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How stereotypes hurt

A national study led by a USC researcher found people who encountered the threat of being judged by negative stereotypes related to weight, age, race, gender, or social class in health care settings reported adverse effects. The researchers found those people were more likely to have hypertension, to be depressed, and to rate their own health more poorly. They were also more distrustful of their doctors, felt dissatisfied with their care, and were less likely to use highly accessible preventive care, including the flu vaccine.

Health care stereotype threats stems from common stereotypes about unhealthy lifestyle choices or inferior intelligence that may be perpetuated, often unintentionally, by health care professionals or even by public health campaigns. Although health messages are intended to raise awareness of health issues or trends that may affect specific communities, one implication of this study is that these messages can backfire, said lead author Cleopatra Abdou, an assistant professor at the USC Davis School of Gerontology and Department of Psychology.

"An unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of people," Abdou said. "As a result, they may inadvertently increase experiences of what we call 'healthcare stereotype threat,' which can affect health care efficacy and even prompt some patients to avoid care altogether."

As an example, Abdou cited campaigns about reproductive health in African American women and other women of color, sexual health in the LGBTQ community, depression among women, and memory problems in older adults. Such messages can reinforce and magnify the negative lens through which these groups of people are commonly viewed in society, she said.

"It's not that there aren't real health concerns in specific communities that we need to do more--much more--to address, but how we communicate about these concerns is key," Abdou said.

Abdou and her team surveyed an estimated 1,500 people as part of the U.S. Health and Retirement Study. More than 17 percent of the respondents said they felt vulnerable to prejudice with regard to racial or ethnic identity, gender, socio-economic status, weight or age in health care settings. People who felt threatened based on several identities were worse off, healthwise, than people who felt threatened based on just one identity.

Abdou said the challenge now is to find ways to inform all people, including people at heightened risk, about how to live healthier, happier, and longer lives while also minimizing the experience and effects of health care stereotype threat.

"It's time for us to implement policies that enhance medical school training in cultural competency and increase the diversity of our physicians and broader health care workforce," Abdou said. "Hospitals and other health care institutions with inclusive policies which welcome diversity and celebrate tolerance, both symbolically and explicitly, hold great promise for reducing health care stereotype threat and the short- and long-term health disparities that we are now learning result from it."

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