Understanding the impact of discrimination on health and wellbeing

Growing evidence suggests that people who experience discrimination suffer poorer mental health and may even be at increased risk of physical health conditions, including cardiovascular disease and obesity. Discrimination, as a social stressor, may adversely affect health and wellbeing through biological stress pathways, promotion of unhealthy behaviours as a means to cope with or escape negative affect, and/or restricted access to or uptake of healthcare and disease prevention services. Research in this field has been dominated by studies of racism in the USA, and the current evidence base on the impact of discrimination on health lacks high-quality longitudinal data, and consideration of varied types of discrimination (e.g. discrimination on the basis of age, sex, ethnic group, nationality, religion, language, sexual orientation, health condition, disability and weight). Examining the influence of social factors on mental health is one of the ESRC's core strategic priorities. Discrimination is a topical issue in Europe with the migrant crisis, UK 'Brexit' vote and recent terrorist attacks in England and elsewhere fuelling negative attitudes towards social minority groups. Moreover, addressing health inequalities is a major policy focus, so it is crucial to understand how discrimination affects health and wellbeing in vulnerable groups and to identify the policy levers that can reduce inequalities in health that occur as a direct result of discrimination. This study is a collaboration between an academic group at University College London and several charities working on issues of discrimination and wellbeing (Age UK, Leonard Cheshire Disability and Weight Concern), and will clarify these relationships using data from large cohorts of adults from the UK and across Europe. Our partner charities have a specific focus on discrimination based on age, disability and obesity, but we shall also address issues related to gender, ethnicity/nationality, and religion. Our specific objectives are: 1) To estimate the impact of perceived discrimination on health and wellbeing, including the extent to which effects vary according to the type of discrimination, health outcome, and European country; 2) To examine health impacts in relation to the frequency and pervasiveness of discrimination; 3) To explore mechanisms through which the multi-faceted nature of discrimination affects health and wellbeing. We anticipate that findings from this study will help policy-makers and practitioners develop policies and interventions that can help improve health and wellbeing in the different groups that experience discrimination.

There are a number of beneficiaries of this research on whom the impact of the proposed work will be apparent. These include:
i) Policy-makers: Addressing health inequalities remains a central concern for governments worldwide, and features of the current social climate in the UK and across Europe such as the migrant crisis, terrorist attacks in Paris, Brussels, Nice and England, and the UK's 'Brexit' vote make discrimination an increasingly critical issue. This research offers great potential to evaluate whether policies designed to address discrimination deal effectively with inequalities in health, and identify policy targets that could reduce the burden of discrimination on health and wellbeing. The research questions addressed in this project have been identified through discussion with Age UK, Leonard Cheshire Disability and Weight Concern; charities concerned with discrimination and health, with the explicit intention to ensure the results are policy-relevant. We intend that our findings will be relevant to policy-makers in national and local government. By identifying specific types and sources of discrimination that are relevant to health and wellbeing in vulnerable groups, our findings will be useful in targeting levers for change, and directing policies and initiatives to reduce health inequalities. Professor Steptoe has regular contact with policy advisors and analysts in the Departments of Health, Work and Pensions, and Transport, and will use these connections to ensure that the research funding will have impact.
ii) Third-sector organisations: A large number of voluntary sector organisations and charities have recognised inequalities in health and wellbeing in minority and vulnerable groups (e.g. the elderly, people with disabilities, ethnic minorities) and the high risk of discrimination in these groups. These include Age UK, Leonard Cheshire Disability, The Monitoring Group, Scope and the LGBT Foundation, which have all highlighted the need for high-quality research to support policy and lobbying activities. We anticipate that our findings will contribute to their work, and plan to work with our collaborators at Age UK, Leonard Cheshire Disability and Weight Concern to produce policy briefing papers targeted at policy-makers as part of our dissemination activities.
iii) Practitioners: Our findings will be valuable to social and health professionals, carers and volunteers who work with groups vulnerable to discrimination, helping them identify individuals at risk and provide them with appropriate support. If certain types of discrimination prove to be particularly harmful for health and wellbeing, it may be possible to target these more precisely and ensure that resources are focused more effectively.
iv) General public: We aim to increase knowledge and awareness of different sources of discrimination and prejudice, and document how these processes may not only be hurtful and distressing, but may also impact on health and wellbeing. These issues are relevant not only to individuals belonging to groups that are vulnerable to discrimination (of whom there are many), but also to the wider public among whom awareness of the consequences of discrimination may encourage greater consideration of their actions and fair and equal treatment of others, irrespective of group membership. This could be achieved by writing articles for broadsheet newspapers, as well as publications targeted at the general public, such as the Economist, Community Care and the Health Service Journal.
We will disseminate our findings at a workshop targeted at stakeholders from each of these groups upon conclusion of the study. Our work with Age UK, Leonard Cheshire Disability and Weight Concern will ensure dissemination of these findings at the highest levels of policy-making in the UK and the EU.