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Last year, when Congress was attempting to repeal and replace the Affordable Care Act, I had the honor of presenting a briefing on the psychology of ethnic-racial health disparities to congressional staffers. I was impressed by their enthusiasm, but concerned by their surprise at the pervasiveness of health disparities. Two questions came to mind. First, if congressional staffers are mostly unaware of the health disparities research, then what are the implications for their main responsibility to write health legislative initiatives fair to Americans from all ethnic-racial backgrounds? Second, what are psychologists doing to democratize our knowledge of health disparities so that we break the cycle of historical under-representation of certain ethnic-racial groups in health legislation?
The diversity of ethnic-racial groups in the United States today is one of the country’s greatest assets. However, the social benefits of our heterogeneous society are overshadowed by the reality that stigmatized ethnic-racial groups carry a disproportionate burden of negative health outcomes. For example, Hispanics and African Americans are more likely than White Americans to be obese, which is a risk factor for a variety of chronic physical health conditions like heart disease and diabetes. Furthermore, Hispanics, African Americans, and Native Americans suffer disproportionately from higher rates of hypertension and some cancers. Finally, Black and Hispanic American adults are less likely to rely on a private physician for their medical care than White American adults, and the overall quality of healthcare received by Hispanics, African Americans, Asians and Native American tends to be worse than that received by White Americans. These differences in the burden of health conditions and the quality of health care experienced by socially disadvantaged relative to socially advantaged groups are referred to as health disparities.
The issue of health disparities draws the attention of medical doctors and scientific researchers alike because they are not generic health differences, but rather systematic health inequities targeting groups with relatively low position in the social status hierarchy. This low status is a function of the unequal distribution of social, economic, and environmental resources. Poverty, inadequate health care, less education, greater residential segregation, and lack of access to healthy foods are among the resource-based variables that leave individuals vulnerable to poor health. One common factor among all of these resources is an individual’s ethnic-racial identity. Individuals who identity as African American, Hispanic, and Native American are less likely than those who are White American to possess these tangible resources necessary for good health.
Over the past two decades, psychologists have worked to demonstrate that intangible psychological factors can determine an individual’s health and the quality of health care they receive above and beyond social, economic, and environmental resources. We have begun to shed light on the psychological processes by which one’s ethnic-racial identity translates into poor health; these processes are strongly tied to ethnic-racial biases and stigma, operate at multiple stages, namely at the intra-individual, interpersonal, and intergroup levels, and these different levels interact with structural-based resources that are frequently less available to stigmatized individuals.
To empirically demonstrate the existence of health disparities and their underlying psychological processes is motivation enough for research psychologists. However, there is arguably an even more fundamental issue for why psychology must persist in studying and democratizing its health disparities research - it’s a social justice issue! The issue of health disparities is about social justice because every person should have the right to enjoy optimal health regardless of their ethnic-racial identification.
The United States has played a historical role in addressing social justice issues. Brown vs. Board of Education, the Civil Rights Act, and the American with Disabilities Act are examples in which social issues drove our government to reject (or protect its citizens from) institutional forms of bias. The present social issue is health disparities, and like the issues that came before it, this issue is about justice. Social justice principles are driven by the belief that all human beings regardless of their ethnic-racial background should be afforded basic, equal, and fair rights. One such right should be the opportunity to live a healthy life because it enables citizens to work, participate in government and political activities, and enjoy their personal lives and relationships. Health disparities are an injustice because they limit the ability of certain social groups to function optimally in society. It is unfair that stigmatized individuals who suffer poor health should be further disadvantaged by their inability to enjoy a host of social benefits and privileges.
April is National Minority Health Month. It is an opportunity to remind psychology that the burden of translating laboratory and community-setting research into public policy recommendations lies on the shoulders of psychological scientists. It is our obligation as psychologists, and as citizens, to make clear how health disparities research can inform public health policies.
Dr. Luis M. Rivera, Ph.D., is an experimental social psychologist and faculty member in the Department of Psychology at Rutgers University, Newark. His research focuses on the implicit social cognitive processes underlying stereotyping and prejudice, and how they shape the self, identity, and health of stigmatized individuals.
For more information about health disparities research, access the following issue of SPSSI's Journal of Social Issues edited by Dr. Rivera entitled, "Ethnic-Racial Stigma and Physical Health Disparities in the United States of America: From Psychological Theory and Evidence to Public Policy Solutions."
