Discrimination in the United States: Experiences of black Americans

Abstract

Objective To examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes. Data Source and Study Design Data come from a nationally representative, probability‐based telephone survey including 802 non‐Hispanic black and a comparison group of 902 non‐Hispanic white US adults, conducted January–April 2017. Methods We calculated the percent of blacks reporting discrimination in several domains, including health care. We used logistic regression to compare the black‐white difference in odds of discrimination, and among blacks only to examine variation by socioeconomic status, gender, and neighborhood racial composition. Principal Findings About one‐third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A majority of black adults reported experiencing discrimination in employment (57 percent in obtaining equal pay/promotions; 56 percent in applying for jobs), police interactions (60 percent reported being stopped/unfairly treated by police), and hearing microaggressions (52 percent) and racial slurs (51 percent). In adjusted models, blacks had significantly higher odds than whites of reporting discrimination in every domain. Among blacks, having a college degree was associated with higher odds of experiencing overall institutional discrimination. Conclusions The extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black‐white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice.

Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes

“…Black, Hispanic, Asian American, and Native American adults are more likely to report experiencing discrimination in health care and avoiding health care out of concern for discrimination or poor treatment compared to white adults [ 14 , 15 , 16 , 17 ]. Patients’ acceptance of home health care is associated with the quality of hospital discharge planning communication and prior positive or negative experiences with post-acute care [ 18 , 19 ].…”

Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research

“…Indeed, over the last several years, a constant and growing barrage of national news reports have illuminated the PLOS ONE myriad occurrences of racial discrimination experienced by African American women, men, and children across the country. White bystanders have requested unnecessary police intervention in situations where African Americans are engaging in routine, everyday activities such as bird watching, jogging, swimming in community pools, operating lemonade stands, entering their apartments, moving into new single-family homes, hosting neighborhood barbeques, or transacting business with their bank teller at a local financial institution [12,[23][24][25][26][27][28][29][30][31][32][33][34][35][36]. Paralleling these news reports is an uptick in anti-Black hate crimes documented by the Federal Bureau of Investigation across 2017 and 2018 [24,25].…”

“…Across decades of social science research, African Americans consistently self-report the highest levels of race-related and general interpersonal discrimination across major life domains. Indeed, 80 to 100% of African Americans report lifetime exposure to racial discrimination in daily life [26][27][28][29][30][31][32]. In one longitudinal study, 90% of African Americans reported persistent racial discrimination at work; in the marketplace; when seeking employment, housing, or medical care; and when engaging with law enforcement and the judicial system across a seven-year span [40].…”

Should Clinical Guidelines Incorporate Cost Pathways for Persons With Financial Hardship?

“…Difficulty affording medications leads patients to make unpalatable decisions, such as taking medications less frequently than prescribed, buying less nutritious food to afford medication, or choosing between the needs of family members or their own needs. 35 Furthermore, people with low income are subject to structural forces that suppress wages, create dangerous work environments, undermine social services, limit affordable and stable housing, create food deserts, contribute to disproportionate rates of incarceration or control by judicial systems, threaten the social fabric of early childhood, make health care less accessible, expose people to pollutants, undercut the quality of primary and secondary education, and limit access to higher education, thereby maintaining a skewed playing field. 9 As described above, the poor are blamed for their poverty.…”