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      Understanding how discrimination can affect health

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          Abstract

          Background

          To provide an overview of the empirical research linking self‐reports of racial discrimination to health status and health service utilization.

          Methods

          A review of literature reviews and meta‐analyses published from January 2013 to 2019 was conducted using PubMed, PsycINFO, Sociological Abstracts, and Web of Science. Articles were considered for inclusion using the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) framework.

          Results

          Twenty‐nine studies met the criteria for review. Both domestic and international studies find that experiences of discrimination reported by adults are adversely related to mental health and indicators of physical health, including preclinical indicators of disease, health behaviors, utilization of care, and adherence to medical regimens. Emerging evidence also suggests that discrimination can affect the health of children and adolescents and that at least some of its adverse effects may be ameliorated by the presence of psychosocial resources.

          Conclusions

          Increasing evidence indicates that racial discrimination is an emerging risk factor for disease and a contributor to racial disparities in health. Attention is needed to strengthen research gaps and to advance our understanding of the optimal interventions that can reduce the negative effects of discrimination.

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          Most cited references58

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          Racism as a Determinant of Health: A Systematic Review and Meta-Analysis

          Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health (r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health (r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.
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            Racism and Health: Evidence and Needed Research

            In recent decades, there has been remarkable growth in scientific research examining the multiple ways in which racism can adversely affect health. This interest has been driven in part by the striking persistence of racial/ethnic inequities in health and the empirical evidence that indicates that socioeconomic factors alone do not account for racial/ethnic inequities in health. Racism is considered a fundamental cause of adverse health outcomes for racial/ethnic minorities and racial/ethnic inequities in health. This article provides an overview of the evidence linking the primary domains of racism—structural racism, cultural racism, and individual-level discrimination—to mental and physical health outcomes. For each mechanism, we describe key findings and identify priorities for future research. We also discuss evidence for interventions to reduce racism and describe research needed to advance knowledge in this area.
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              Racial residential segregation: A fundamental cause of racial disparities in health

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                Author and article information

                Contributors
                dwilliam@hsph.harvard.edu
                Journal
                Health Serv Res
                Health Serv Res
                10.1111/(ISSN)1475-6773
                HESR
                Health Services Research
                John Wiley and Sons Inc. (Hoboken )
                0017-9124
                1475-6773
                29 October 2019
                December 2019
                29 October 2019
                : 54
                : Suppl 2 , Experiences of Discrimination in America: Race, Ethnicity, Gender, and Sexuality ( doiID: 10.1111/hesr.v54.s2 )
                : 1374-1388
                Affiliations
                [ 1 ] Department of Social and Behavioral Sciences Harvard T.H. Chan School of Public Health Boston Massachusetts
                [ 2 ] Department of African and African American Studies Department of Sociology Harvard University Cambridge Massachusetts
                Author notes
                [*] [* ] Correspondence

                David R. Williams, PhD, MPH, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.

                Email: dwilliam@ 123456hsph.harvard.edu

                Author information
                https://orcid.org/0000-0002-8654-6228
                https://orcid.org/0000-0003-4162-9860
                Article
                HESR13222
                10.1111/1475-6773.13222
                6864381
                31663121
                669e1a8f-c15d-41b1-9c68-54e1b5bdae5f
                © 2019 The Authors. Health Services Research published by Wiley Periodicals, Inc. on behalf of Health Research and Educational Trust

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 1, Tables: 1, Pages: 15, Words: 9409
                Funding
                Funded by: W.K. Kellogg Foundation , open-funder-registry 10.13039/100007746;
                Award ID: P0131281
                Categories
                Special Issue: Experiences of Discrimination in America
                Special Issue: Experiences of Discrimination in America: Race, Ethnicity, Gender, and Sexuality
                Custom metadata
                2.0
                December 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:05.12.2019

                Health & Social care
                discrimination,health,health disparities,mental health,racism
                Health & Social care
                discrimination, health, health disparities, mental health, racism

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