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The Perceived Impact of Minorities Mental Health Issues in Corporate America

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Overall, mental health conditions occur in Black and African American (B/AA) people in America at about the same or less frequency than in White Americans. However, the historical Black and African American experience in America has and continues to be characterized by trauma and violence more often than for their White counterparts and impacts emotional and mental health of both youth and adults

Historical dehumanization, oppression, and violence against Black and African American people has evolved into present day racism - structural, institutional, and individual – and cultivates a uniquely mistrustful and less affluent community experience, characterized by a myriad of disparities including inadequate access to and delivery of care in the health system.

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In the mental health arena, unlike general health, health care disparities predominate over disparities in mental health per se. Strategies to improve health care in general, such as improving access to care and improving the quality of care, would do much to eliminate mental health care disparities. However, a diverse mental health workforce, as well as provider and patient education, are important to eliminating mental health care disparities. A consensus about what constitutes a “disparity” has not been reached despite a voluminous literature on the topic

The term disparity clearly connotes an unfair difference, but measurement of this difference is far from uniform. Here, we rely on the definition employed by the Institute of Medicine (IOM) in its Unequal Treatment report: a disparity is a difference in health care quality not due to differences in health care needs or preferences of the patient. As such, disparities can be rooted in inequalities in access to good providers, differences in insurance coverage, as well as stemming from discrimination by professionals in the clinical encounter. The IOM definition is distinct from that applied by the Agency for Healthcare Quality and Research (AHRQ) in its annual National Healthcare Disparities Reports, where any difference between populations is a disparity, with no adjustment for underlying need for care. The IOM definition is also distinct from much of the research literature which adjusts disparity estimates for socio-economic and geographic variables, thus disregarding disparities associated with lack of insurance coverage, geographic access to providers, education, or income that are considered disparities within the IOM concept. We strongly believe that disparities should be identified only when there is need for care, and that social circumstances, such as lack of insurance, constitute disparities if they lead to poorer care when care is needed. Disparities in mental health exhibit a decidedly different pattern from disparities in health. In general, minorities, particularly African Americans, have poorer health and health outcomes than do Whites.

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The impact of discrimination occurs at both structural and individual levels. Structural discrimination refers to macro-level conditions (e.g., residential segregation) that limit “opportunities, resources, and well-being” of less privileged groups (Krieger N., 2000). Individual discrimination refers to negative interactions between individuals in their institutional roles (e.g., health care provider and patient) or as public or private individuals (e.g., salesperson and customer) based on individual characteristics (e.g., race, gender, etc.). Individual and structural discrimination can cause either intentional or unintentional harm, whether or not it is perceived by the individual

Discrimination can be understood as a social stressor that has a physiological effect on individuals (e.g., irregular heartbeat, anxiety, heartburn) that can be compounded over time and can lead to long-term negative health outcomes. Discrimination is often measured by either everyday or major discriminatory events (Pavalko EK, 2003). Everyday discrimination taps into more ongoing and routine experiences of unfair treatment. Some examples of everyday discrimination include being treated with less courtesy or respect than other people, receiving poorer service than other people at restaurants or stores, or being threatened or harassed.9, 11 Major discriminatory events capture important or more significant experiences of unfair treatment. Some examples of major discrimination include being unfairly dismissed from a job, being unfairly prevented from moving into a neighborhood because a landlord or realtor refused to sell or rent, or being unfairly denied a bank loan. Major discriminatory events are often the result of structural discrimination that can negatively affect individuals and communities. Residential segregation, disparities in access to quality education, and disparities in incarceration rates are some specific forms of structural discrimination. Residential segregation is a form of structural discrimination in the housing market.

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In any event, an uneasy tension exists between researchers and the communities they study

Community leaders may see researchers as exploitative and divorced from real issues and real-life problems, while researchers view community leaders as compromising research methods and thereby diminishing out-comes, which would have eventually benefited the community. Such tensions can hinder the initiation of research projects in both white and nonwhite communities.

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Krieger N. Discrimination and health. Social Epidemiology. 2000;1:36-75.

Pavalko EK, Mossakowski K.N, Hamilton VJ. Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women's physical and emotional health. J Health Soc Behav. 2003;44(1):18–33.

Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of health psychology, 2(3), 335-351.

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