IHP 501 Module 4 Racism and Health Paper Example

More Than Individual Bias: Discrimination, Structural Racism and Diabetes in Riverside Heights

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Southern New Hampshire University

IHP 501: Global Health and Diversity

Module Four Paper

[Instructor Name]

[Date]

More Than Individual Bias: Discrimination, Structural Racism and Diabetes in Riverside Heights

Public health has long described differences in health by race and ethnicity. More recently, researchers have argued that race itself is not the cause; racism is. This paper examines how discrimination and structural racism may contribute to the diabetes disparity among Latino immigrant adults at La Esperanza Community Health Center in Riverside Heights, a composite neighborhood. It reviews research on interpersonal discrimination and on structural racism, applies both to the population and proposes responses at several levels.

Interpersonal Discrimination and Health

Williams and Mohammed (2009) reviewed studies published over several years on perceived discrimination and health. They found consistent associations between reported experiences of discrimination and poorer mental health, including depression and anxiety, and evidence linking discrimination to physical health indicators such as high blood pressure, as well as to health behaviors like smoking and alcohol use. They described possible pathways, including chronic stress responses, and noted that discrimination can reduce people's willingness to seek care and trust clinicians. They also called for better measurement and longitudinal research, since many studies were cross-sectional.

What a Meta-Analysis Adds

Paradies et al. (2015) pooled results from nearly 300 studies to estimate the overall association between racism and health. Racism was associated with poorer health across outcomes, with the strongest associations for mental health, such as depression, psychological distress and anxiety, and weaker but significant associations for physical health. The associations were found across racial and ethnic groups and study designs, strengthening the case that racism is a determinant of health rather than a coincidental correlate.

Structural Racism

Bailey et al. (2017) argued that the most powerful effects of racism operate through structures rather than individual attitudes. Structural racism refers to the ways societies foster discrimination through mutually reinforcing systems of housing, education, employment, earnings, benefits, credit, media, health care and criminal justice. They described how residential segregation concentrates poverty and environmental hazards, how discriminatory lending and policing shape wealth and exposure to stress and how these systems interact to produce inequities that persist even when individual bias declines. They reviewed interventions, including place-based and multisector efforts and policy changes, and urged public health to measure structural racism directly.

Applying the Research: Interpersonal Experiences

In informal conversations with promotoras at La Esperanza, patients described being followed in stores, being told to speak English at work and, occasionally, feeling rushed or talked down to at medical appointments elsewhere. Some said they avoid the emergency department because of past experiences. According to the research, such experiences may contribute to stress that affects blood sugar and blood pressure, to depression that makes self-management harder and to reluctance to seek care, all of which could worsen diabetes control.

Applying the Research: Structural Conditions

Structural factors are visible in Riverside Heights' history and present. The neighborhood was among those rated as high risk by federal mortgage maps in the 1930s, limiting investment for generations, and today it has more industrial sites and fewer grocery stores than wealthier parts of the city. Immigration enforcement practices, including past workplace raids at a local meat plant, shape where people feel safe going. Many residents work in jobs with little protection from wage theft or unsafe conditions. These are not individual acts of prejudice, but they systematically limit residents' resources and raise their stress, as Bailey and colleagues describe.

Table 1. Levels of Racism and Possible Effects on Diabetes

Note. Pathways follow those described in the reviewed research.

Why Levels Matter

Separating levels of racism is not an academic exercise. If the disparity were caused only by individual prejudice, training clinicians might be enough. Because structural factors such as disinvestment, labor conditions and immigration enforcement shape residents' lives regardless of any clinician's attitude, a health center acting alone can reduce only part of the gap. Recognizing this protects the center from promising more than it can deliver and points it toward partners who can address the rest.

Responses at the Health Center

La Esperanza can address institutional factors directly. It can ask patients about experiences of discrimination as part of screening for stress and depression, train staff on bias and respectful communication, review policies such as late-arrival rules that may penalize people with inflexible jobs and hire staff from the community. Patients' experiences with the center itself should be measured through surveys that ask about respect and trust, broken down by language and ethnicity.

Responses at the Health Department

Structural responses require partners. The county health department can include measures of structural racism, such as segregation and historic disinvestment, in its community health assessment, work with city planners on investment in Riverside Heights and partner with worker centers on labor protections. It can also document how immigration enforcement affects health care use and share that evidence with local officials, as Bailey and colleagues recommend.

Measuring Progress

Responses to racism need measures like any other intervention. At the health center, patient experience surveys can include items on being treated with respect and being listened to, broken out by the language each patient prefers, and the center can track whether gaps in diabetes control narrow over time. Staff training can be evaluated by observed communication, not just attendance. At the county level, the community health assessment can track indicators such as residential segregation, grocery access and investment in Riverside Heights compared with other neighborhoods. Reporting these measures publicly holds institutions accountable and signals to residents that their experiences are taken seriously.

Cautions

Much of the evidence comes from studies of Black Americans, and experiences among Latino immigrants may differ by country of origin, skin color, language and legal status. Measures of discrimination rely on self-report, and cross-sectional studies cannot prove cause. These cautions argue for careful local research alongside action.

Conclusion

Diabetes disparities in Riverside Heights cannot be understood without considering racism, both the everyday discrimination residents describe and the structures that shaped their neighborhood and jobs. The evidence links both to poorer health, and responding requires action inside the clinic and beyond it.

References

Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet, 389(10077), 1453-1463. https://doi.org/10.1016/S0140-6736(17)30569-X

Paradies, Y., Ben, J., Denson, N., Elias, A., Priest, N., Pieterse, A., Gupta, A., Kelaher, M., & Gee, G. (2015). Racism as a determinant of health: A systematic review and meta-analysis. PLoS ONE, 10(9), Article e0138511. https://doi.org/10.1371/journal.pone.0138511

Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20-47. https://doi.org/10.1007/s10865-008-9185-0