Krieger N
Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA.
Int J Health Serv. 1999;29(2):295-352. doi: 10.2190/M11W-VWXE-KQM9-G97Q.
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.
研究歧视对健康的影响需要清晰的概念、方法和措施。问题既涉及歧视的经济后果，也涉及在各个经济层面上被当作二等公民的日常乃至有时暴力的经历所累积的侮辱。然而，关于人们如何体现种族主义、性别歧视和其他形式社会不平等的流行病学调查及其他公共卫生研究的指导方针并未明确界定，因为该领域的研究尚处于起步阶段。因此，本文运用生态社会框架，审视了美国国内歧视的定义和模式；评估了研究人员为研究不同类型歧视对健康的影响而开发的分析策略和工具；并描绘了歧视可能直接或通过扭曲关于人群健康决定因素的流行病学知识的产生来损害健康的多种途径。本文考察了三种研究歧视对健康影响的方法（间接方法；直接方法，在个体层面上，与个人的歧视经历相关；在人群层面上，例如通过隔离），并就开发测量对歧视不同方面的急性和累积暴露的研究工具提出了建议。
