Self-reported discrimination in health surveys: results from a scoping review

Abstract

Abstract Background Surveying perceived discrimination in the context of health monitoring can help to clarify the connection between unequal treatment and health. We aimed to review, identify and extract data on definitions and measures of discrimination. Methods A scoping review of both peer reviewed and grey literature was conducted. Survey instruments used in representative surveys in Germany were compared and discussed regarding their strengths and limitations. Ethical and methodical guidelines and policy reports by WHO, ECDC, EUPHA, migration research institutions and local NGOs were considered. Results Research from North America, South Africa and, to a lesser extent, European countries shows a clear link between discrimination and health. Various scales, individual items and instruments operationalize discrimination as worse treatment in everyday life or disadvantage in the structural field (authorities, housing market, working life). Possible reasons and frequencies of experiences are surveyed. Additional instruments are used to evaluate moderators such as vigilance or coping. Besides validity and reliability, ethical aspects such as voluntary self-disclosure, avoidance of external ascriptions and assessment of multiple dimensions of discrimination should be considered. Conclusions We propose a three-stage instrument for surveying perceived discrimination in German health surveys. First, the frequency of interpersonal experiences is surveyed by the everyday discrimination scale validated for different settings. Second, possible reasons for the reported experiences are asked, based on the categories of the German General Equal Treatment Act. Lastly, questions on discrimination in health care and by public authorities will address specific public health areas. Key messages Only few studies are available on discrimination and health in Europe, more is needed to effectively address health disparities. We propose to consider specific ethical and methodical aspects when surveying perceived discrimination as a health determinant.