The pathways from perceived discrimination to self-rated health: an investigation of the roles of distrust, social capital, and health behaviors

Abstract

Although there has been extensive research on the adverse impacts of perceived discrimination on health, it remains unclear how perceived discrimination gets under the skin. This paper develops a comprehensive structural equation model (SEM) by incorporating both the direct effects of perceived discrimination on self-rated health (SRH), a powerful predictor for many health outcomes, and the indirect effects of perceived discrimination on SRH through health care system distrust, neighborhood social capital, and health behaviors and health conditions. Applying SEM to 9880 adults (aged between 18 and 100) in the 2008 Southeastern Pennsylvania Household Health Survey, we not only confirmed the positive and direct association between discrimination and poor or fair SRH, but also verified two underlying mechanisms: 1) perceived discrimination is associated with lower neighborhood social capital, which further contributes to poor or fair SRH; and 2) perceived discrimination is related to risky behaviors (e.g., reduced physical activity and sleep quality, and intensified smoking) that lead to worse health conditions, and then result in poor or fair SRH. Moreover, we found that perceived discrimination is negatively associated with health care system distrust, but did not find a significant relationship between distrust and poor or fair SRH.

Keywords: Health care system distrust; Neighborhood social capital; Perceived discrimination; Self-rated health; Structural equation model; USA.

Figure 1

Conceptual framework and hypotheses Note: variables in rectangles represent manifest variables, and variables in ovals denote latent variables. The numbers in parentheses are used to simplify our future tables.

Figure 2

Direct and indirect effects of perceived discrimination on poor or fair SRH Note: numbers in the figure represent standardized path coefficients. ***p ≤ 0.001; **p ≤ 0.01; *p ≤ 0.05.