What are the effects of racism on health and mental health?

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According to the CDC, racial and ethnic minority populations experience higher levels of poor health and disease across various conditions when compared with their White counterparts.

These stark disparities have driven interest and research into how racism may affect people’s physical and mental health.

A 2019 research review found positive associations between reports of racial discrimination and many physical and mental health conditions, as well as preclinical indicators for disease.

These include:

• cardiovascular disease
• coronary artery calcification
• mental health disorders (e.g., depression, anxiety disorders, post-traumatic stress disorder, eating disorders, and psychosis)
• obesity
• hypertension (high blood pressure)
• alcohol use and misuse
• engaging in high-risk behaviors
• poorer sleep
• inflammation
• cortisol dysregulation (a hormone that regulates stress levels in the body)

Health inequality and racism

The above research review examined evidence linking mental and physical health outcomes to three key mechanisms of racism. It found that people can experience health inequality through:

• Structural or institutional racism: The processes of racism embedded in policies, laws, and societal practices that give advantages to racial groups deemed superior, while racial groups deemed inferior are disadvantaged. For example, structural racism in the criminal justice system can lead to poorer health outcomes.
• Cultural racism: The spread of the ideology that certain groups are inferior through language, values, media, and symbols. For example, racist stereotypes can influence the housing decisions of White property owners and lead to racial segregation in neighborhoods. This can create communities of concentrated poverty with worse housing and environmental conditions.
• Individual-level discrimination: Where individuals or companies discriminate against racial groups, whether intentionally or without intent. This can result in worse access to employment, education, and medical care.

Learn more about structural racism in medicine here.

A 2015 systematic review collated the results of almost 300 studies to examine how racism affects the physical and mental health of Asian American, African American, and Latinx American people.

The sections below will detail the conclusions of this review, as well as those of other studies.

Physical health

The above review found that experiencing racism has associations with poor mental health and, to a lesser extent, poor physical health.

There is considerable research to suggest that the stress that comes with experiencing racism can have long-lasting physical effects.

Stress can elevate blood pressure and weaken the immune system, which, in turn, raises the risk of developing long-term health conditions.

Racism has links with higher rates of stress, increasing a person of color’s risk of developing high blood pressure. The CDC report that Black people are more likely to have hypertension than any other racial or ethnic group.

Also, a 2019 study found that racist experiences appear to increase inflammation in African American people, raising their risk of developing chronic conditions such as heart disease and kidney disease.

Another study found that unfair treatment of people of color significantly affects sleep and physiological functioning in midlife.

Many studies have cited structural racism within medical care as a key factor in poor physical health. For example, a 2016 study of racial bias and pain management found a link between undertreating pain in Black patients and false biological beliefs, such as, “Black people’s skin is thicker than White people’s skin.”

A 2015 study found that compared with other racial groups, Black children with severe pain from appendicitis are less likely to receive medication. This suggests that racial bias is causing medical professionals to use different pain thresholds for different racial groups, either inadvertently or purposefully, before administering care.

Mental health

The 2015 meta-analysis found that the association between racism and mental health is twice as strong as the link between racism and physical health. Of those the researchers sampled, BIPOC who reported experiences of racism also experienced the following mental health issues:

• depression
• stress
• emotional distress
• anxiety
• post-traumatic stress disorder (PTSD)
• suicidal thoughts

Hate crimes against Asian American people and Pacific Islanders surged during the COVID-19 pandemic, and a 2021 study found that COVID-19-related racial/ethnic discrimination had links with a greater risk of depression, anxiety, self-harm, binge drinking, and suicidal ideation among Asian American and Pacific Islander students.

A 2018 paper suggested that fear of racism itself is harmful and that it can undermine good mental health characteristics, such as resilience, hope, and motivation. The paper also underlined how verbal and physical assault can cause PTSD.

Learn more about the link between racism and mental health here.

The American Academy of Pediatrics (AAP) is so concerned about how racism affects the well-being of young people that it released a 2019 policy statement on it.

The statement says that failure to address racism in the United States “will continue to undermine health equity of all children, adolescents, emerging adults, and their families.”

Physical health

Researchers have linked racism to poorer birth outcomes, such as infant mortality, for BIPOC. Studies suggest that mothers who report experiences of racism are more likely to have babies with a low birth weight, which can cause further health problems for infants later in life.

Like older BIPOC, young people also experience the ongoing stress of living with and witnessing racism and discrimination. As young BIPOC get older, they risk developing chronic health conditions similar to their parents.

Learn more about maternal health outcomes in BIPOC here.

Mental health

The AAP recommends that young people who report experiences of racism should undergo routine assessment for mental health conditions, including:

• PTSD
• anxiety
• grief
• depression

The AAP also said that even if children do not directly experience racism themselves, they can be just as significantly affected by witnessing racism as those who experience it firsthand.

Intense and persistent stress can influence how the brain develops, intensifying negative emotions such as fear and impacting learning and memory.

BIPOC alone should not carry the burden of coping with racism. To reduce discrimination, everyone must address structural disadvantage, socioeconomic deprivation, and institutionalized racism.

Learn more about how to be an ally for the Black Lives Matter movement here.

However, there is evidence to suggest that certain factors can help people cope with the negative effects of racism, both physically and mentally.

The sections below will discuss these factors in more detail.

Talk about racist experiences with others

According to the American Psychological Association (APA), talking about racist experiences, instead of bottling them up, can help a person process feelings of distress in the aftermath of racial trauma and stress.

Similarly, engaging with — instead of ignoring — racism is likely beneficial.

A person may feel strong emotions such as anger, distress, or hopelessness when sharing these experiences. Some studies have suggested that talking about racism can even exacerbate distress and depression for some people.

There is nothing to be ashamed of about these feelings, but if talking about experiences of racism makes someone feel worse, then a counselor may be able to help a person process these emotions.

Learn more about types of therapy here.

Get involved in social activism

Many people find it helpful to channel feelings of anger and injustice into activism and campaigning for racial equality. Being involved in a movement that is working toward progressive change can help people connect with a network of like-minded people and find purpose.

A 2018 study found that political activism served as a protective factor to mitigate the negative effect of racial and ethnic discrimination on stress and depression among Latinx students at a predominantly White college in the U.S.

However, for Black students, higher levels of political activism had an association with more stress and anxiety compared with Black students who were less politically involved.

We need more research to understand the disparities in activism as a coping mechanism for different ethnic groups.

However, a history of law enforcement targeting Black activists, and police violence at more recent Black Lives Matter (BLM) protests, from reports by advocacy group Amnesty International, may explain these greater levels of stress and anxiety.

A 2022 study suggested that social activism might be an important method for coping with emotional distress from watching media coverage of police brutality and protests. But the authors said they need more research to understand how African Americans might engage in social activism without adversely impacting mental health.

Learn more about police violence and its physical and mental impacts on Black Americans here.

Foster a strong sense of racial identity

A study into racial identity and its effects on well-being found that African Americans who identified positively with their racial identity were more likely to have greater self-esteem and fewer depressive symptoms.

Participants who identified negatively with their racial identity, perhaps due to internalized racism, were more likely to have higher depressive symptoms.

Therefore, having a well-developed sense of ethnic or racial identity may help to blunt or buffer the effects of racism. However, research must continue in this area because findings are still limited.

Learn more about the role of family in multiracial identities and resilience here.

Lean on friends and family

A network of people to talk with for support, advice, and comfort can help a person cope with racial discrimination. It can encourage a sense of security and identity and reduce negative thoughts and feelings.

According to the American Psychological Association, socioeconomic status can directly affect physical and mental health. Researchers have linked low socioeconomic status and a lack of economic development to poor health and a shorter life expectancy.

Physical health

According to a 2017 analysis of 1.7 million people, having a low socioeconomic status is harmful to a person’s health, alongside other key risk factors such as smoking, drinking a lot of alcohol, or eating an unhealthful diet.

People with low socioeconomic status are also more likely to have avoidable medical procedures, hospitalizations, and conditions that do not receive treatment.

Mental health

Reduced access to housing, employment, and mortgage lending due to low socioeconomic status can adversely affect mental health and increase feelings of depression, stress, and anxiety.

Although Hispanic and African American people seem to have a lower risk of mental health conditions than those in other racial or ethnic groups, those who develop such conditions tend to have more persistent psychological issues.

However, it is worth noting that this perceived lower risk may be due to racial inequities in the healthcare system.

Also, although there is an association between socioeconomic status and race, there is no perfect correspondence between race and low socioeconomic status. Among BIPOC of middle and upper socioeconomic status, the effects of racism on mental and physical health persist.

Racism can be a key factor in the onset of physical and mental health issues in BIPOC.

Research suggests that the stress that develops due to experiencing or witnessing racism can have long-lasting effects, increasing the risk of chronic disease and mental health conditions such as anxiety and depression in both children and adults.

Utilizing the support of peers and community, forging a strong sense of racial identity, and talking about racist experiences can all be effective ways of coping with the stress of racism.

Research suggests that low socioeconomic status has a significant harmful impact on physical health. Racial groups with higher levels of low socioeconomic status also tend to have more persistent mental health conditions.