Discrimination in general, and racism specifically, have profound negative effects on health, for adults and children alike. The impact of discrimination has come into sharp focus over the last year as the COVID-19 pandemic has revealed the effects of systemic racism on health.
Even before the pandemic, for the past two years, Chicago parents identified discrimination and racism as top social concerns for youth in Chicago. In this month’s Voices of Child Health in Chicago report, we focus on parents’ own experiences of “everyday discrimination,” defined as unfair treatment that is chronic, routine and occurs in everyday life. We asked over 1,500 Chicago parents from all 77 community areas in the city about their experiences with everyday discrimination, as well as other family demographic and health questions.
To understand the kinds of everyday discrimination that Chicago parents face, we asked parents, “In your day-to-day life, how often have the following things happened to you?” followed by a list of five experiences: 1) You are treated with less courtesy or respect than other people, 2) You receive poorer service than other people at restaurants or stores, 3) People act as if they think you are not smart, 4) People act as if they are afraid of you and 5) You are threatened or harassed.4 Each experience of discrimination was considered “high” frequency if parents indicated that the experience happened to them almost every day or at least once a week, “medium” frequency if it occurred a few times a month or a few times a year and “low” frequency if it occurred less than once a year or never.
The most common form of discrimination Chicago parents faced was being treated with less courtesy or respect than other people: 22% of parents reported high frequency and 37% of parents reported medium frequency. Other forms of discrimination were: people act as if they think you are not smart (17% high frequency, 33% medium frequency), receiving poorer service than other people at restaurants or stores (14% high frequency, 33% medium frequency), people act as if they are afraid of you (13% high frequency, 17% medium frequency) and being threatened or harassed (11% high frequency, 19% medium frequency) (Figure 1). Overall, 22% of Chicago parents experienced at least one form of discrimination on a weekly or more frequent basis, and another 46% experienced at least one form of discrimination a few times per year or more.
We also explored parents’ perceptions about the reasons they experienced discrimination. For parents who had experienced at least one form of discrimination, we asked them to indicate what they thought were the main reasons for these experiences. The most common reasons reported were their race (52%), gender (38%), ancestry or national origin (26%), education or income level (25%), age (23%) and shade of skin color (22%) (Figure 2).
There were demographic differences in parents’ perceived reasons for discrimination. For instance, Black (non-Latinx) parents, Asian and other-race or multiracial (non-Latinx) parents, and Latinx parents were more likely to report their race, their ancestry or national origin, or shade of skin color as main reasons they experienced discrimination than White (non-Latinx) parents (62–67% vs. 30%). Among White (non-Latinx) parents, the most common perceived reasons for discrimination were their gender (46%) and their age (33%).
One way that discrimination can impact health is when it is experienced in the context of healthcare. To understand parents’ experiences with discrimination when seeking healthcare for their children, we asked parents, “Within the past 12 months when seeking healthcare for your child, do you feel your experiences were worse than, the same as or better than for people of other races?” Overall, 7% of parents said worse than other races; 11% said worse than some races, better than others; 56% said the same as other races; 22% said better than other races; and 4% said they did not seek healthcare for their child in the last 12 months.
Black (non-Latinx) parents were more likely than White (non-Latinx) parents to report that their experiences when seeking healthcare for their child were worse than other races (13% vs. 3%), and Black (non-Latinx) parents were more likely than White (non-Latinx) parents to report their experiences were worse than some races but better than others (18% vs. 5%). There were no other differences in perceptions of discrimination in children’s healthcare across parents’ racial/ethnic groups. Research on adult healthcare has shown that when adults report racial discrimination in a healthcare setting, it is associated with lower scores on important health-related outcomes such as getting needed care, timeliness of care, communication with doctor and ratings of care received.
Other research has shown that experiencing racial discrimination is associated with negative health outcomes for racial/ethnic minorities. When parents experience racial discrimination, it also has a negative impact on their children. Prior research has shown that the influence of racism on health is not only limited to an individual’s direct experiences. When a child witnesses racial discrimination toward another person such as a parent, this is a type of vicarious racism, or secondhand racism. Vicarious racism in children is associated with worse child health. Research on the impact of societal discrimination on youth health found that adolescents who reported higher levels of concern about increasing societal discrimination had worse mental and behavioral health outcomes than those with lower levels of concern.
The American Academy of Pediatrics encourages pediatricians and other child health care providers to create culturally safe medical homes and to train clinical and office staff in culturally competent care. Healthcare providers can be a strong partner for parents, families and youth to discuss their concerns about the impact of discrimination on physical and mental health