In the United States, there is a strong cultural belief that if you work hard, you can accomplish anything in life. Socialism is largely rejected because people feel that they are in their position because of their own hard work or intelligence and shouldn’t have to share their bounty with those undeserving people who didn’t put the work in. Unfortunately, this cultural belief is largely an illusion. People in this country experience disparate outcomes based on numerous uncontrollable factors such as their race, gender, or family history (economic or otherwise). The reality is that demographic factors can literally be the difference between life and death, or at the very least between a shorter/more sickly life and a longer/healthier one.
While there is a huge literature detailing both socioeconomic and racial disparities in access to health care, I would like to explore more subtle factors that may fly under the radar but have enormous consequences for our health. Poverty is the single biggest risk factor for health outcomes including deadly diseases such as cardiovascular disease and cancer (Sapolsky, 2004). One of the main reasons Sapolsky (2004) cites for this outcome is that low socioeconomic status (SES) leads to chronic stress, which, as I’ve discussed in previous blogs, has severe consequences on various aspects of our health. Thinking of what it must be like to not know where your child’s next meal is coming from, fearing your heat may be shut off in the middle of winter because you couldn’t pay the bill, or hearing gunshots in your neighborhood as you fall asleep are obvious examples of how low SES individuals might struggle with both physical and psychological stressors on a daily basis.
However, beyond stressors that threaten impoverished individuals’ immediate survival, their psychological relationship to these structural inequalities can also be telling. In fact, an individual feeling poor can be more predictive of health than actually being poor (Sapolsky, 2004). Not surprisingly then, income inequality in one’s local community predicts poorer health outcomes (Sapolsky, 2004). Not only is income inequality on the rise, but also our understanding of “local” has expanded with globalization and the invention of the internet, leaving us to compare ourselves to the richest of the rich. Hence, it is not surprising that despite being a very wealthy country, America (with it’s extreme income inequality) suffers from subpar health outcomes (and likely getting worse with Trump in town…).
Seeing how mere psychological variables can be better predictors at times than actual financial ones when looking at health outcomes for the poor, it is not surprising that other stigmatized groups suffer from poor health as well. A rich social psychological literature speaks to the ways in which racial minorities in particular fall victim (see Major, Mendes, & Dovidio, 2013, for review). Low status individuals often experience both implicit and explicit prejudice from high status members, are vigilant as they try to stay prepared for these adverse events, and experience uncertainty in their interactions as a result of not knowing whether or not to attribute outcomes to their race. All of these factors lead to more stress and subsequent negative health outcomes. Interestingly, incongruence between how much injustice an individual expects and how much they experience can be an additional stressor, even if their experience was more just than they were expecting (Lucas et al., 2017). Finally, racial minorities may experience sub-par health care when they seek treatment for their health concerns as the largely White population of physicians may also show bias against them (Major et al., 2013).
Interestingly, interracial interactions are not only stressful for minority participants, but for Whites as well. Perhaps ironically, Whites who are concerned about appearing prejudiced experience the most anxiety in interracial interactions, demonstrated both by increased cortisol levels and behavioral indicators (Trawalter, Adam, Chase-Lansdale, & Richeson, 2012). In fact, over the long-term, participants concerned with appearing prejudiced showed signs of chronic stress in association with their interracial interactions.
Whether we like it or not, race and other group differences play a huge role in our society and cannot be ignored. As we work to give people equal opportunities in life, it is vital that we continue to recognize that factors totally unrelated to an individual’s abilities or effort are constantly at play and affect things as fundamental as their health. Of course, racial disparities involve both structural and interpersonal factors, and learning how to approach these difficult topics more comfortably is essential to produce positive outcomes for both high and low status groups.
Lucas, T., Pierce, J., Lumley, M. A., Granger, D. A., Lin, J., & Epel, E. S. (2017). Telomere length and procedural justice predict stress reactivity responses to unfair outcomes in African Americans. Psychoneuroendocrinology.
Major, B., Mendes, W. B., & Dovidio, J. F. (2013). Intergroup relations and health disparities: A social psychological perspective. Health Psychology, 32(5), 514.
Sapolsky, R. M. (1994). Why zebras don’t get ulcers. New York: WH Freeman.
Trawalter, S., Adam, E. K., Chase-Lansdale, P. L., & Richeson, J. A. (2012). Concerns about appearing prejudiced get under the skin: Stress responses to interracial contact in the moment and across time. Journal of experimental social psychology, 48(3), 682-693.