DiversityNursing Blog

Though discrimination exists in many forms, racial discrimination brings a unique set of implications that threaten the mental and physical health of patients and acts as a barrier to seeking care from medical professionals. Eliminating racism, therefore, is not just a concern for civil rights activists, but also for medical professionals.

Whether it’s the mere anticipation of discrimination, or violence as a manifestation of prejudice, racism has negative impacts on the mental and physical health of its victims, including “increased stress, depression, high blood pressure, cardiovascular disease, breast cancer, and mortality.” A study in the American Journal of Public Health found that perceived discrimination influences lifestyle decisions like overeating, internalizing aggression, and developing poor coping strategies that impact long-term health.

These lifestyle choices are part of a vicious cycle that can be influenced by social determinants of health, which are “conditions in one's environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not,” according to Healthy People 2020.

One study found that racism experienced by minority communities increased vulnerabilities to social and environmental factors that contribute to health, like access to health care and income level. The National Association of Social Workers found that these social determinants of health also include “poor health and health services, inadequate mental health services, low wages, high unemployment and underemployment, overrepresentation in prior populations, substandard housing, high school dropout rates, decreased access to higher education opportunities and other institutional maladies.”

In addition to affecting long-term health, social determinants can be barriers in seeking quality health care, and can lead to poorer outcomes after treatment. Many minorities cite racial discrimination as a primary barrier to seeking health care — particularly treatment for mental health issues. In a survey of adults who experienced an unmet need for mental health treatment in the past year, respondents across all racial group cited discrimination as a primary barrier to seeking treatment. Nearly a quarter of respondents said they anticipated negative stigmas surrounding treatment to impact relationships and employment circumstances.

As key resources in patients’ access to quality primary care, health care professionals, like Family Nurse Practitioners, must understand these implications of racial discrimination among other social determinants, and mitigate harmful, pervasive effects through opportunities like these:

• Advocating for awareness: Nurses, as they interact with patients closely and regularly, can be advocates for patient needs, as they help identify key social determinants that leave patients vulnerable to the systemic racism. Public health advocates can also reach out to minority communities to help them understand the importance of physical and mental health.
• Treating mental health as primary health: Integrating behavioral health care screening and treatment can help patients make better use of clinic visits and resources they might not otherwise be able to access. This increased access can reduce health disparities and increase effectiveness of treatment.
• Promoting cultural competency: A diverse nursing staff can improve cultural competency — being conscious of social and cultural differences — and increase quality of care to underserved groups. By valuing diversity, nurses and other health professionals can take pivotal steps in ensuring access to care for an increasingly diverse patient population.

An integrated approach to mitigating discrimination can address both the causes and effects of its impact on accessing quality care. This means nurses should work together with other health practitioners, social workers and educators to understand and identify at-risk patients and appropriate strategies. Above all else, the goal is to help patients feel safe, understood and heard when seeking health care or treatment.

Discrimination in the United States has historically cut a wide swath across a number of demographics, including race, gender, ethnicity, sexual orientation, age, disability and religion. Despite a major cultural and political shift through the implementation of the long overdue Civil Rights Act of 1964 and other efforts at fighting discrimination, we still see it today — particularly in the form of modern-day racism. According to the National Association of Social Workers (NASW), racism is “the ideology or practice through demonstrated power of perceiving the superiority of one group over others by reason of race, color, ethnicity, or cultural heritage.”

Though all discrimination is harmful, an examination of the effects of racism — the most commonly studied and cited form of discrimination — reveals implications for the mental and physical health of individuals and communities that can be applied to other types of discrimination. Racism, therefore, is not just a civil rights issue, but also a public health concern.

As key figures in addressing such consequences, health care professionals, such as Family Nurse Practitioners, must recognize the health implications involved and know the steps they can take to help stop discrimination and mitigate its negative outcomes.

Impact of Discrimination on Health

The NASW says racism results in “poor health and health services, inadequate mental health services, low wages, high unemployment and underemployment, overrepresentation in prior populations, substandard housing, high school dropout rates, decreased access to higher education opportunities and other institutional maladies.” Some of these factors can be classified as social determinants of health (SDOH), which have a major influence on health outcomes. According to Healthy People 2020, SDOHs are defined as “conditions in one's environment — where people are born, live, work, learn, play, and worship — that have a huge impact on how healthy certain individuals and communities are or are not.” 

In one study of the health effects of discrimination on black and white communities, SDOHs were defined as a critical factor, since populations that lack appropriate resources are affected the most: “On average, black adults typically experience more health risks in their social and personal environment than white adults (including higher poverty and lower-quality medical insurance), they may be especially vulnerable to negative health effects as a result of racial discrimination." 

There are a number of physical and mental health effects related to discrimination, including increased stress, depression, high blood pressure, cardiovascular disease, breast cancer, and mortality. According to a study published in the American Journal of Public Health, “Merely anticipating prejudice leads to both psychological and cardiovascular stress responses. These results are consistent with the conceptualization of anticipated discrimination as a stressor and suggest that vigilance for prejudice may be a contributing factor to racial/ethnic health disparities in the United States.” Additionally, discrimination has been found to impact lifestyle decisions that affect health long after the experience is over.

Communities at highest risk for discrimination are the same communities that are perpetually marginalized by the negative impact of SDOHs. In a 2013 Atlantic article titled “How Racism is Bad for Our Bodies,” writer Jason Silverstein points out that the cyclical effect of discrimination on health is what epidemiologist Nancy Krieger refers to as “embodied inequality,” which creates poor health outcomes that are often passed down through generations. This results in a vicious cycle where the sickest and poorest among us are more likely to remain sick and poor.

Solutions and Strategies

Health care professionals and policymakers can play a key role in curbing discrimination by supporting legislation and policies that address these issues, such as the U.S. Department of Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities. The U.S. Office of Minority Healthprovides a summary of this action plan, and serves as a “one-stop source for minority health literature, research and referrals for consumers, community organizations and health professionals.” Through use of such resources, and appropriate support networks, victims of discrimination can find the support they need to exercise their rights and end the various forms of discrimination they may be vulnerable to.

Additionally, it is essential that health care professionals work to better recognize the effects of discrimination by taking SDOHs into consideration as part of their approach to care, understanding which populationsmay be at greater risk for discrimination, screening for negative health outcomes that may be a direct result, and ensuring that discrimination is not occurring within their own practice settings. Providing access to necessary resources and additional support for these patients is critical.

Implications for FNPs

Family Nurse Practitioners are integral to comprehensive care for all patients, and serve as a key resource for those most vulnerable to discrimination’s negative effects on health. “At the University of Southern California Department of Nursing in the School of Social Work, we are teaching our students about the central importance of social determinants of health, with racism being a key determinant, in the health of individuals and families,” said Ellen Olshansky, Professor and Chair of Nursing at USC School of Social Work. Although the policy statement by the American Nurses Association, “Discrimination and Racism in Health Care,” dates to 1998, its principles are just as relevant today, addressing both the health care environment and the patients who are served:

ANA believes it is critically important for Americans to come to a shared understanding of the negative consequences of discrimination and racism which still pervades our society and be willing to take individual as well as collective actions to bring America closer to our ideal of equality and justice. Equality and justice must also extend to other minorities such as the aged and disabled. Health care that is individualized to the health practices and specific needs of each person and/or population group is vital to maintain and improve the health of all Americans.