Int J Health Serv. 2014;44(4):643-710. doi: 10.2190/HS.44.4.b.
In 1999, only 20 studies in the public health literature employed instruments to measure self-reported experiences of discrimination. Fifteen years later, the number of empirical investigations on discrimination and health easily exceeds 500, with these studies increasingly global in scope and focused on major types of discrimination variously involving race/ethnicity, indigenous status, immigrant status, gender, sexuality, disability, and age, separately and in combination. And yet, as I also document, even as the number of investigations has dramatically expanded, the scope remains narrow: studies remain focused primarily on interpersonal discrimination, and scant research investigates the health impacts of structural discrimination, a gap consonant with the limited epidemiologic research on political systems and population health. Accordingly, to help advance the state of the field, this updated review article: (a) briefly reviews definitions of discrimination, illustrated with examples from the United States; (b) discusses theoretical insights useful for conceptualizing how discrimination can become embodied and produce health inequities, including via distortion of scientific knowledge; (c) concisely summarizes extant evidence--both robust and inconsistent--linking discrimination and health; and (d) addresses several key methodological controversies and challenges, including the need for careful attention to domains, pathways, level, and spatiotemporal scale, in historical context.
1999 年，仅有 20 项公共卫生文献中的研究采用了工具来衡量自我报告的歧视经历。15 年后，关于歧视与健康的实证研究数量轻松超过了 500 项，这些研究的范围越来越全球化，重点关注各种形式的歧视，包括种族/族裔、原住民地位、移民身份、性别、性取向、残疾和年龄，单独和组合。然而，正如我所记录的，即使调查数量急剧增加，范围仍然狭窄：研究仍然主要集中在人际歧视上，几乎没有研究调查结构性歧视对健康的影响，这与关于政治制度和人口健康的有限流行病学研究是一致的。因此，为了帮助推进该领域的发展，这篇更新的综述文章：(a) 简要回顾了歧视的定义，并举例说明了美国的情况；(b) 讨论了有助于概念化歧视如何通过扭曲科学知识而产生影响和产生健康不平等的理论见解；(c) 简明总结了现有的证据——既有强有力的证据，也有不一致的证据——将歧视与健康联系起来；(d) 探讨了几个关键的方法学争议和挑战，包括需要在历史背景下仔细关注领域、途径、水平和时空尺度。
