Discrimination in America

{***Pause/Music***}

{***Amie***}

Coming up on Harvard Chan: This Week in Health…Discrimination in America.

{***Robert Blendon Soundbite***}

(African-Americans, Latinos, and Native Americans, and people who are LGBTQ, have anywhere from one-and-a-half to three times more discriminatory reports on every measure than whites. To be African-American, or Latino, or Native American, is a very different experience than being white in America.)

A new series of polls is painting a picture of the daily discrimination faced by a range of people in America. In this week’s episode, we speak with the director of the survey about the key findings and what they mean for some of the country’s most pressing health issues.

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{***Amie***}

Hello and welcome to Harvard Chan: This Week in Health…It’s Thursday, February 22, 2018. I’m Amie Montemurro.

{***Noah***}

And I’m Noah Leavitt.

{***Amie***}

In past episodes we’ve talked about the health effects of discrimination and racism in America—particularly institutional racism.

{***Noah***}

But what does discrimination look like on day-to-day basis? How do people experience it in their workplace, doctor’s office, or while interacting with law enforcement?

{***Amie***}

That was the focus of a new series of polls conducted by the Harvard Chan School’s Opinion Research Program, NPR, and the Robert Wood Johnson Foundation.

{***Noah***}

The series, Discrimination in America, included nationally representative samples of African Americans, Latinos, Asian Americans, Native Americans, whites, men, women, and LGBTQ adults.

{***Amie***}

While previous surveys have explored Americans’ beliefs about discrimination, this survey asked people about their own personal experiences with discrimination.

{***Noah***}

In this week’s episode, you’ll hear from Robert Blendon, Richard L. Menschel Professor at the Harvard Chan School, and director of the series.

Blendon explained the key findings of the series—and what they mean for a range of pressing issues in America—including the “Me Too” movement, health care, and policing.

{***Amie***}

The findings are broad so we won’t have time to share all of them in detail, but if you’re interested in reading the survey results for each group, you can head to our website, hsph.me/thisweekinhealth.

{***Noah***}

The Forum webcast series at the Harvard Chan School has also hosted two webcasts on this series—focusing on African-Americans and Native-Americans, and we’ll be sharing some clips from those shows throughout the episode.

{***Amie***}

But first, we’ll jump into our conversation with Robert Blendon.

And we started by talking about the survey focusing on women in America.

{***Noah***}

That survey showed that women reported experiencing extraordinary levels of harassment in a variety of settings.

And while the survey was conducted before the “Me Too” movement shone a spotlight on sexual assault, harassment, and misconduct, Blendon says these findings actually reveal something current reporting on the “Me Too” movement has missed.

{***Blendon Interview***}

BOB BLENDON: Almost every day now, there’s a new poll that highlights discrimination and the harassment against women. So the big issue that sort of is lost in today’s discussion is that a very substantial number of women we interviewed really felt they felt discrimination at work.

It’s just a lot of harassment, particularly around the issue of promotions. So a large number of them just felt that they didn’t get promoted, because they were women, so in a world where we think those issues have just disappeared. And the people we surveyed really feel that they have faced employment-related discrimination.

And then we had just asked about other things that go on in people’s lives and found this very, very large number who experienced over their lifetime– types of sexual harassment. And a surprise– and this is changing already in the current dialogue.

Older women were much more reluctant to say that they had faced sexual harassment. And younger women really felt that this was something they could discuss very quickly with you. But I think our contribution was sort of early on, to show how there was a very high level concern about this.

And people had normally not tapped into that. They usually ask about other issues facing women. And then, suddenly, the national light turned on this. And it became part of a discussion that we have not had, probably in 25 years.

NOAH LEAVITT: And so was one of the takeaways, as you mentioned– I mean, there is this national conversation over sexual misconduct, assault, harassment. But it seemed like what the poll is showing is that discrimination and even harassment, I guess, take many different forms. As you mentioned, discrimination at work, discrimination in other areas of daily life.

BOB BLENDON: Absolutely. And so, again, we looked at– what is unique about the whole effort is to look across all groups by gender, and by race, and ethnicity, and allow them to speak about their lives, and employment, and police, and courts, and interactions with people.

And so often, people will just focus on one area for this. So the most visible thing today is sexual harassment. In the survey, the most visible thing is real employment issues, that we have not moved away from the fact where women don’t feel that their assigned roles– they’re not promoted– that really are very gender related.

And I think after we get through this wave of discussion about sexual harassment, we are as a country going to go back and look at whether or not the opportunities, really in the employment sector, are really there the way all the laws say they’re supposed to be. People’s experiences were not what you would read from the legislation in this area.

NOAH LEAVITT: And I wanted to follow up on that, talking about people’s experiences. And I know you asked people to kind of describe their personal experiences. So, I guess, kind of a two-part question. Why was this, do you think, a valuable approach? And how is it maybe different than other research that’s typically conducted around discrimination?

BOB BLENDON: The whole project is different a couple ways. One is it allows groups across the board, including white men, to have a chance to express themselves about their own lives. But the biggest issue here– and it’s not the first time, but it’s not what we normally do with polling.

In polling, we normally ask people their perceptions of what’s going on in the country. And so, how is it doing? How do you think African Americans are treated in America today? This poll focuses on your own life. It’s a chance to give people a voice.

And so the polling actually started in the 1930s. And most of the polls asked you how the country was going, how Roosevelt was going, what’s happening to employment. And a small number asked you about your life. What’s it like to be in the depression?

And so we really picked up on that and said we are not asking you about the country, or the state, or political leaders. Let’s talk about your own life. And this is a chance we will give voice to you. African American, Asian American, men, women, about your own lives and experiences.

And we know from other research that people give, actually, more cautious answers about themselves than about the country. So people often think the crime rates are always going up. But in their own lives, they actually report less incidents of crime– particular. And then it goes the other way.

But you get a different answer when I say, let’s talk about your life versus, how do I think the country is going? And that’s what the series are about. And it got involved– really important for a school of public health. Because of the related research, it turns out that if people really feel they’re discriminated in their life, it raises their stress levels.

And where medical science has moved along is– it turns out that higher levels of stress push all types of chronic illnesses and diseases for that. So many people for years didn’t think– oh, it doesn’t matter how stressed I am. It has nothing to do with my heart disease, or diabetes, or I can’t sleep at night.

And it turns out it does. So we were able to link the two together. It’s important to know that people really feel harassed, or prejudiced against, or discriminated in these activities, because it actually affects their health. But, also, when we started this– and it’ll come back to it.

The underlying issue was the relationship of the police and the legal system.

{***Noah***}

And we want to jump in here to share one of those Forum clips we mentioned at the top of the show. These polls shed key insight on how people interact with the police in America.

{***Amie***}

As Elizabeth Hinton, an Assistant Professor in the Departments of History and African and African American Studies at Harvard University, explains, high levels of distrust of the police make it less likely that African-Americans will call law enforcement when needed.

{***Elizabeth Hinton Soundbite***}

(African-Americans do not have a high level of trust in police. A third of African-Americans don’t feel comfortable to call the police when they’re in need. And that– and this was extremely troubling to me– that more than a quarter avoid doing ordinary, everyday activities because of fear of coming into contact with police demonstrates just how fractured police community tensions are in the United States today. And this obviously became really clear and it moved the center of national discussions beginning with the killing of Michael Brown in Ferguson. So a number of police departments are beginning to embrace reforms to help improve police legitimacy in low income communities. So we have procedural justice training programs going on for police, implicit bias training programs going on for police which recognize that police carry sets of assumptions about racial and ethnic minorities that affects the way that they police and target certain communities. And so procedural justice, as a way to restore integrity and trust, encourages police officers to treat everybody like a human being, not only to keep officers safer but to improve general safety within the communities and make it more likely that people will feel comfortable to call the police when they’re needed.)

{***Amie***}

The polls revealed that other groups also have a tense relationship with law enforcement.

{***Noah***}

For example, a third of Native-Americans say they had experience discrimination when dealing with the police.

And data from the Centers for Disease Control and Prevention show that Native Americans are killed in police encounters at a higher rate than any other racial or ethnic group.

{***Amie***}

Blendon says these survey findings about personal experiences with police are so important as America engages in an ongoing conversation about policing and the use of force.

{***Blendon Interview***}

BOB BLENDON: And the reason why this is a very important life experience– America is divided on what they see about the news. There are people who feel that the shootings or the incidents are really a broader pattern of what’s facing minority Americans today.

There are others who feel– yes, there are terrible incidents of things that go wrong. But they don’t represent a broader pattern. And so we didn’t ask whether or not there was a broader pattern. We asked each group to describe their relationship to the police and to the court system.

And the difference between groups– whites and blacks, whites and Native Americans, whites and Latinos on the police issues and the courts is just horrendous. It’s three times higher. So it doesn’t mean someone who isn’t white doesn’t– had an incursion with the police.

But the rates are just extraordinarily higher, which just– in this middle of the huge debate– which we’ll go on about– how serious a problem interaction with the legal and police system is. From an individual point of view, there is a real pattern of difference.

Something is really going on that so many people do that. And on every measure of a personal experience, it’s just dramatically different, particularly among those three groups and white Americans. And so that is really important. People are telling their life stories that something is wrong here in their relationship.

{***Amie***}

And we’re going to jump in here again.

A moment ago you heard how perceptions of discrimination make many people less likely to call the police. Blendon says we’re actually seeing similar effects in other areas—including health care.

{***Noah***}

For example, the survey of LGTBQ Americans found that nearly one in five LGBTQ people avoid medical care out of concern for discrimination and nearly a third of transgender people have no regular doctor.

{***Amie***}

Blendon says findings like this should be used to inform broader conversation about access to health care and insurance in America.

{***Blendon Interview***}

BOB BLENDON: Most discussions today say that people cannot see a doctor, because they can’t pay for it. End of discussion. It turns out, among minority communities, a share of them really feel they seek care, and they are discriminated against.

And it deters them from going places for that. And we found examples of that among gender communities, where people really feel that there is no sensitivity to their particular circumstances. And they report, I don’t go back for that.

And so it changes a bit of the national discussion. For many groups, it’s not just insurance coverage. There is whether or not there is a sensitive group to your particular needs for that. And if they don’t treat you that way, it really affects your willingness to go back.

NOAH LEAVITT: Was that surprising at all to see– I think both with related to policing or health care– that there were these experiences of discrimination kind of across all genders, across all income levels, that it seemed to be kind of really widespread? I think that you had mentioned, for example, Asian Americans, that they were the highest overall income group, but there were still experiences of discrimination. So is that surprising how widespread it was?

BOB BLENDON: So there are really two separate findings. And the one you’re touching on is really something people do not realize. Among many minority communities, the people who report the most harassment, and behavior, or discrimination are often higher income or educated.

So there is across American culture a belief that you get more successful– I get more degrees, I live in the suburbs. Things move on. It won’t be the way it was years ago for mom and dad. And we find among a number of minority groups, people who are better off– higher education, higher income, living in suburban communities– reporting more insults, harassments based on their ethnicity.

And so this story about, oh, the college professor stopped by the police, or somebody treated badly. Oh, no, that doesn’t really happen. Well, it turns out all across our states, particularly among minority groups that have faced discrimination, that when they confront a more successful American life, they confront problems that don’t go away. So that was one surprise.

And a more general thing– it’s important. We asked everyone if their group is discriminated in America because of their group. And headlines were– a majority of whites say they are discriminated against. And so all the groups did. And so a takeaway is that we live in a very tense situation in the United States, where people feel that they are being treated differently.

When we actually said, let’s stop talking about the aggregate, let’s talk about you, it turns out that African Americans, Latinos, and Native Americans, and people who were LGBTQ have anywhere from one and a half to three times more discriminatory reports on every measure than whites.

So people answering would have an experience, but the rates are astronomically different. To be African American, or Latino, or Native American is a very different experience than being white in America. But in discussing, it’s important to realize that people feel today that there’s prejudice.

And in whites, it was around employment. And so we have a situation that every group we interviewed felt that in some way they were being discriminated in terms of hiring and promotion for that. So we have a tense discussion here about how we work our way through those decisions.

But things like just inappropriate behavior. When people insult you, they make fun of your group. It is much higher rates if you are among those minority communities, and it gets people angry. And it leads them to, also, high levels of stress for that.

Women– and it varies, obviously, by group– have more threats of violence, more harassments than men in their group. There are just big gender issues. And there are issues which are just not subtle. People are threatened.

They’re insulted. They fear violence. Much more so among women for that. So hidden beneath these gender discussions are discussions about inappropriate behavior that are very threatening to people, and it differs by gender.

Even in this world where we’re saying we’re moving away from it, we find in almost every group, women face a range of problems. They’re more likely to feel they’re discriminated against than every group by the health care system.

NOAH LEAVITT: And in terms of the forms of discrimination– I mean, was it fairly equally balanced, I guess, between something that might be called interpersonal, maybe kind of the more systemic things, like in the workplace, in the health care system?

Or are there differences based on the different groups, in terms of facing maybe interpersonal– like you said, threats or violence, versus maybe some of the more systemic forms of discrimination, like I’m getting passed over for a promotion at work?

BOB BLENDON: The African Americans, Latinos, and LGBTQ have sort of the highest on almost all the measures. Other groups may face more institutional discrimination, but the personal interactions aren’t there.

One of the things that we were taken back is the relatively high proportion of times people say that they have been insulted, based on their ethnicity, whether it’s jokes, whether it’s fun, and even threatened because of what their background is for that. Most people ask you about institutional discrimination. We do surveys.

Most things are about jobs, occasionally about schools, but not about whether or not– how people are really insulted verbally in all kinds of ways. And for those four groups, the rates of personally being assaulted– and if you just think about the psychology, the stress, people confront a substantial number of just insults, because of their background, their family.

And that really comes out here. And when you ask people, they say it’s mostly individuals. It’s not institutional. Native Americans are more concerned institutionally, because they actually– some of them do confront having to deal with governments, and Indian Health Service, and living on tribal lands, and things like that.

But more people think it is individual. But the level of being insulted because of your background and the fact that it doesn’t go away with education, and income, and living in the suburb– now, I’m out of this. It’s not going to be this way for myself or my kids– turned out just not to be true.

{***Amie***}

We’re jumping here again before Bob Blendon makes a key point about the purpose of this poll.

{***Noah***}

And he told us that this really was about giving voice to different groups and their experiences with discrimination.

{***Amie***}

And we wanted to share a clip from the Forum webcast on Native-American discrimination to illustrate why this matters.

{***Noah***}

Stephanie Fryberg, Associate Professor for American Indian Studies and Psychology at the University of Washington, says that Native American voices are not being heard by the general public—or by scientists. And she explains the impact that can have in area like suicide prevention.

{***Stephanie Fryberg Soundbite***}

(Often when we think about suicide, we think about the ways in which individual’s self continuity gets disjointed from their cultural continuity. And so as tribal people, we often understand ourselves as part of a collective. But much of the language about suicide is very individual. And so one of the things that we’ve tried to do is to really push back against some of that, it’s you’re in a black box, you– this is an individual choice. It’s not an individual choice. It’s a choice that you make that impacts the entire community. Changing that connection, but also recognizing the ways in which the systemic discrimination against native people, in schools, and in other spaces, where kids don’t get to learn about their future self and don’t get to learn about who they are as contemporary people, we are creating that disjointedness. And so a big part of what we have to do is really get America to stand up and want to see us as contemporary people, to allow us to redefine ourselves, to allow us to have a voice in who we are, and to not continue this frozen in time, vanishing Indian rhetoric. Because it’s not true. I mean, when you look at under age 25, natives are growing at a higher rate than any other group in America. And so we are here and we are functioning. But also, to clinicians, as we think about psychologists, and how we get the news out there, you can’t come to Indian country and talk about suicide as an individual choice, because you make us feel more alone. And so some of it is whose responsibility is it. To my own field, I mean, we’ve been trying to call out– if you look at the 40,000 papers on discrimination, less than a half of a percent even mention natives. And one tenth of a percent actually have natives in some substantial way. So we’re a much higher part of the population, but we’re not being studied. And people are not using science to help our communities.)

{***Noah***}

Often when we talk about polling, it’s used to gauge sentiment about a particular issue or maybe a policy proposal.

{***Amie***}

But Bob Blendon says that wasn’t the case here. As Stephanie Fryberg said, this is about making sure the voices of diverse groups are being heard.

{***Robert Blendon Interview***}

BOB BLENDON: This effort with National Public Radio was an effort to bring people’s voices in and say there’s real life experience going on. It wasn’t a way to find five policy ways for that. And what happens is you discredit the results when the people doing it have an answer. I think we should be doing this or that.

And, actually, there are groups who have suggested to us they may use it in court hearings. What it shows is much broader patterns occurring in people’s life. It’s not just individual. So when discussions go further in the future, this data will help say– whether it’s African Americans, or Native Americans, or Latinos, it’s not the isolated incident on the news.

You have patterns here that are really affecting communities very broadly. And they’re not talking about some news story that I saw in Florida, or here, or there. I’m talking about my own life. So how I think it’s going to affect it is I think it will be used, saying you can’t just say this is a case.

There is patterns going on in our communities that are very, very real that cut across all over the country. You have to talk about the patterns. That’s where the contribution is. You cannot say, oh, something terrible happened in Long Island– won’t happen again. We’ll do that. There’s not a pattern.

And so you have people who are more successful in life, talking about being mistreated, because of their race and others. And it’s their life– and not talking about the neighborhood. They’re just talking about their own lives. It will provide a framework.

And that’s how people who have emails and all, said, we’re involved with various cases. And we’re going to use this to say, what happened with Johnny is not an individual case. There is a pattern of how people interact. And I think on issues like the police and court system, it’s the same thing.

It’s not a matter of a particular incident where the police were or not. There is a pattern that lets people feel through their lives that they are just being mistreated for that. That pattern is just not among African Americans. There are other Latinos, Native Americans.

There are gender levels of discrimination here that are real, across lots of people. And so the people saying, these things happening to me, are millions of people. So the contribution is really saying it’s not an individual case. When you read this story, hear about it, and say, oh, that’s awful, but it really doesn’t happen, there is a pattern.

And if we’re going to deal with it, it’s going to have to be around patterns. For those of us in health care, we’ve introduced just a new discussion. It’s not all just insurance. There are minority communities, all of whom have health problems disproportionately to whites.

And they’re reporting being treated in a way, and including women and various different gender issues, that in a way the health care system has to focus on much more clearly. So that’s sort of the takeaway. It’s using people’s individual lives to say there are patterns here that have to be addressed.

NOAH LEAVITT: And I think it probably makes it easier for people to discount it and say, oh, that type of discrimination doesn’t happen here. That doesn’t happen in our community.

BOB BLENDON: Yes, some shooting. Oh, I heard the court somewhere treated somebody very terribly. It doesn’t happen here. It’s rare. And what we have is people telling you about their lives. It happens frequently. It happens to millions of people. It leads them to be afraid of interacting with various– going for medical care– ever calling the police.

Because they’re convinced that they’ll be mistreated for that. And these patterns are what we have to do. And that’s what institutional responses are all about– are setting up structures, which say there are patterns going on. And we have to set it up, so it doesn’t go on this way anymore.

{***Noah***}

That was our conversation with Bob Blendon on the polling series “Discrimination in America.”

As we mentioned, if you want to read the full polling results, we’ll have them on our website, hsph.me/thisweekinhealth.

{***Amie***}

And you heard clips from a couple of Forum webcasts. We want to let you know there will actually be a future webcast focusing on LGBTQ Americans and health.

We don’t have an exact date yet, but it will be coming up in March. You can stay up-to-date on the latest Forum events by following them on Facebook at facebook.com/forumhsph.

{***Noah***}

And a quick programming note that we’ll be posting new episodes a little less frequently for the next month or so. We’re actually hitting the road to do some field reporting for a series of stories we’ll be airing in the fall.

{***Amie***}

That’s all for this week’s episode.

And before we go—some exciting news—if you’re a Spotify user, you can now listen to this podcast there. Just search for “Harvard Chan: This Week in Health.”

Of course, you can also still find us on iTunes, Soundcloud, and Stitcher.