This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health. KeywordsRacism; Discrimination; Stress; Health disparities; Race; Ethnicity This paper will provide an overview of the current evidence for and needed research on the role of perceived discrimination in health. It seeks to situate the research on personal experiences of discrimination within the larger literature on racism and health. It begins by describing some salient patterns in the large and persistent racial/ethnic variations in health that have provided an impetus to better understand the role of racism in health. It centrally focuses on recent research on perceived discrimination and health. It critiques the existing literature with an eye toward highlighting the needed improvements in the conceptualization and measurement of perceived discrimination that would advance our understanding of the potential role of race-related stressors in health. Disparities and the added burden of raceRacial disparities in health in the U.S. are large and pervasive. For most of the 15 leading causes of death including heart disease, cancer, stroke, diabetes, kidney disease, hypertension, liver cirrhosis and homicide, African Americans (or blacks) have higher death rates than whites (Kung et al. 2008). These elevated death rates exist across the life-course with AfricanCorrespondence to: David R. Williams, dwilliam@hsph.harvard.edu. NIH Public AccessAuthor Manuscript J Behav Med. Author manuscript; available in PMC 2010 February 14. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptAmericans and American Indians having higher age-specific mortality rates than whites from birth through the retirement years (Williams 2005). Other data indicate that almost 100,000 black persons die prematurely each year who would not die if there were no racial disparities in health (Levine et al. 2001). Another noteworthy characteristic of racial disparities is their persistence over time. Despite gains in life expectancy for both blacks and whites, the 7 year racial gap in life expectancy in 1960 was still 5.1 years in 2005 (National Center for Health Statistics (2007). Similarly, altho...

This paper provides an overview of racial variations in health and shows that differences in socioeconomic status (SES) across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality and individual and household indicators of SES capture relevant but limited aspects of this phenomenon. Research is needed that will comprehensively characterize the critical pathogenic features of social environments and identify how they combine with each other to affect health over the life course. Migration history and status are also important predictors of health and research is needed that will enhance understanding of the complex ways in which race, SES, and immigrant status combine to affect health. Fully capturing the role of race in health also requires rigorous examination of the conditions under which medical care and genetic factors can contribute to racial and SES differences in health. The paper identifies research priorities in all of these areas.

This article reviews the scientific research that indicates that despite marked declines in public support for negative racial attitudes in the United States, racism, in its multiple forms, remains embedded in American society. The focus of the article is on the review of empirical research that suggests that racism adversely affects the health of non-dominant racial populations in multiple ways. First, institutional racism developed policies and procedures that have reduced access to housing, neighborhood and educational quality, employment opportunities and other desirable resources in society. Second, cultural racism, at the societal and individual level, negatively affects economic status and health by creating a policy environment hostile to egalitarian policies, triggering negative stereotypes and discrimination that are pathogenic and fostering health damaging psychological responses such as stereotype threat and internalized racism. Finally, a large and growing body of evidence indicates that experiences of racial discrimination are an important type of psychosocial stressor that can lead to adverse changes in health status and altered behavioural patterns that increase health risks.

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.

Black women have higher incidence of breast cancer before the age of 40, more severe disease at all ages, and elevated mortality risk compared to white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse, and the complex ways that socioeconomic status and racism shape exposure to psychosocial, physical, chemical and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which Black women live is also needed to maximize the opportunities to prevent breast cancer among this underserved group.

The adage “time is money” signifies that time itself is a major social resource, but the role of time as a determinant of health inequities remains underappreciated. Time is fundamental to health promotion and human agency, as in having time to exercise and maintain social relationships. Further, scarcity in time is related to stress and illness. Time is also racialized, such that racial/ethnic minorities often have less free time and suffer a time penalty in multiple facets of life. Such penalties manifest in problems such as greater time in prison or more time spent accessing services. We argue that time may be a social determinant of health that is shaped by racism across the life course. We focus on three aspects: time as age, time as exposure, and time as a resource and privilege. We distinguish between chronological age, biological age, and social age. We discuss issues of accelerated aging and potential interconnections with critical periods. We also examine racial inequities in time. By more deeply considering time, we may advance our understanding of racial inequities in health.

There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared towards improving access, coverage, quality and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This paper highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health, as well as, interventions in upstream factors such as housing, neighborhood conditions and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.

Objectives Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination. Methods We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods. Results More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts. Conclusions Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.