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Stressing Discrimination

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“Surveys often capture only the blatant discrimination. Yet, we know that stress from more subtle forms matters.”

A LONG HISTORY OF RESEARCH SHOWS THE HEALTH BENEFITS of climbing the socioeconomic ladder: People with higher levels of education, income and job prestige tend to have more knowledge and resources to achieve good health, and this is reflected in better health outcomes among better-educated and more affluent populations than for lower socioeconomic groups. But in recent years, it’s become clear that African-Americans don’t accrue the same health benefits from higher socioeconomic standing as non-Hispanic whites. Moreover, racial health disparities can’t be fully explained by differences in socioeconomic status (SES).

Why might the so-called SES health gradient not be as steep for African-Americans? Dr. Courtney S. Thomas is examining the role of discrimination-related factors. Thomas, who joined the Fielding School faculty in July, notes that because of broader institutional inequalities, African-Americans on average have lower incomes and less wealth than whites with the same educational attainment. But Thomas is also finding evidence that as they move into higher-SES categories, African-Americans are exposed to more race-based discrimination — and that the stress from these exposures has implications for physical as well as mental health. “When we see higher rates of hypertension, obesity, heart disease, and other chronic conditions,” Thomas explains, “much of that can be linked back to everyday experiences of stress and discrimination that build up over time.”

Thomas notes that race-based stress can often be traced to micro-aggressions and other nuanced experiences in diverse settings that can leave African-Americans to wonder whether what they encountered was due to racial bias. “Let’s say an African-American male in upper management is being congratulated for giving a great presentation, and one particular colleague is going on and on about how articulate he was rather than talking about the actual content,” Thomas says. “That African-American male may think to himself, ‘You’re supposed to speak well in upper management. Is this observation being made because I’m black?’ ”

Thomas has coined the term “ambiguous discrimination stress” in her research to describe the types of subtle experiences many African-Americans face on a regular basis, particularly as they move up the socioeconomic ladder. “Surveys often capture only the blatant discrimination,” she says. “Yet, we know that stress from more subtle forms matters, and if we don’t measure it, that makes it hard to intervene effectively to prevent the negative health effects.”

Beyond measuring the problem, Thomas is seeking to understand the roles of coping and resilience among African-Americans who face these race-based stressors. “There is no denying that improving the resources and opportunities for communities of color is important,” she says. “And we are all working hard to improve diversity, inclusion and equality. But at the same time, our efforts to address health disparities should consider people’s current experiences and harness the resources they already have.”