In this Convention, the term ‘racial discrimination’ shall mean any distinction, exclusion, restriction or preference based on race, colour, descendent, or national or ethnic origin which has the purpose or effect of nullifying or impairing the recognition, enjoyment or exercise, on an equal footing, of human rights and fundamental freedoms in the political, economic, social and cultural or any other field of public life.
Unesco Convention against Discrimination (1960)
Several studies in the area of public health and psychology dealing with the adverse effects of discrimination on people’s health have documented the impact of racial prejudice and discrimination on the mental and physical well-being among various minority groups.
In general terms, racism and ethnic prejudices affect health in two broad dimensions. Firstly they operate within the structure of societies to produce inequalities in employment, housing and environment. This can translate into different health outcomes among diverse racial/ ethnic populations. Secondly, discrimination and ethnic/racial bias also act upon the individual, creating psycho-physiological responses that can ultimately result in negative health outcomes.
A comprehensive review of the studies on ethnic/racist discrimination and health is presented by Williams (2003).13 The author reviewed a number of studies documenting
the adverse impact of racial discrimination on health in first world countries. Although most of these studies were conducted in the United States with a particular focus on the African-American population, they are helpful if we are to understand the effects of discrimination on health. Recently though some studies have begun to look at the situation of immigrant populations in Canada, England, Ireland, the Netherlands and Finland.
The majority of these studies have based their measurements upon ‘perceived discrimination.’ They often used self-reported tests with scales of exposure to discriminatory events. This was followed by alternatives, to establish the frequency of exposure to these events. In general, as the mentioned review confirmed, these studies have shown a strong association between discrimination and multiple indicators of poor physical health – and especially – mental health status.
13 Study based on a search of the MEDLINE database for the period 1998-2003, using prejudice as the
key word. It also included a search of the same time period in the PSYCHINFO and SOCIOFILE databases, using the key words: discrimination, race discrimination, social discrimination, and racism. Fifty three studies were reviewed, among which 32 included measures on mental health.
25 Mental health status was mostly measured using scales of non-specific distress. This showed a strong, distinct association between discrimination and distress as well as a definite relation between discrimination and psychological well-being (e.g. happiness and life satisfaction, self-esteem and perceptions of mastery and control). A relation between perceived discrimination and depression was established. In addition, a strong correlation between mental health and discrimination was determined in the case of generalised anxiety disorder, early initiation of substance use, psychosis and anger.
With physical health, most of the studies were based on self-reported measures, using general indicators of physical health status. In general, as Williams observed (idem), studies that included a global self-rated health item as an outcome variable, reported that discrimination was strongly associated with poorer health. This included chronic conditions, indicators of disability and other general ratings of health status.
Physiological reactions to exposure to racist events were reviewed by Harrell and colleagues (Harrell 2003). These studies used both self-reports by the participants and laboratory studies which exposed individuals to analogues of racist situations. These studies tested the proposition that “analogues of racist events or memories of these encounters result in physiological arousal or negative health sequelae” (ibid:243).
The association between blood pressure and discrimination and the potential of discrimination to account for the prevalence of hypertension has been studied among African Americans in the United States (idem). Subsequent studies tested other cardiovascular outcomes and racial discrimination, revealed that the development of atherosclerotic disease was definitely associated with experiences of everyday discrimination.
Other health outcomes have also been examined resulting in a positive association with perceived discrimination, such as low birth weight of children born to women who scored high on other health risks factors. There is also a definite association with cigarette smoking and alcohol abuse among people who regularly experience discrimination.
However, as it has also been found, there are a variety of factors moderating the effects of discrimination upon health. Williams found that “personality and coping processes moderate the relationship between discrimination and physiological variables” (2003:203). Krieger and Sidney, on the other hand, reported findings pointing towards the relationship between health and personal response to discrimination. They argued that “a passive posture and denial of discriminatory treatment were related to higher blood pressure readings” (Krieger 1996; Harrell 2003). With regards to social support, immigrants receiving high levels of social support had significantly lower blood pressure levels than those receiving less social support.
Even though existent studies give sufficient proof of the adverse effects of discrimination upon health, Williams (2003) pointed to some persistent gaps in knowledge within the field. For example, the difficulty to ‘objectively’ measure discrimination is visible in the studies reviewed, and renders the results questionable.
Additionally, the variety of methods used in these studies does not make it possible to determine the extent to which exposure to perceived discrimination leads to increased
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risk of disease. Also, it does not allow one to establish whether this exposure “leads to patterns of habituation, such that the effect of perceived discrimination is minimized” (ibid:200). Studies seem to confirm the current challenge in the field; which is to reach a deeper understanding of the underlying processes.
The next section discusses some of the conceptual and methodological challenges of studying the effects of discrimination upon general health. This discussion will help to define my own approach to the study of the effects of discrimination upon Peruvian migrants’ health.
1.4.1 Some theoretical and methodological challenges in measuring the
effects of discrimination on health
Studies devoted to the analysis of adverse effects of discrimination on health as referred to above, have not only documented such a relationship but also have shown the existence of some conceptual and measurement problems (Meyer 2003). The suitability of methods and scopes, plus the feasibility to measure outcomes of discrimination will be discussed in this section.
Studies of the effects of discrimination on health have used ‘the psychosocial stress model’. This is based on the sociological notion which sees racial discrimination and prejudice as stressors embedded within the social structure. This model has been used to explain health disparities emphasising stress associated with minority group status, and especially experiences of racism and discrimination.
In line with this model, discrimination can be seen as a twofold phenomenon; with objective and subjective dimensions. As an objective phenomenon, discrimination is viewed as “a stressful life event, real and observable phenomena that is experienced as stressors because of the adaptational demands they impose on most individuals under similar circumstances” (Dohrenwend 1993, quoted by Meyer 2003).
As a subjective phenomenon, discrimination is seen as “an experience that is contingent on the relationship between the individual and his or her environment. This relationship depends on properties of the external events but also, significantly, on appraisal processes applied by the individual” (Lazarus 1984, quoted by Meyer 2003).
As Cain put its, stressors have ultimate effects on health. “…Perceptions and experiences of racial/ethnic bias leading to unfair treatment can result in personal negative emotional and stress responses, which in turn, have been shown to relate to hypertension, cardiovascular disease, mental health and other negative states of health”. (Cain 2003:191). Discrimination can affect an individual or it can be institutional. It can be expressed in the daily hassles or life events, as mentioned before. Each one of these dimensions should be consistently addressed in the methods used to measure discrimination.
Individual v/s structural measures
Many studies, which are intended to measure the health effects of discrimination, simply analyse the effects of broader social oppressive relations at the individual level.
27 This approach leads to limitations in capturing the broader impact of prejudice and discrimination. Meyer points to the fact that existent barriers to the improvement of certain groups can be hidden and are, therefore, difficult to detect at the individual level. Thus, measurements relying upon individual reports of discriminatory practices run the risk of under-representing the phenomenon, simply because individuals are not always aware of the existence of such barriers (Meyer 2003). This is especially true in cases where institutional barriers are illegal, hidden and therefore, not easily detected.
On the other hand, when structural discrimination is not hidden and widely practiced, these practices are likely to affect many or all members of a minority group (ibid). Therefore, there is little use in studying its variability at the individual/personal level. This is more prevalent in cases where only members of the affected group are considered. In this situation, “within-group variability” is identified. However, this approach fails “to detect the potentially stronger manifestation of structural prejudice” (ibid:263). For Meyer “the impact of institutional stressor may best be documented via the assessment of differences in population parameters (including economics and health) at the group rather than the individual level” (ibid:264).
Subjective v/s objective measurements
A second problem noted by Meyer is that most studies measuring discrimination – either in the form of daily hassle or life events – are based on subjective perceptions. According to the author, “individual reports of discrimination depend on perception, which produces discrepancies in findings” (ibid:264). In fact, the cognitive dimension of ‘perceived discrimination’ leads to the need to scrutinise those factors influencing the subjective appraisal of discriminatory events.
Contrada (2000) tells us there is a set of motivational factors that influence the recognition of discrimination among minority groups. The author states that “although minority group members are motivated by self-protection in detecting discrimination, they are also motivated to ignore evidence of discrimination through a desire to avoid false alarms which can disrupt social relations and undermine life satisfaction” (Contrada 2000 quoted by Meyer 2003:263). He further reminds us that “in ambiguous situations, people tend to maximise perception of personal control and minimise recognition of discrimination” (ibid:263).
Meyer draws some conclusions from these observations in terms of health, arguing that “healthier individuals may use strategies that lead them to underestimate prejudice and discriminative events” (Meyer 2003:264). Furthermore there seems to be variations in perception of discrimination, according to the coping strategies used by the individuals affected.
Cognitive studies have shown that people who are resilient to prejudice have a stronger tendency to notice, recall and report prejudice events. Members of a minority group “have strong motivations to ignore prejudice-related events in some instances but to be ‘hyper-vigilant’ of such prejudicial instances” (ibid:264). These motivational factors represent challenges to researchers who are interested in an objective account of what actually occurred, as they can lead to inaccurate reports of events of discrimination and prejudice.
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There is also another risk involved in the subjective measurement of discrimination specifically in the area of mental health. This is the confounding of the measurement of perceived discrimination as an independent variable with its outcomes. For Meyer, it is problematic to rely only upon subjective perceptions of stress as confounding can occur between an individual’s health and his or her perception of stressors.
This problem is particularly evident in the case of research which examines the association between life events and mental disorders. Such studies, according to the author, require a methodological approach which is able to conceptualise and measure stress as an objective phenomenon, independent of an individual’s own view and feelings (Meyer 2003).
Daily hassles v/s life events
Discrimination as a major life event versus daily life hassles brings a third challenge to its measurement. Meyer states: “daily hassles are ubiquitous; most people perceive hassles as an unavoidable part of life and are expected to recover relatively quickly from such experiences”. However, “the association between daily hassles and mental health outcomes are likely to be underestimated, because the state of one’s mood probably affect perceptions and reports of daily hassles as well as outcomes measures” (ibid:264). This distinction between major life events and minor repetitive ones should be looked at from the perspective of what these events may convey in the collective history of a minority group.
For Williams (2003), the implication of everyday discrimination is what such acts of discrimination mean in a social context. They, in fact, are more significant than other differently rooted and traditionally defined daily hassles. Meyer points to the fact that they can evoke painful memories which relate to personal and collective history of prejudice against minority groups.
These minor discriminative events can have a negative and cumulative effect on health outcomes. For example, the effects of these events on cardiovascular health, via activation of the sympathetic nervous system, have been examined (Meyer 2003). An additional point is made by Meyer on ethical problems involved in looking at discrimination and prejudice solely based on subjective perceptions. That is: it indirectly undermines the notion that racism and other forms of prejudice are social and not individual stressors.