Guest Lecture: Health Disparities, Racism, Discrimination

Health Disparities

There are racial and ethnic disparities in health

• SES and ethnic differences have an impact in the delivery of medical treatment

• To address health disparities, health psychologists should understand the role of culture, discrimination, and racism in health outcomes

• The US spends much more on health care than other countries

Risk Factors of low SES

• Fewer psychosocial resources

• Higher rates of chronic illness

• Low birth weight babies

• infant mortality

• higher risk of accidents

Culture

The customary beliefs, social norms, and material traits of racial, religious, or social group

• The characteristic features of everyday existence (such as diversions or a way of life) shared by people in a place or time

• The set of shared attitudes, values, goals, and practices that characterizes an institution or organization

Discrimination

A socially structured action that is unfair or unjustified and harms individuals and groups

• Can be attributed to social interactions that occur to protect more powerful and privileged groups at the detriment of other groups

• Acts as a social stressor that has physiological effects on individuals (e.g., irregular heartbeat, anxiety, heartburn) that can be compounded over time and lead to long-term negative health outcomes

Ecological Levels of Analysis

Structural and Individual

Structural

Macro-level (e.g., residential segregation)

• Limits opportunities, resources, and well-being of groups

Individual

Based on individual characteristics

• Negative interactions between individuals in their institutional roles (e.g., healthcare provider and patient) or as public/private individuals (e.g., salesperson and customer)

Racism

Discrimination on the basis of race (as well as ethnicity and culture)

Examples in healthcare

• Structural: Blacks have higher death rates for 8/13 leading causes of death

• Individual: Black newborns cared for by black doctors are less likely to die than under the care of white doctors

Dr. Cheryl Armstead

USC Faculty

• Director of the Health Equity Lab with the goal of promoting health equity, prevention, and resilience among medically underserved populations

Dr. Meeta Banerjee

USC Faculty

• Utilizes ecological frameworks to understand the effects of racial discrimination on mental health and educational outcomes

Application 1

• HIV is the virus that can lead to AIDs

• HIV prevention pill is not reaching most who could potentially benefit- especially African Americans and Latinos

• Male-to-Male is also frequently affected

• Racial wealth gap (lower income) may contribute, as well as education, segregation in housing, employment, health care barriers, and racially skewed mass incarceration

Social Determinants of Health

Are the conditions in which people are born, grow, live, work, and age, including the health system

• They are better predictors of HIV outcomes than risk behaviors

• Although this is the case for all chronic conditions, this is especially evident with HIV because of its communicable nature

• Targeting communities of color with attitude/behavior modification alone is ineffective and harmful

• Addressing structural inequalities is necessary to eliminating racial disparities

Residential Segregation

This and housing discrimination is one of the key factors contributing to HIV disparities among communities of color in the US

• Segregation condenses a communities social networks, which ultimately increases the “community viral load” - an aggregation if the individuals viral load across the community

• Southerners are less likely to obtain treatment; POC Southerners are 5x more likely to experience complications than all other regions of US, Canada, Australia, and Brazil

Health Psychologist: Application 1

Can push for the following policy changes:

• Redistribute HIV/AIDs funding to reflect the disproportionate burden in the South

• Pass the Housing Opportunities Made Equal, or HOME, Act

• HIV Prevention and risk reduction interventions focusing on HIV knowledge, sex education, and condom use have effectively decreased health-compromising behaviors

• For stronger and culturally appropriate sex education, which is necessary to combat the health disparities faced by racial, gender, and sexual minorities

  • Example: Representation of racial/ethnic, gender, and sexual minorities in sex education. Distributing materials in familiar language and formats

Cultural Barriers to HIV Prevention

• Distrust of the System

  • Undocumented immigrants face risk of deportation

  • Historical unfair treatment from medical systems towards peple of color (E.g., Tuskegee Syphilis Study)

• Stigma

  • HIV related, LGBTQ related

U=U Campaign

Undetectable=Untransmittable

COVID 19

• Best way to prevent illness is exposure reduction

• Thought to spread mainly from person to person

• Health compromising behaviors include those which may cause harm to their current or future health

  • Behaviors that are not in accordance with CDC recommendation (e.g., close contact with others outside your household

• Long-term effects may include organ damage, neurological defects, blood clots, BV problems, difficulties with mood and fatigue

• Black Americans are dying 3x the rate of white people

• White comorbidities are a factor, there is mounting evidence that Black Americans are disadvantaged in terms of access to testing and treatment for the disease

• How can the medical community address this issue?

  • Understanding our own privilege and biases

  • Medical institutions and associations to require implicit bias training