Abstract

        The United States of America has seen a sequence of health disparities among minority groups. Researching psychological concepts, including Discrimination and Prejudice, is crucial for understanding the reasoning behind the prevailing differences in healthcare. While psychologists find it challenging to come up with definitive answers on the origins of prejudice, they use knowledge of infamous ideologies, including social Darwinism, to determine the development of racism and Discrimination in society. Additionally, Psychologists examine the non-medical factors that contribute to one's health (SDOH factors), including economics, housing, health, environment, and community. By reviewing the catalyst for structural and institutional racism, psychologists can determine what steps need to be taken to improve minorities' SDOH to create equity in 21st century America. Finally, recognizing that the overall health of ethnic groups is not limited to healthcare as an individual is vital to confirming a plan to combat racial health disparities.

Introduction

       While the United States has achieved significant advancements in the efficiency, accessibility, and effectiveness of medicine, disparities in healthcare remain prevalent in the 21st century. Defined by the centers of disease control and prevention, healthcare disparities are preventable differences in the opportunities to achieve optimal health experienced by socially disadvantaged populations (CDC, 2018). Specifically, minority groups experience disproportionate disease, death, and disability compared to white Americans (CDC, 2017). 

       The pattern of health disparities within racial and ethnic minorities can be explained by examining what is referred to as the "Social determinants of health (SDOH)." "SDOH are the non-medical factors that influence health income" (WHO, 2019). While a wide range of factors contribute to an individual's range of health, SDOH can be grouped into five categories: economic dependency, access to education, healthcare quality, environment, and community context (heath.gov). Overall, racism creates inequalities across the SDOH by directly impacting the mental and physical well-being of minority populations (KKF, 2021). By assessing the psychological concepts of institutionalized prejudice and Discrimination, I will explain how these theories contribute to the societal trend of health care disparities among people of color.

origins of prejudice

        Prejudice is "an assumption or an opinion about someone simply based on that person's membership to a particular group." (very well mind, 2021). Psychologists differ in ideas about the origin of prejudice as there is no definitive answer to when prejudice ideologies developed in society. Some have the belief prejudice comes from an "evolutionary basis," while others believe it to be "unique to humans" (Scientific American, 2011).  

        Overall, society has seen a gradient of racial ideologies rooted in prejudice, with one of the earliest being "social Darwinism." A belief translated from Charles darwin's natural selection, Social Darwinism or 'survival of the fittest" can be best described as the idea that "certain people are innately better" (History.com, 2018). The idea of anglo-Saxon superiority was sustained through social Darwinism and preserved by majority groups. Survival of the fittest has been translated to various aspects of society, including "imperialism, eugenics, racism, and social inequality" (History.com, 2018). 

          While many believe racial prejudice is not an issue of the 21st century, the effects of social Darwinism are evident when comparing health care disparities amongst minorities and white people in America. Racial prejudice manifests itself in today's health care system as it has led doctors to mistreat people of color. In 2016, studies examining white medical students concluded "73% held at least one false belief about the biological differences between races' (Medical news today, 2020). For example, Black children with appendicitis were less likely to receive adequate pain medication due to myths of black people having thicker skin (Medical news today, 2020). Ongoing notions of racial prejudice can best explain the impact of these "century-old" beliefs on today's society.   

Structural Racism

          It is important to note that prejudice is not limited to an individual's beliefs but has been implemented in America's institutions and regulations. Many disparities are "influenced by racial inequality outside the healthcare system" (Medical news today, 2020). Racial inequity in healthcare continues to escalate because they fail to neglect the underlying cause for health disparities: "structural racism." "Structural racism describes how our systems are structured to produce racial inequalities between whites and racial-ethnic groups in the SDOH" (Harvard, 2020). Structural racism was implemented in society through discriminatory practices. As healthcare is based on the ability to pay rather than patient needs, ethnic minorities are harmed as they are "disproportionately poor and lack access to health insurance" (Harvard, 2020). 

        In psychology, the concept of Discrimination is important to analyze better understand structural racism and its involvement in healthcare disparities. "Discrimination is the action or behavior directed toward members of certain groups and is used to refer to a person or persons behaving differently" (Fronter sin, 2020 ). Discrimination is not limited to verbal abuse, as it can be non-verbal and physical. Nevertheless, Discrimination leads victims to feel "isolated, rejected, and ignored (Fronter sin, 2020). Prejudice and Discrimination have an inverse relationship and can occur based on extraneous circumstances. Simply psychology believes social norms, meaning what you surround yourself with, can influence prejudice and Discrimination (simply psychology, 2008). Other psychologists second this belief stating that while we work hard to keep prejudice out of our mind, they do not disappear (Richeson and Sheldon, 2007). 

        Discrimination and the development of structural racism in healthcare can be illustrated since the Jim Crow Era (1875-1968). For example, the Hill-burton act of 1946 allowed states to construct racially separate healthcare facilities. Even with accessible healthcare, minority populations often do not have money to pay for care. The federal government enacted laws that supported occupational segregation, forcing ethnic minorities into low-wage jobs (health affairs,2022). 

That being said, structural racism persists in today's world.

  Status of disparities

            A Pattern of disadvantage in health coverage, status, and access is evident when comparing Black, Hispanic, and AIAN people to their white counterparts. The US department of health and human services found various examples of health inequality amongst people of color, including lower life expectancy, higher blood pressure, lower rates of flu vaccination, and strain on mental health (HHS, 2015). In recent years the gap has heightened through the impact of COVID-19. (CDC 2022). According to the CDC, American Indian or Alaska Native people had a COVID-19 hospitalization rate of about 5.3 times more than white people, and Black and Latino's people were both about 4.7 times the rate of white people (CDC 2022). A highly acclaimed medical facility, the Mayo Clinic, stated that there are no underlying conditions that make POC more susceptible to COVID-19, but they are more likely to have underlying conditions. They listed factors including lifestyle, type of work, and access to health care contributing to the COVID-19 risk among minority groups. In addition, they noted how these issues are "long-standing" and are effects of societal racism (Mayo clinic, 2020).   

         Not only are POC at higher risk for COVID-19 and have suffered more prominent social and economic impacts, but they are also less likely to receive the COVID-19 vaccine (KFF, 2021). While this gap has diminished over time, it highlights the importance of addressing disparities within the healthcare system. COVID-19 is a general example that shows the need to promote the health of racial minorities. Recent research shows that "people of color are often more greatly affected by public health emergencies, such as hurricane Katrina" (mayo clinic, 2020). Understanding racial injustice not only within COVID-19 but in health care, in general, is crucial for alleviating further disparities and promoting racial equity. 

    Dismantling health disparities

      While there is no exact order of definite steps that are proven to dismantle health care disparities among racial groups, there are crucial steps society needs to take to narrow the gap between minorities and white people. Psychology researchers have changed the way they approach racism  by utilizing the studies of  scientific psychology to address health inequity in the United States. By merging the understanding of stress with the way groups justify discrimination, psychologists can better understand all that entails of racial health disparities  (NCSU,2019).

       Additionally, developing interventions based on statistics can limit health care inequality. Although there is a copious amount of evidence for racial and health disparities in America, little is done with the utilization of this evidence. According to KFF, increasing the use of electronic medical records to decrease medical error, increasing financial aid to promote high quality of healthcare, and examining how healthcare professionals can offer culturally sensitive services can be beneficial to reducing health disparities (Kff.org, 2008). 

      Arguably, the most effective step to combating the gap between white and racial groups' health status is by continuing to denounce myths and note that it is social conditions, not genetics, that have impacted the health of minorities and caused unproportionate mortality rates. Addressing the prevalence of structural racism and how it affects minorities SDOH can help society come to a conclusion of implements needed to achieve racial equity.  

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