Psychological impact of discrimination on health

Understanding frameworks There are several models that provide explanation to how stress impacts individuals and understanding on where that stress comes from. Three primary frameworks are the Minority Stress Theory, Allostatic Load, and Social Determinants of Health. Each of these are highly referenced in psychological and health disparities research. The Minority Stress Theory created by Ilan Meyer describes the added stress experienced by minority groups in both experienced discrimination, and fear of being discriminated against. This stress is higher in groups who experience prejudice and exclusion based on factors such as race, ethnicity, or sexual orientation. With higher levels of stress, these groups are subjected to negative health affects that other people outside of these groups are not. In Allostatic Load, this framework describes how constant stress and exposure to stressors has harmful repercussions on the body. This refers to both mental and physical health. Similarly, those stressors are more common in minority groups who are subjected to frequent experiences of distress. One final framework that is beneficial to understanding the psychological impact of discrimination on health is the Social Determinants of Health Model. This brings forward intersectionality and the idea that a person is shaped from their background and is unique to themselves. Categories of gender, race, economic status, environment, etc. are all factors in this model which contribute to an individuals access to health and experience receiving medical care. Stress response Research conceptualizes discrimination as stress-inducing experiences that have negative consequences on mental and physical health, as well as health behaviors. In experimental studies, stress in response to discrimination has been measured using a range of both psychological (e.g. perceived stress) and physiological (e.g. cardiovascular reactivity) indicators; evidence indicates that this heightened stress response is associated with poorer mental and physical health and impaired decision-making in relation to health behaviors such as substance use or visits to the emergency department. Some researchers argue that everyday experiences with discrimination can cause chronic and cumulative stress that contributes to physical strain on the body. Instances of discrimination tend to be ambiguous and unpredictable, which research suggests may be particularly harmful. The impact of discrimination-related stress can be long-term. For example, one study on Black adolescents found that perceived discrimination between age 16-18 predicted stress hormone levels, blood pressure, inflammation, and BMI at age 20. The cumulative physiological impact of chronic stress was demonstrated by the longitudinal study, Brody et. al., which showed that greater levels of perceived discrimination during adolescence were linked to heightened allostatic load in early adulthood. alcohol and substance use, reduced physical activity, Research also indicates that discrimination lowers participation in preventative care behaviors, such as cancer screening, diabetes management, and condom use, which are important for maintaining overall health. Disenfranchised groups are concentrated in communities with limited resources due to racial and ethnic residential segregation, an institutional form of discrimination. In addition to exposing people to higher levels of stress and risk-promoting situations, these surroundings frequently lack access to leisure areas, wholesome food alternatives, and high-quality healthcare. This systemic disadvantage emphasizes how social environment shapes personal health chances and choices by reinforcing the connection between discrimination and unhealthy behaviors. Yin Paradies (2006) conducted a thorough meta-analysis of 138 empirical research and discovered a continuous correlation between self-reported racism and unhealthy behaviors. According to the research, being exposed to racism was substantially linked to higher rates of alcohol and tobacco use, lower levels of physical activity, and lower health care usage. This comprehensive data emphasizes how prejudice not only has an impact on mental and emotional health but also leads to behavioral patterns that jeopardize long-term health results.. == Interpersonal discrimination ==

Measurement Studies assessing the link between interpersonal, or individualized, discrimination and health have been both experimental and observational in nature. Studies have explored this relationship by manipulating perceptions of discrimination in a number of ways, including exposing participants to racist film clips, asking them to write about their prior experiences with discrimination, and providing them with articles detailing discrimination against their ingroup. and the New Zealand Health Survey to make deductions about the relationship between discrimination and health. In several cases, perceived discrimination is measured by asking participants to self-report on the frequency with which they experience discrimination daily (chronic); the number of times that they've been the target of severe discrimination (acute); the amount of discrimination experience over their lifetime (lifetime); or whether they had recently experienced discrimination (recent). Racism, for instance, is often measured using the Perceived Racism Scale, the Schedule of Racists Events, the Index of Race Related Stress, and the Racism and Life Experiences Scale. Across studies, there is consistent evidence for the negative impact of discrimination on mental health and health-related behaviors, According to the research, there was a substantial increase in psychological distress, sadness, anxiety, and other signs of poor mental health among those who reported experiencing racial prejudice. Some studies suggest that the relationship between perceived discrimination and clinical mental illness becomes stronger as perceptions of discrimination and instances of experienced discrimination increases. A meta-analysis conducted by Pascoe and Richman Smart in 2009 concluded that the link between discrimination and mental health is a broad phenomenon, with targets of discrimination experiencing poorer mental health regardless of ethnicity or gender. obesity, hypertension, ambulatory blood pressure, breast cancer, Perceived discrimination also shows association with indicators of forthcoming health problems, such as increased allostatic load, shorter telomere length, inflammation, cortisol dysregulation, and coronary artery calcification. and higher ambulatory blood pressure at night in response to discrimination. Although the association between discrimination and blood pressure has been found in multiple studies, a 2012 analysis of 22 studies by Couto and colleagues only found evidence of this link in 30% of the analyzed studies. Krieger (2014) approaches this issue by stressing that a more comprehensive socio-ecological framework is necessary to comprehend how prejudice affects physical health, including blood pressure, cardiovascular risk, and allostatic load. The article contends that by repeatedly triggering the stress response, both brief and prolonged exposure to discrimination can dysregulate bodily systems. This physiological deterioration over time adds to the so-called allostatic load, which includes a number of indicators such as blood pressure, cortisol levels, and inflammatory markers. Krieger also notes that discrepancies in results, like those reported by Couto et al., might be caused by variations in study design, sample demographics, discriminatory measures, and whether or not research takes interpersonal encounters into consideration as opposed to structural forms of discrimination. == Institutional racism in the United States ==

Institutional (or structural) racism refers to the policies and practices embedded in the legal, economic, social, and political systems of society that creates differential access to resources, opportunities, and services based on race. In the United States, studies have examined connections between institutional racism and health, particularly through residential segregation and environmental racism. Wildeman and Wang (2017) go on to emphasize how mass imprisonment is a potent structural racism mechanism that has serious negative effects on public health. Although residential segregation was made illegal in 1968 through the Fair Housing Act, it persists in many cases, with Black Americans experiencing the highest rates of segregation as compared to Hispanics and Asian Americans. The historical segregation of Black Americans has been identified as a fundamental contributor to persisting Black-White disparities in adverse birth outcomes, health behaviors, and chronic diseases such as asthma, diabetes, and hypertension. Segregation contributes to health disparities by creating physical and social conditions that increase exposure to environmental pollutants, contribute to the prevalence of chronic and acute psychosocial stressors, and make it more difficult for residents to practice healthy behaviors. For example, Landrine and Corral (2009) identified three potential pathways through which racial segregation contributes to disparities: Black neighborhoods, relative to White neighborhoods, are equipped with inferior healthcare facilities and less competent physicians; exposed to higher levels of pollution and toxins in the environment; and provided greater access to fast foods but lower access to recreational facilities and supermarkets. Other researchers argue that segregation leads to the creation of neighborhoods with high levels of poverty and lower quality education that receive less government support. [citation needed] Studies have indicated that segregation is associated with poorer overall health. intentional harm, and later-stage breast and lung cancer diagnosis. Segregation has also been associated with negative health consequences for Black women, such as increased risk for obesity, low birth weight, preterm birth, Environmental racism Current research shows that people of color, low-income communities, ethnic minorities, and indigenous populations are more likely to be exposed to pollution, toxins, and chemicals as a result of their proximity to industrial and military activity and consumer practices. For example, research conducted in Warren Country, NC shows that 75% of their hazardous waste landfills are located in Black communities, despite the fact that Black Americans only make up 20% of the county's population. This pattern is present in most parts of the U.S.; 40% of the country's landfills are located in Black communities. Communities of color not only live close to landfills, but they are also more likely than their white counterparts to live near medical waste incinerators, diesel bus depots, and Superfund sites. Research shows that living in proximity with sources of air, water, and soil pollution is associated with asthma, eczema, cancer, chemical poisoning, heart disease, and neurological disorders in Black Americans. Altgeld Gardens Homes; Dickinson County, TN toxic wells; North Birmingham, AL coke plants Lead contamination is known to be particularly harmful to children and pregnant women as it can lead to anemia, kidney failure, brain damage, fetal death, and premature delivery. == Impact of discrimination on various social groups ==

U.S. racial minorities Racial minorities in the U.S. include Black Americans, Asian Americans, Latino Americans, and Native Americans. Members belonging to these racial minority groups often face discrimination in daily interactions and situations. These repeated experiences with discrimination has been shown to lead to heightened stress responses in racial minorities, which leads to poorer mental and physical health, and increased participation in harmful health-behaviors. They also tend to fare worse, compared to other racial/ethnic groups, when it comes to physical illnesses such as heart disease and cancer incidence. Black Americans report experiencing discrimination in a range of situations (e.g. healthcare visits, job applications and interviews, interactions with the police) and through microaggressions and racial slurs. Perceptions of racial discrimination has been linked with psychological distress, hypertension, depression, harmful health behaviors (e.g. alcohol abuse), and a range of chronic illnesses in Black Americans. A meta-analysis of 19 studies published between 2003 and 2013 on the link between perceived discrimination and the health of Black women finds that perceptions of discrimination is associated with preterm birth and low birth weight. According to the research, racial prejudice is a long-term stressor that might lead to these unfavorable birth outcomes by causing physiological reactions including inflammation and elevated cortisol levels. According to Nadimpalli and Hutchinson (2012), these correlations show how profoundly racial prejudice, whether overt or covert, may affect Asian American people' physical and emotional well-being. According to Gee et al. (2009), who examined a wide range of studies, there is consistent evidence that racial discrimination is strongly linked to higher psychological distress, including feelings of anxiety, sadness, and low self-esteem. A review of 33 studies on the topic reveals that perceived discrimination is associated to poorer mental health and health-related decisions in Latinos residing in the U.S. Latinos who came to the United States at a younger age are at a higher rate of developing mental health issues due to the discrimination they face at a younger age. While Latino immigrants who come to the United States at a later age have a lower risk than non-Latinos of developing a mental health disorder. However, the review did not find evidence of a robust relationship between perceived discrimination and physical health. Perceived racial discrimination in those instances have been associated with poorer mental health, including experiencing psychological distress, suicidal ideations, anxiety, and depression. These experiences of discrimination, unique to indigenous populations, are thought to be transmitted generationally and influence health outcomes in individuals with Native American ancestry. Thus, perceptions of discrimination in Native Americans tend to be measured in terms of historical trauma, which is the extent to which Indigenous people experience discrimination as a result of the collective history of violence perpetrated against Native Americans during the colonization process. Studies examining the relationship between historical trauma and health in Native Americans find that perceptions of discrimination are associated with increased participation in unhealthy behaviors (e.g. alcohol abuse), and psychological distress. Studies investigating the relationship in Indigenous adolescents finds that perceptions of discrimination is associated with early substance use, suicidal ideation, anger, and aggression. Sexual minorities (LGBTQIA+) LGBTQ+ individuals tend to be victims of bullying, harassment, and family rejection. Bullying and harassment in school on the basis of sexual orientation has been linked to negative mental health (increased depression and lower self-esteem) and education-related outcomes (increased school absences and lower performance). Some researchers also argue that the higher prevalence of clinical mental disorders in the LGBTQ+ population can be understood as a consequence of the discrimination experienced in their daily environments and interactions. LGBTQ+ people of color tend to be targets of both racism and heterosexism, which independently predicts depression, but associations between discrimination and suicidal ideation has only been found in relation to heterosexism. LGBTQ+ individuals report experiencing discrimination during job searches and interactions with the police. Although stigma and discrimination also show association with the aforementioned psychological and psychosocial issues, internalized homophobia has been found to be the most reliable predictor of mental and physical health issues in LGBTQ+ communities. Research on the impact of sexual assault on health in women populations find that targets of sexual harassment experience a range of mental health outcomes– including depression, anxiety, fear, guilt, shame, anger, and PTSD– and physical health problems such as headaches, digestive system issues, and sleep disorders. Research relating assault to health in women populations offers a glimpse as to the potential impact of assault on sexual minorities, who are more likely to be victims of physical and sexual assault relative to non-sexual minorities. Elderly population Discrimination against the elderly population has been document in healthcare and employment settings, where elderly individuals tend to devalued and the targets of ageist stereotypes. For example, doctors tend to prescribe milder treatments for elderly individuals whom they are likely to perceive as physically and psychologically frail. Elderly populations in the UK also experience discrimination in the form of neglect and financial exploitation. A meta-analysis of U.S.- and UK-based studies on the impact of ageism found associations with poorer mental health, well-being, physical and cognitive functioning, and survival chances.[citation needed] Research also finds that exposure to ageist stereotypes reduces memory performance, self-efficacy, and willingness to live and increases cardiovascular reactivity. == Coping mechanisms ==

Research identifies a few potential moderators of the impact of discrimination on health such as strength of ethnic identity, social network, and coping strategies. Racial/ethnic identity Social identity theory suggests that individuals are social beings who derive benefits from group identification and belonging, which could act as a buffer against the discrimination. Evidence of the potential for racial/ethnic identification to moderate the relationship between discrimination and health comes from research on large samples of Latino and Filipino American samples, which found that the relationship between discrimination and mental health was weaker for individuals higher in racial/ethnic identification. On the other hand, self-categorization theory indicates that higher levels of identification may lead to increased awareness and anticipation of discrimination, which consequently elicit negative emotions. A meta-analysis of 51 studies and a review of the literature investigating the potential moderating effect of racial/ethnic identity reveals that the association between discrimination and physical health is weaker in individuals who are committed to their racial/ethnic identity.[citation needed] They also find that, in individuals who are still exploring their racial/ethnic identity, associations between discrimination and poorer mental health and risky health behaviors was stronger. Coping strategies Responses to discrimination can vary from anger suppression, avoidance, and confrontation to advocacy, seeking social support, and making changes to the self. Research sorts coping strategies into two categories: problem-focused coping, which are strategies that take a direct approach to tackling the experience of discrimination (e.g. cognitive reframing or support seeking), and emotion-focused coping, which are strategies that seek to reduce psychological distress experienced from discrimination (e.g. avoidance or distraction). The literature on coping strategies indicates that individuals usually use a combination of both problem-focused and emotion-focused strategies, but that problem-focused coping tends to be more effective and adaptive. Similarly, research on Black Americans finds emotion-focused coping, in the form of anger suppression, to be associated with elevated blood pressure levels in Black Americans. on mental health and health-behaviors in Mexican youths, and on depression in Southeast Asians. Coping strategies can also be adaptive (e.g. positive reframing, acceptance, planning) or maladaptive (e.g. denial, self-blame, distraction). In a population of college students, research finds that adaptive coping is associated with decreased tendency to overeat in response to discrimination experiences while maladaptive coping is associated with an increased tendency to overeat. A meta-analysis of 9 studies investigating the relationship between coping strategies and health suggests that problem-focused and adaptive coping strategies are more likely to buffer the impact of discrimination on health than emotion-focused and maladaptive strategies.[citation needed] == References ==