Investigating effects of discrimination upon health requires clear concepts, methods, and
measures. At issue are both economic consequences of discrimination and accumulated
insults arising from everyday and at times violent experiences of being treated as a
second-class citizen, at each and every economic level. Guidelines for epidemiologic
investigations and other public health research on ways people embody racism, sexism, and
other forms of social inequality, however, are not well defined, as research in this area
is in its infancy. Employing an ecosocial framework, this article accordingly reviews
definitions and patterns of discrimination within the United States; evaluates analytic
strategies and instruments researchers have developed to study health effects of different
kinds of discrimination; and delineates diverse pathways by which discrimination can harm
health, both outright and by distorting production of epidemiologic knowledge about
determinants of population health. Three methods of studying health consequences of
discrimination are examined (indirect; direct, at the individual level, in relation to
personal experiences of discrimination; at the population level, such as via segregation),
and recommendations are provided for developing research instruments to measure acute and
cumulative exposure to different aspects of discrimination.
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