methodological issues in previous studies; (2) extent to which perceived discrimination leads to increased risk of disease & conditions where this occurs; (3) mechanisms & processes involved; (4) dose-response relationship; (5) persistent exposure; & (6) more studies with children/adolescents & other groups except blacks vs. whites.
Nazroo. (2003). The structuring of ethnic inequalities in health: Economic position, racial discrimination, and racism.
Gist: The idea that race is really picking up on SES factors makes the incorrect assumption that minority groups in the US are uniformly disadvantaged, meaning that researchers should look at socioeconomic stratification within ethnic minority groups when examining health outcomes. When SES is used as a confounder of the ethnicity-health relationship, this obscures the explanatory role that SES has for health. Existing data doesn’t usually contain the information necessary to examine within-group heterogeneity. Fenton distinguished 5 types of ethnic-making or migration situations that may have different effects on health due to their different contexts:
1) Urban minorities ( often migrant worker populations).
2) Proto-nations or ethnonational groups (maintains elf-governance).
3) Ethnic groups in plural societies (descendants of populations who typically migrated).
4) Indigenous minorities (dispossessed by colonial settlement).
5) Postslavery minorities (descendants of African people formerly enslaved in the New World).
It’s not a comprehensive list, but it highlights the fact that there may be different contexts within which ethnicity or race is created to form distinct groupings & reflects different historical trajectories by race & ethnicity.
Darity. (2003). Employment discrimination, segregation, and health.
Gist: Regarding social psychological theories of motivation & locus of control (expectancy theory) as applied to employment, there is evidence that the experience of unemployment undermines worker’s will to perform, resulting in lowered productivity & lowered likelihood of being employable thereafter. There is evidence that both the perception of racism & an individual’s responses to racism (e.g., coping strategies) affect health. The majority of blacks are not recognizing labor market discrimination or are engaged in cognitive dissonance or denial. Minorities with darker skin fare worse on social & economic dimensions; they tend to have less education, less prestigious occupations lower personal income, & lower family income than those with lighter complexions (true for blacks & Chicanos).
Institute of Medicine. (2002). Chapter 2: The healthcare environment and its relationship to disparities.
Gist: Reviews the social & economic contexts in which racial/ethnic minorities live & reviews history of segregated healthcare, contemporary setting in which racial/ethnic minorities receive healthcare, & the healthcare workforce in minority communities.
Health status - African Americans have the highest morbidity & mortality rates followed by American Indians & Alaska Natives.
Insurance status - Minorities less likely to possess health insurance or more likely to be covered via Medicaid/other publicly funded insurance.
Linguistic barriers - disproportionately represented in large urban areas & 5 states (CA, NY, TX, NM, & HI); issue for Hispanics, AIAN, & Asians.
Racial attitudes & discrimination - mortgage lending for AA & Hispanics; housing discrimination; employment; criminal justice.
Context of healthcare delivery for minority patients - history of legally segregated healthcare facilities & contemporary de facto segregation; lack of minorities in health care professions (more likely to work in hospital-based practices while non-minority more likely to work in office-based practices).
Racial/ethnic disparities in healthcare emerge from an historical context in which healthcare has been differentially allocated on the basis of social class, race, & ethnicity. Despite public laws & sentiments to contrary, vestiges of this history remain & affect current context of healthcare delivery. Persistent pattern of inequality suggests that interventions to eliminate disparities must be comprehensive & sustained.
Kessler, Michelson, & Williams. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States.
Gist: Perceived discrimination is common in total population. The associations between perceived discrimination & mental health are comparable to other commonly studied stressors & associations do not vary consistently across subsamples defined on basis of social status.
