Social Discrimination Pdf

[Mike Fowler]

Thissummary of the literature on Discrimination as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Access to Foods That Support Healthy Dietary Patterns, Housing Instability, Incarceration, and Quality of Housing literature summaries.

Discrimination is a socially structured action that is unfair or unjustified and harms individuals and groups.1,2,3,4 Discrimination can be attributed to social interactions that occur to protect more powerful and privileged groups at the detriment of other groups.3,4 Stressful experiences related to discrimination can negatively impact health.5 Discrimination, especially racial discrimination, has also been known to cause symptoms of trauma.6,7,8

This summary discusses types of structural discrimination (e.g., residential segregation, disparities in access to quality education, and disparities in incarceration) and individual discrimination (e.g., discrimination based on race, gender, sexuality, gender identity, disability, and age).

Major discriminatory events are often the result of structural discrimination that can negatively affect individuals and communities. Residential segregation, disparities in access to quality education, and disparities in incarceration rates are some specific forms of structural discrimination.15,16,17,18,19

Residential segregation is a form of structural discrimination in the housing market. Redlining is a form of discrimination where individuals living in neighborhoods mainly populated by certain racial/ethnic groups are denied loans.20 Basing credit lending decisions on property location has created a legacy of urban areas experiencing chronic health inequities.21 In one study there was an association found between redlining and poor mental health, a nondermatological cancer diagnosis, and a lack of health insurance.21 Another study found that small-for-gestational-age birth, prenatal mortality, and preterm birth have a higher prevalence in redlined neighborhoods than in other areas.22 Residential segregation is a major cause of differences in health status between African American and White people because it can determine the social and economic resources for not only individuals and families, but also for communities.19

Discrimination on the basis of race (commonly referred to as racism) has been linked to disparities in health outcomes for some racial/ethnic groups.39 Racism has been linked to low birth weight, high blood pressure, and poor health status.29,40 For example, infant mortality rates among the non-Hispanic Black population is 11.11 infant deaths out of 1,000 live births while the overall rate in the United States is 5.96 infant deaths per 1,000 live births.52 Further, the 2019 National Healthcare Disparities Report indicated that White patients receive better quality of care than 40.6 percent of Black patients, 40.5 percent of American Indian/Alaska Native patients, 34.5 percent of Hispanic patients, and 28.6 percent of Asian and Pacific Islander patients.53 This differential quality of care may be based on racial discrimination.39,53

The health vulnerabilities of older adults may amplify the health effects of discrimination (commonly referred to as ageism).58 One study found that experiences of discrimination are frequent among the elderly population, with 63 percent and 31 percent of older adults reporting everyday discrimination and major discriminatory events, respectively.3 Discrimination based on age was the most common type of discrimination.3 After controlling for general stress, everyday discrimination still had effects on emotional health, such as depressive symptoms and self-reported health in older adults.3 Although older adults perceive lower levels of discrimination as they get older, they are more likely to associate experiences of discrimination with their age.3

Given the health impacts of discrimination on various populations, there is an ongoing need for innovative research methods, improved instrumentation, and new approaches for identifying all types of discrimination and its impact on health and health care.39 Cumulative and structural consequences of racism are hard to determine through traditional research methods. Innovative advancements in examining this area of discrimination are needed for future examinations.16 Additional research is needed to increase the evidence base on the effects of discrimination on health outcomes or disparities. This additional evidence will help facilitate public health efforts to address discrimination as a social determinant of health.

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. The University of Chicago Legal Forum, 1989(1).

This microsite is coordinated by the Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Office of the Secretary, U.S. Department of Health and Human Services.

For many people, discrimination is an everyday reality. Discrimination is the unfair or prejudicial treatment of people and groups based on characteristics such as race, gender, age, or sexual orientation.

The anticipation of discrimination creates its own chronic stress. People might even avoid situations where they expect they could be treated poorly, possibly missing out on educational and job opportunities.

Focus on your strengths. Focusing on your core values, beliefs, and perceived strengths can motivate people to succeed, and may even buffer the negative effects of bias. Overcoming hardship can also make people more resilient and better able to face future challenges.

Help yourself think clearly. Being the target of discrimination can stir up a lot of strong emotions including anger, sadness, and embarrassment. Such experiences often trigger a physiological response, too; they can increase your blood pressure, heart rate, and body temperature.

If you have questions about policies or concerns about discrimination in your workplace, the human resource department is often a good place to start. To learn more about discrimination in housing and employment, or to file a complaint, visit:

More than half of people with mental illness don't receive help for their disorders. Often, people avoid or delay seeking treatment due to concerns about being treated differently or fears of losing their jobs and livelihood. That's because stigma, prejudice and discrimination against people with mental illness are still very much a problem.

Stigma often comes from lack of understanding or fear. Inaccurate or misleading media representations of mental illness contribute to both those factors. A review of studies on stigma shows that while the public may accept the medical or genetic nature of a mental health disorder and the need for treatment, many people still have a negative view of those with mental illness.

Stigma around mental illness especially an issue in some diverse racial and ethnic communities and it can be a major barrier to people from those cultures accessing mental health services. For example, in some Asian cultures, seeking professional help for mental illness may be counter to cultural values of strong family, emotional restraint and avoiding shame. Among some groups, including the African American community's, distrust of the mental healthcare system can also be a barrier to seeking help. (See more on mental health in Diverse Populations.)

Media representations of people with mental illness can influence perceptions and stigma, and they have often been negative, inaccurate or violent representations. A study published by Scarf, et. al. in 2020 looked at a recent example, the popular film Joker (2019), which portrays the lead character as a person with mental illness who becomes extremely violent. The study found that viewing the film "was associated with higher levels of prejudice toward those with mental illness." Additionally, the authors suggest, "Joker may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking."

The stigma of mental illness is universal. A 2016 report on stigma concluded "there is no country, society or culture where people with mental illness have the same societal value as people without mental illness."

Stigma and discrimination can contribute to worsening symptoms and reduced likelihood of getting treatment. A recent extensive review of research found that self-stigma leads to negative effects on recovery among people diagnosed with severe mental illnesses. Effects can include:

A 2017 study by Oexle et al involving more than 200 individuals with mental illness over a period of two years found that greater self-stigma was associated with poorer recovery from mental illness after one and two years.

An editorial in the Lancet notes that the impacts of stigma are pervasive, affecting political enthusiasm, charitable fundraising and availability, support for local services and underfunding of research for mental health relative to other health conditions.

Stigma around mental illness is especially an issue in some diverse racial and ethnic communities, and it can be a major barrier to people from those cultures accessing mental health services. For more information, please see Mental Health Disparities: Diverse Populations.

Substantial research shows that knowing or having contact with someone with mental illness is one of the best ways to reduce stigma. Individuals speaking out and sharing their stories can have a positive impact. When we know someone with mental illness, it becomes less scary and more real and relatable.

Teens are searching for health information online and mental health issues are among the top searches, according to a national survey from Hope Lab (Hope Lab, 2021). About four in 10 teens said they have looked for people with similar health concerns. Many celebrities, such as Demi Lovato, Dwayne "The Rock" Johnson, Michael Phelps, Taraji P. Henson and Lady Gaga have publicly shared their stories of mental health challenges and brought the discussion much more into the general media and everyday conversation. Young people are looking for information and for these personal stories online.

3a8082e126