Routine, even subtle, racial discrimination places significant mental stress on minorities that may provoke the development of chronic illness, new research suggests.

The finding is based on perceptions of discrimination and health histories elicited from Asian-Americans across the United States.

"Post-civil rights, most people think of discrimination as the commitment of a hate crime. But I think it's important to realize that discrimination occurs on a daily basis," said study lead author Gilbert C. Gee, an assistant professor at the University of Michigan School of Public Health. "And what the research is showing is that everyday slights can turn into long-term health effects."

Reporting in the July issue of the American Journal of Public Health, Gee and his colleagues called their work the first national exploration of a link between discrimination and health problems among Asian-Americans.

The study authors analyzed survey responses on health status and discrimination perceptions from almost 2,100 Asian-Americans primarily of Chinese, Filipino, or Vietnamese descent. The researchers noted that in ma ny quarters, Asian-Americans -- a fast-growing population of more than 11 million people -- are stereotypically, and misleadingly, thought of as a "successful" minority group that is a "model" of discrimination-free living.

All the study participants were 18 or older, and most had been interviewed in person -- either in English or their native language -- as part of the 2002-03 National Latino and Asian American Study.

They were asked to recall the frequency of "unfair treatment" they had been subjected to, including disrespect, discourteousness, insulting behavior, harassment, poor service, fearful reactions, and/or assumptions of dishonesty or stupidity. They were also asked to recount their medical histories, including heart and respiratory illness, chronic pain, allergies, arthritis, and asthma. Physician records were not reviewed.

Gee and his team found that Filipinos reported the highest level of discrimination, followed by Chinese-Americans and those of Vietnamese descent. And everyday discrimination was found to be associated with a variety of health problems, including chronic cardiovascular, respiratory, and pain-related health trouble.

Discrimination against those of Chinese descent was not linked to either pain or respiratory problems, but was associated with heart disease. In contrast, discrimination against those of Vietnamese descent was linked to cardiovascular illness, respiratory disease, and pain issues. Filipinos appeared subject to respiratory and pain difficulties, the study said.

The study authors theorized that the differences among the three Asian groups might be explained, in part, by their differing historical and cultural backgrounds.

But in all cases, the association between discrimination and health did not seem to be influenced by age, education level, income level, job status, language ability, or a desire to view one's life in a positive light, the researchers said.

In view of the findings, the study authors suggested that efforts to bolster civil rights in the United States might not only strengthen the nation's democracy but also improve its health.

"Discrimination is associated with a lot of different health outcomes, from mental health problems like depression to substance use, tobacco use, and heart disease," Gee said. "So what's important is that we keep acknowledging that discrimination does occur and find ways to combat it as well as to continue policies that promote civil rights."

Stephen Thomas, director of the Center for Minority Health at the University of Pittsburgh Graduate School of Public Health, said he was "surprised and encouraged" by the study authors' effort to highlight the negative impact that discrimination can have on health.

"The bottom line here is that well into the 21st century, race still matters," he said. "Even though the human genome project has basically concluded that genetically we're the same, the fact is that the way in which we look, the color of our skin, and the accent that we carry affects the way in which we are treated in the social environment of American society. And this impacts us in ways that can have detrimental effects on our health."

"So having evidence of this absolutely helps really bring the message home that we need to finish the work, so to speak, of the civil rights movement," Thomas added. "Because, for people to be suffering from premature illness and death related to exposure to discrimination is not acceptable."

Abstract of the Study

Objectives. We examined whether self-reported everyday discrimination was associated with chronic health conditions among a nationally representative sample of Asian Americans.

Methods. Data were from the Asian American subsample (n=2095) of the National Latino and Asian American Study conducted in 2002 and 2003. Regression techniques (negative binomial and logistic) were used to examine the association between discrimination and chronic health conditions. Analyses were conducted for the entire sample and 3 Asian subgroups (Chinese, Vietnamese, and Filipino).

Results. Reports of everyday discrimination were associated with many chronic conditions, with age, gender, region, per capita income, education, employment, marital status. Social desirability bias was controlled for. Discrimination was also associated with indicators of heart disease, pain, and respiratory illnesses. There were some differences by Asian subgroup.