Discrimination: A Social Determinant Of Health Inequities

It is well understood that stress is a significant predictor of poor mental and physical health and health-harming behaviors, such as alcohol and substance use, poor sleep, and so forth. The unequal distribution of stressors is believed to be a key mechanism that explains health disparities among socially disadvantaged communities. However, researchers and communities alike know that groups such as sexual and gender minorities, women, lower-income people, and communities of color, also face another important stressor more frequently than other groups: discrimination.  

The link between health and social factors—such as housing, employment, and education—is well explored in research. Epidemiologists and other researchers continue to reveal the complex, interconnected influence of non-health factors, or “social determinants of health,” on the well-being of communities. As a stressor, discrimination is a social determinant of health in its own right, getting “under the skin,” or embodied, through the direct physiologic impact of stress. Discrimination also exists within the larger social environment, impacting individuals’ health by denying them access to resources, dignity, and a high quality of life. As a follow-on to a recent Health Affairs blog post by Aric Prather exploring stress as a pathway between social factors and health, this post examines the unique role of discrimination as a stressor and the part it plays in creating health inequities. 

What Is Discrimination?
Discrimination is unequal treatment based on physical characteristics or social group assignment. While “to discriminate” simply means to divide, or make distinct, to “discriminate against” connotes adverse and unfair treatment of the groups being distinguished based on underlying prejudicial beliefs, stereotypes, or general antagonism toward that target. Discrimination is most often attributed to race, sexual orientation, gender, and gender identity, but can be directed toward individuals or communities with a variety of physical and social attributes such as age, body size, ability, social class, or religion—as well as the multiple intersections thereof.