Categories and examples of health inequities, stems from social, economic, environmental,

and structural differences that have a hand in intergroup disparities in health outcomes both
within and between communities. People within socially disadvantaged groups face
numerous challenges that negatively impact their health outcomes ( Rivenbark and Ichou,
2020, p.1-10). Research has increasingly focused on encounters of discrimination, among a
myriad of factors and how they may relate to individuals well-being and health.
Apart from a direct influence on health that discrimination has through physiologic pathways,
it is also thought to impact health indirectly through behavioral responses (Mays, Cochran
and Barnes, 2007, p.201). A meta-analysis conducted by Pascoe and Richman (2009, p.531),
outlined a vital association between the discernment of discrimination and health-related
behaviors such as substance abuse, sleep, exercise or diet. Even so, health care utilization has
been at the end of receiving comparatively less focus in its one health-related behavior that
has received comparatively less attention in its relation with discrimination (Lyons and
Hosking, 2014, p. 1621-1635). People with a past encounter with discrimination maybe more
disinclined to look for health care, as they may appraise it to be a hub of further mounting of
discrimination in the form of receiving low quality of health care and even refusal of being
offered a service (Bird and Bogart, 2001, p. 554-563). This may be especially true for those
who have experienced discrimination within the health care setting itself. Earlier efforts have
postulated that individuals who have encountered discrimination when receiving care, might
lose trust and satisfaction with the health care setting leading to reluctance in seeking health
services (Quach et al., 2012, p. 1027-1034). Differences in the amount of discrimination in
health care across language capabilities, immigrant standing, insurance status and
race/ethnicity has been recorded by research from the United States of America (USA)
(Lauderdale et al., 2006, p.914-920). Mixed findings have come up by further research which
has looked into the viable connections between healthcare utilization and discrimination
(Dehkordy et al., 2016, p. 1044). A link between reduced preventive care use and encounters
with racial discrimination in the health care setting was recorded in a comprehensive survey
carried out in New Zealand (Harris et al., 2012, p. 1012-1019). Although a separate wide
survey in the USA did not find significant associations when the sociodemographic elements
were taken care of (Hausmann et al., 2008, p. 1679-1684).
Differences based on race and ethnicity remain to be interminable and hard to address. Health
inequities may arise from being socially disadvantaged among other factors and I will
illustrate these points through the eye of racism in African American minorities in the USA.
Because racial elements among other factors are responsible in structuring social and
economic differences, addressing health disparities that stems from racism is likely to
positively affect also other social and economic factors (Assari, 2018, p.112-145). The
following paragraphs discuses how racism influences health outcomes via three main
mechanisms which include discrimination and segregation.
Discrimination presents in many forms such as undisguised, deliberate treatment,
unintentional and unconscious treatment of individuals in ways that are different which leads
to minorities being treated unsatisfactorily. Contemporary meta-analysis studies have
indicated that racial discrimination has detrimental effects not only to the mental health but
also to the physical wellbeing of the victims (Toosi, 2012, p. 1). A study done by Mays,
Cochran and Barnes (2007, p. 201), found remarkable percentage of racial and ethnic
minority members who gave an account of encountering racism in both health and non-health
care settings. More than members of other groups, African Americans reported to have
encountered racism personally or perceived it to be affecting the general African American
population.
Mouzon et al., (2017 p.175-182) highlighted that in general, discrimination is associated with
poor mental health outcomes such as mood and anxiety disorders, with some studies
suggesting schizophrenia  (Selten and Cantor-Graae, 2007; Howes and Murray, 2014),
increased allostatic load ( e.g. when environmental challenges surpass the individual ability to
adapt,) and other biomarkers that signals a reduced neurological response and increased risk
of cardiovascular and metabolic related outcomes, even though some studies have proposed
that discrimination does not bring out these out comes (Shavers et al., 2012, p. 953-966);
substantial involvement in dangerous behavior and diminished probability of exercising
health protecting behaviors (Viruell-Fuentes, Miranda and Abdulrahim, 2012, p. 2099-2106).
The health outcomes of racism seem to emerge from stress of persistent subjection to small
forms of day-to-day racism also known as racial microaggressions, such as treating someone
has a second-class citizen because of their race which often leaves them demoralized or a
security guard following a black person, presuming they are going to cause damage or steal
(Anderson et al., 2016, p. 31; Paradies, 2006, p. 888-901). Persistent subjection plays a part
in stress related biological effects. Hence a single traumatic encounter of discrimination is not
enough to employ great effects but that people have to contend with seemingly minor racial
aggressions mentally and physically on a near regularly basis (Weinberger et al., 2018, p.
1308-1315). The repercussions are greatest with problems that stems from stress such as
mental health outcomes, hypertension, behaviors that involves substance abuse, preterm birth
and low birth weight than for other results (Braveman and Gottlieb, 2014, p.19-31).
Instead of shielding racial and ethnic minorities from discriminatory encounters, a high social
economic status lender even more vulnerability to discrimination. The John henryism theory
which encourages to expend high levels of efforts to overcome economic hardships and racial
discrimination among African American males, may lead to unpleasant cardiovascular related
health outcomes due to the accumulation of physiological costs (James, 1994; Hill and
Hoggard, 2018, p. 1817-1835).
Another form of discrimination is implicit bias, defined as unconscious attitudes and
stereotypes that affect our understanding, decisions and actions (Saluja and Bryant, 2021, p.
270-273). A lot of the public health studies have highlighted that health care providers, with
not much time to attend to individual patients can provide care that is inferior to African
American patients than for white patients, supposing that the health care provider did not
intend to do so (Williams and Collins, 2016). Based on the results of pictures from the brain
through magnetic resonance imaging, FitzGerald and Hurst (2017, p. 1-18), indicated that
researchers found white health care providers to enfold implicit biases against African
Americans. Burgess, Beach and Saha (2017, p. 372-376), highlighted that this is not only
confined to health care providers, the biases drive professionals to connect negative attributes
to individuals they discern to be African Americans and this leads to patients being treated
differently depending on their race.
African Americans appear to be assessed negatively by health care providers for example,
physicians being reluctant to prescribe narcotics and pain medications because deem African
Americans to be on the likelihood of engaging in risky behaviors (Roberts et al., 2011, p. 71-
83). A longitudinal study showed that health care providers who are white dallied to prescribe
protease inhibitors to HIV infected African American individuals than to HIV infected whites
(Stangl et al., 2013, p. 18734).
Segregation in terms of social isolation can not only reduce the general public awareness of
the interventions needed, but can also aggravate the rates of disease among African American
minorities (Gee and Ford, 2011, p. 115-132). These minorities are likely to reside in areas of
intense poverty than even low socioeconomic status whites where even poor-quality shared
resources that can compound the effects of low SES challenges are scarce (Foster, 2010, p.
49-51). Racial segregation reduces access to health care and socioeconomic resources in
African American societies in that there’s reduced number of health care providers within the
communities and residents who attain an improved SES leave the communities (Arnett et al,
2016, p. 456-467). Contentious policies and gun violence have consequentially impacted
African American minorities mentally and physically, racial segregation also increases
vulnerability to environmental hazards and in addition it is related to greater prevalence of
liquor stores and fast-food outlets (Vaeth, Wang‐Schweig and Caetano, 2017 p. 6-19).
Few studies have shown interventions that have been put to the test to help curb disparities in
health outcomes. Everret a city in boston, is among the communities taking action by
improving community police interaction through mitigating racial profiling by police
officers, police department hiring practices and youth perceptions about the police. This has
helped the African American minorities with information on what to expect when stopped by
the police, the fight against substance abuse, addressing misconceptions, increase the
diversity of the police force and establishing a ground of trust (Kent et al., 2016, p. 114-122).
To address structural elements such as segregation, multifactorial and policy interventions are
important (Nation et al., 2020, p. 715-730). A study by Came and Griffith (2018, p. 181-188)
highlighted that addressing direct and indirect factors that result in health outcome
differences especially in organizational and environmental settings is key to change. Also, to
dismantle racial health disparities, the undoing racism project’, underlines integrating
community based participatory research concept with an undoing racism process’ creating
relationships founded on trust within communities (Oetzel et al., 2018). The Praxis project,
whose mission is to create racial equity, provide justice and establish powerful relationships
and structures for health to help minorities thrive (Fields, 2015, p. 144-165).
Community based interventions has helped to dismantle implicit bias through Plan of actions
such as principled policing’ and policy transformation enrolled by law enforcement
establishments in the US, which has resulted in toughening police-community relationship
thereby shaping the outcomes of police and resident’s interaction (Trinkner et al., 2019, p
661-671). Encouraging strategies through new evidence has shown that cognitive based
interventions has the prospect of mitigating implicit bias through mindfulness which helps in
decision making (Bohner and Dickel, 2011, p. 391-417). Mindfulness operates on the
attention process of the brains cognitive function responsible for executive functions which
helps in exercising intention and not judgement (Forscher et al., 2019, p. 522).
The outcomes of health for African Americans as socially disadvantaged group, is a subject
matter of expanding scientific and policy importance in the US. The study has highlighted the
impact of racial discrimination and segregation on health outcomes of African American
minorities and evidence-based interventions. Even though there is new body of literature of
tested and promising interventions, there’s need for research to expand in order to mitigate
the disparities.
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