Society makes a stringent effort to teach children the difference between right and wrong when it comes to discriminating against others because of race, religion, or sexual orientation. New research shows that this list needs to be expanded to include discrimination based on income, in part because a child’s health may depend on it, advises Thomas Fuller-Rowell, PhD, a 2011-2013 Robert Wood Johnson Foundation (RWJF) Health & Society Scholar.
“I’ve always been interested in how stress influences health,” Fuller-Rowell says. “But I also believe it’s important to study how social inequalities link with health. For these reasons, I decided to study class discrimination as one potential explanation for socioeconomic health disparities.”
In order to look at the health impact of social class and income-based discrimination on a group of young people, Fuller-Rowell’s study focused on a rural community. “A large number of low-income Americans live in rural areas,” he explains, “but they are often excluded from research on poverty.”
The Discrimination/Hypertension Link
For their study “Poverty and Health: The Mediating Role of Discrimination,” published in the June issue of Psychological Science, Fuller-Rowell and his co-authors Gary Evans, PhD, and Anthony Ong, PhD, measured the physical health of teens (age 17) by assessing allostatic load (an index of wear on the body due to stress, which combines several physiological measures including stress hormones). Perceived discrimination was assessed with a questionnaire that was administered in participants’ homes. Half of the families studied lived at or below poverty level. The other half lived at two to four times the poverty level. Each child was also assessed at ages 9, 13, and 17 to see how many years he or she had lived in poverty. Of the 252 adolescents studied, 92 percent were White.
“We found that 13 percent of the impact of poverty on factors contributing to allostatic load—such as higher blood pressure and levels of the stress hormones cortisol, epinephrine, and norepinephrine—could be attributed to perceived discrimination,” Fuller-Rowell says.
To empirically link poverty and discrimination, study participants were asked to respond to the following statements: “People treat me differently because of my background. People do not respect me because of who I am. I feel I am excluded from certain activities because of my background.”
“As expected, higher levels of poverty correlated with higher levels of perceived discrimination in response to these statements,” Fuller-Rowell says. “The results were in keeping with literature that associates high levels of stigma with being on food stamps or welfare, as many of these adolescents were, and with qualitative studies showing that low-income youth are often treated differently by peers and teachers.”
Fuller-Rowell and his co-authors found that when perceived discrimination was present, “there were clear differences in physical health, as measured by blood pressure, stress hormones, and body mass index,” he says. “And those physical consequences of poverty were partially explained by discrimination.”
An Interdisciplinary Perspective
Prior to this research, investigators had not explored social class discrimination as a reason for socioeconomic differences in physical health disparities. “There are several lab-based studies showing that the middle class looks down on the poor. This study builds on this work to show that individuals from low-income families report experiencing discrimination, and that this discrimination is influencing their health,” explains Fuller-Rowell, a RWJF Health & Society Scholar in the department of population health sciences at the University of Wisconsin at Madison, who conducted the study along with Evans, a professor of design and environmental analysis at Cornell University and Ong, a professor of human development at Cornell.
“My Health & Society Scholar program experience has allowed me to focus my research on the mechanisms behind health disparities,” Fuller-Rowell adds. “In an upcoming project, I’ll be exploring the health trajectories of Black and White college students and considering whether various discrimination-related stresses in the lives of stigmatized minority students at predominantly White colleges may be influencing changes in their health over time.”
Fuller-Rowell points out that his current study is unique in that it looks at social class distinctions, plus group health disparities. “Research that looks at the impact of discrimination on health, based on racial differences, can often produce different findings because issues of racial identity come into to play. It can be difficult to link perceived discrimination among African Americans, for example, to health because in some cases, perceived discrimination correlates with a strong sense of racial identity, which can be beneficial to health.”
A Need for Change
“In America, there is often a tendency to think that we are a classless society. As a result, discussions of social class interactions are often silenced. Our study suggests that class-based discrimination is affecting public health, so it’s time for a more open discussion about it,” Fuller-Rowell says. “We need to be aware of subtle overtones about class in the media, for example. And, in addition to talking to children about how it’s wrong to discriminate based on race, parents and teachers should also discuss the harmful effects of prejudice based on class.”
The Robert Wood Johnson Foundation Health & Society Scholars program is based on the principle that progress in the field of population health depends upon multidisciplinary collaboration and exchange. Its goal is to improve health by training scholars to rigorously investigate the connections among biological, genetic, behavioral, environmental, economic and social determinants of health; and develop and disseminate knowledge and interventions that will improve health. The program is intended to produce leaders who will change the questions asked, the methods employed to analyze problems, and the range of solutions to reduce population health disparities.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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