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      Racism as a Determinant of Health: A Systematic Review and Meta-Analysis


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          Despite a growing body of epidemiological evidence in recent years documenting the health impacts of racism, the cumulative evidence base has yet to be synthesized in a comprehensive meta-analysis focused specifically on racism as a determinant of health. This meta-analysis reviewed the literature focusing on the relationship between reported racism and mental and physical health outcomes. Data from 293 studies reported in 333 articles published between 1983 and 2013, and conducted predominately in the U.S., were analysed using random effects models and mean weighted effect sizes. Racism was associated with poorer mental health (negative mental health: r = -.23, 95% CI [-.24,-.21], k = 227; positive mental health: r = -.13, 95% CI [-.16,-.10], k = 113), including depression, anxiety, psychological stress and various other outcomes. Racism was also associated with poorer general health ( r = -.13 (95% CI [-.18,-.09], k = 30), and poorer physical health ( r = -.09, 95% CI [-.12,-.06], k = 50). Moderation effects were found for some outcomes with regard to study and exposure characteristics. Effect sizes of racism on mental health were stronger in cross-sectional compared with longitudinal data and in non-representative samples compared with representative samples. Age, sex, birthplace and education level did not moderate the effects of racism on health. Ethnicity significantly moderated the effect of racism on negative mental health and physical health: the association between racism and negative mental health was significantly stronger for Asian American and Latino(a) American participants compared with African American participants, and the association between racism and physical health was significantly stronger for Latino(a) American participants compared with African American participants. Protocol PROSPERO registration number: CRD42013005464.

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          Racial Differences in Physical and Mental Health: Socio-economic Status, Stress and Discrimination.

          This article examines the extent to which racial differences in socio-economic status (SES), social class and acute and chronic indicators of perceived discrimination, as well as general measures of stress can account for black-white differences in self-reported measures of physical and mental health. The observed racial differences in health were markedly reduced when adjusted for education and especially income. However, both perceived discrimination and more traditional measures of stress are related to health and play an incremental role in accounting for differences between the races in health status. These findings underscore the need for research efforts to identify the complex ways in which economic and non-economic forms of discrimination relate to each other and combine with socio-economic position and other risk factors and resources to affect health.
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            Does rejection hurt? An FMRI study of social exclusion.

            A neuroimaging study examined the neural correlates of social exclusion and tested the hypothesis that the brain bases of social pain are similar to those of physical pain. Participants were scanned while playing a virtual ball-tossing game in which they were ultimately excluded. Paralleling results from physical pain studies, the anterior cingulate cortex (ACC) was more active during exclusion than during inclusion and correlated positively with self-reported distress. Right ventral prefrontal cortex (RVPFC) was active during exclusion and correlated negatively with self-reported distress. ACC changes mediated the RVPFC-distress correlation, suggesting that RVPFC regulates the distress of social exclusion by disrupting ACC activity.
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              Racial/ethnic discrimination and health: findings from community studies.

              The authors review the available empirical evidence from population-based studies of the association between perceptions of racial/ethnic discrimination and health. This research indicates that discrimination is associated with multiple indicators of poorer physical and, especially, mental health status. However, the extant research does not adequately address whether and how exposure to discrimination leads to increased risk of disease. Gaps in the literature include limitations linked to measurement of discrimination, research designs, and inattention to the way in which the association between discrimination and health unfolds over the life course. Research on stress points to important directions for the future assessment of discrimination and the testing of the underlying processes and mechanisms by which discrimination can lead to changes in health.

                Author and article information

                Role: Editor
                PLoS One
                PLoS ONE
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                23 September 2015
                : 10
                : 9
                : e0138511
                [1 ]Alfred Deakin Institute for Citizenship and Globalization, Faculty of Arts and Education, Deakin University, Melbourne, Victoria, Australia
                [2 ]School of Social Sciences and Psychology, University of Western Sydney, Sydney, New South Wales, Australia
                [3 ]Australian Centre for Applied Social Research Methods, Australian National University, Canberra, Australian Capital Territory, Australia
                [4 ]Division of Counseling Psychology, University at Albany, State University of New York, New York, New York, United States of America
                [5 ]Oppenheimer Center for Neurobiology of Stress, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
                [6 ]Centre for Health Policy Programs and Economics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
                [7 ]Department of Community Health Sciences, University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California, United States of America
                Cardiff University, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: YP JB NP AP AG MK GG. Performed the experiments: YP JB AE NP AP AG MK GG. Analyzed the data: YP JB ND. Wrote the paper: YP JB ND AE NP AP AG MK GG.


                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

                : 20 April 2015
                : 30 August 2015
                Page count
                Figures: 5, Tables: 4, Pages: 48
                The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This research was partially funded by grant LP100200057 (YP, MK) funded by the Australian Research Council ( http://www.arc.gov.au/), Victorian Health Promotion Foundation ( https://www.vichealth.vic.gov.au/ YP, MK, NP) and the Australian Human Rights Commission ( https://www.humanrights.gov.au/ YP). YP is supported by an Australian Research Council Future Fellowship grant ( http://www.arc.gov.au/ FF130101148).
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