Racism, xenophobia, and discrimination: mapping pathways to health outcomes.

Despite being globally pervasive, racism, xenophobia, and discrimination are not universally recognised determinants of health. We challenge widespread beliefs related to the inevitability of increased mortality and morbidity associated with particular ethnicities and minoritised groups. In refuting that racial categories have a genetic basis and acknowledging that socioeconomic factors offer incomplete explanations in understanding these health disparities, we examine the pathways by which discrimination based on caste, ethnicity, Indigeneity, migratory status, race, religion, and skin colour affect health. Discrimination based on these categories, although having many unique historical and cultural contexts, operates in the same way, with overlapping pathways and health effects. We synthesise how such discrimination affects health systems, spatial determination, and communities, and how these processes manifest at the individual level, across the life course, and intergenerationally. We explore how individuals respond to and internalise these complex mechanisms psychologically, behaviourally, and physiologically. The evidence shows that racism, xenophobia, and discrimination affect a range of health outcomes across all ages around the world, and remain embedded within the universal challenges we face, from COVID-19 to the climate emergency.

Racism, xenophobia, discrimination, and the determination of health.

This Series shows how racism, xenophobia, discrimination, and the structures that support them are detrimental to health. In this first Series paper, we describe the conceptual model used throughout the Series and the underlying principles and definitions. We explore concepts of epistemic injustice, biological experimentation, and misconceptions about race using a historical lens. We focus on the core structural factors of separation and hierarchical power that permeate society and result in the negative health consequences we see. We are at a crucial moment in history, as populist leaders pushing the politics of hate have become more powerful in several countries. These leaders exploit racism, xenophobia, and other forms of discrimination to divide and control populations, with immediate and long-term consequences for both individual and population health. The COVID-19 pandemic and transnational racial justice movements have brought renewed attention to persisting structural racial injustice.

Anti-Asian Xenophobia, Hate Crime Victimization, and Fear of Victimization During the COVID-19 Pandemic.

While the World Health Organization advised against referring to COVID-19 using racial overtones, as the COVID-19 pandemic spread, many disparagingly called it the "Wuhan virus," the "Chinese virus," and other terms. In this context, the FBI warned police agencies about an expected increase in anti-Asian hate crimes during the early months of the pandemic. But, while some researchers and media outlets discussed these potential increases at length, very few studies have been able to directly assess the nature of anti-Asian hate and bias victimization during the pandemic. Following this, the current study directly examines variation in anti-Asian bias and victimization in the United States during the COVID-19 pandemic. Specifically, this research presents results from two studies using a survey of 3,163 non-Asian and 575 Asian American and Pacific Islander respondents, respectively. The first study examines the prevalence of anti-Asian xenophobia among the non-Asian sample and assesses differences in these prejudicial attitudes across respondent characteristics, while the second study examines variation in experiences with bias during the pandemic among the Asian sample. The results illustrate the ubiquity of anti-Asian sentiment, suggesting that those who indicate greater fear of the pandemic report more prejudicial attitudes, as well as important racial differences in these patterns. The results also demonstrate the extent to which the pandemic has impacted individual experiences with anti-Asian bias victimization, such that more than one-third of Asian respondents report bias victimization during the pandemic, and more than half of Asian respondents report that they know someone who has been victimized. These patterns have important implications for addressing COVID-19-related hate crime moving forward.

Does COVID-19 threat increase xenophobia? The roles of protection efficacy and support seeking.

BACKGROUND: In response to the COVID-19 pandemic, people in many countries have shown xenophobia toward China, where the pandemic began. Within China, xenophobia has also been observed toward the people of Wuhan, the city where the first cases were identified. The relationship between disease threat and xenophobia is well established, but the reasons for this relationship are unclear. This study investigated the mediation role of perceived protection efficacy and moderation role of support seeking in the relationship between perceived COVID-19 risk and xenophobia within China. METHODS: An online survey was administered to a nationally representative sample (N = 1103; 51.7% women; ages 18 to 88) of Chinese adults during the early stage of the COVID-19 pandemic. Participants completed questionnaires about their perceived COVID-19 risk, perceived protection efficacy in reducing risk, support seeking, and xenophobic attitudes toward people of the Wuhan area. RESULTS: Regression based analyses showed that the perceived COVID-19 risk positively predicted xenophobia. Low perceived protection efficacy partly mediated the relationship between perceived COVID-19 risk and xenophobic attitudes, and this indirect effect was moderated by support seeking. Specifically, the indirect effect was weaker among individuals who sought more social support. CONCLUSIONS: Under disease threat, xenophobia can appear within a country that otherwise seems culturally homogeneous. This study extends the extant research by identifying a possible psychological mechanism by which individuals' perception of disease threat elicits xenophobia, and by addressing the question of why this response is stronger among some people than others. Increasing the public's perceived efficacy in protecting themselves from infection, and encouraging support seeking, could reduce xenophobic attitudes.

Discrimination experienced by Asian Canadian and Asian American health care workers during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Asian Canadians and Asian Americans face COVID-19-related discrimination. The objective of this qualitative study was to explore the experiences of Asian health care workers dealing with discrimination, with a focus on racial micro-agressions, in Canada and the United States during the COVID-19 pandemic. METHODS: We adopted a qualitative descriptive approach. We used convenience and snowball sampling strategies to recruit participants. We conducted individual, in-depth semistructured interviews with Asian health care workers in Canada and the US via videoconferencing between May and September 2020. Eligible participants had to self-identify as Asian and be currently employed as a health care worker with at least 1 year of full-time employment. We used an inductive thematic approach to analyze the data. RESULTS: Thirty participants were recruited. Fifteen (50%) were Canadians and 15 (50%) were Americans; there were 18 women (60%), 11 men (37%) and 1 nonbinary person. Most of the participants were aged 25-29 years (n = 16, 53%). More than half were nurses (n = 16, 53%); the other participants were attending physicians (n = 5), physiotherapists (n = 3), resident physicians (n = 2), a midwife, a paramedic, a pharmacist and a physician assistant. Two themes emerged from the data: a surge of racial microaggressions related to COVID-19 and a lack of institutional and public acknowledgement. Participants noted that they have experienced an increase in racial microaggressions during the COVID-19 pandemic. They have also experienced threats of violence and actual violence. The largely silent organizational response to the challenges being faced by people of Asian descent and the use of disparaging terms such as "China virus" in the early stages of the pandemic were a substantial source of frustration. INTERPRETATION: Asian health care workers have experienced challenges in dealing with racial microaggressions related to COVID-19 in the US and Canada. More research should be done on the experiences of Asian Americans and Asian Canadians, both during and after the pandemic, and supportive measures should be put in place to protect Asian health care workers.

Everything is going to be all right. Psychopathology in the time of an epidemic in Italy.

Scopo del presente lavoro è descrivere alcune reazioni umane e alcuni elementi di psicopatologia durante la pandemia. La pandemia ha messo in luce diversi aspetti dell'animo umano negli operatori sanitari, nei pazienti e nelle altre persone. Vi sono medici, infermieri, operatori che lavorano 24 ore su 24 per curare e assistere i malati, accompagnare chi non ce la fa. Incuranti del rischio di contagio, della fatica, dei propri bisogni hanno un'unica priorità : aiutare, fare il proprio dovere. Molti di loro si sono ammalati, molti sono morti. Tra loro vi è un alto tasso di contagiati, malati, qualcuno muore. Tutti sono stremati. Sono stati chiamati eroi, ma non tutti sono eroi. I nostri pazienti psichiatrici, inizialmente, sono i più adeguati, prudenti, saggi, responsabili. Con poche, semplici parole esprimono tanta consapevolezza e sana umanità. Al contrario, altre persone, quelle che normalmente si sentono "al di sopra delle cose", entrano nel panico Questa pandemia ci ha fatto capire (se ancora lo ignoravamo) che la vita è fragile, che tutto ciò che ci circonda e su cui costruiamo le nostre sicurezze è precario e incerto.

From margin to center: An Asian Americanist psychology.

In the midst of a global pandemic and movements for racial justice, there is an opportunity to (re)imagine an Asian Americanist psychology that can bring about a more just society. The authors describe the contours of an Asian Americanist psychology that is grounded in historical context, an intersectional analysis, and representational ethics while focusing on community strengths and structural change. The article concludes with calls to action for Asian American psychologists, other psychologists of color, and White psychologists to envision a new era that centers Asian Americans in the multiracial pursuit of social justice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychology and the Threat of Contagion: Feeling Vulnerable to a Disease Moderates the Link Between Xenophobic Thoughts and Support for Ingroup-Protective Actions.

The widespread threat of contagious disease disrupts not only everyday life but also psychological experience. Building on findings regarding xenophobic responses to contagious diseases, this research investigates how perceived vulnerability to a disease moderates the psychological link between people's xenophobic thoughts and support for ingroup-protective actions. Three datasets collected during the time of Ebola (N = 867) and COVID-19 (Ns = 992 and 926) measured perceived disease risk, group-serving biases (i.e., xenophobic thoughts), and support for restrictive travel policies (i.e., ingroup-protective actions). Using correlational and quasi-experimental analyses, results indicated that for people who perceive greater disease risk, the association between group-serving bias and restrictive policy support is weakened. This weakened association occurred because people who felt more vulnerable to these diseases increased support for ingroup-protective actions more strongly than xenophobic thoughts. This research underscores the importance of understanding the impact of threats on psychological processes beyond the impact on psychological outcomes.

Under the spell of SARS-CoV-2: A closer look at the sociopolitical dynamics.

Sitting on the fine line between pathogen 'transmissibility' and 'severity', the Behavioural Immune System (BIS) is responsible for activating behaviours that minimise infection risks and maximise fitness. To achieve self-preservation, the BIS also fuels social and political attitudes. We aim to explain societal changes that may be sparked by COVID-19 by highlighting links between human evolutionary history and our psychological faculties mediated by the BIS.

Openness and COVID-19 induced xenophobia: The roles of trade and migration in sustainable development.

Along with the plight of the COVID-19 outbreak in 2020 come the xenophobic behaviors and hate crimes against people with Asian descent around the globe. The threat of a public health emergency catalyzed underlying xenophobic sentiments, manifesting them into racial discrimination of various degrees. With most discriminatory acts reported in liberal societies, this article investigates whether an economy more open to trade and migration can be more susceptible to xenophobia. Using our first-hand survey data of 1767 Chinese respondents residing overseas from 65 different countries during February of 2020, we adopt an instrumental variable strategy to identify the causal effect of openness to trade and migration of their residence country on the likelihood of them receiving discriminatory behaviors during the early stage of the COVID-19 outbreak. Our results show that greater openness to trade increases the likelihood of reported xenophobic behaviors, while openness to migration decreases it. On the other hand, stronger trade or immigration relationships with China are associated with less reported discrimination. And these effects primarily influence discriminatory behavior in interpersonal spaces, rather than through media outlets. Our findings highlight nuances of the effect of trade relations on the culture of a society.

Why public health framing matters: An experimental study of the effects of COVID-19 framing on prejudice and xenophobia in the United States.

The COVID-19 pandemic has triggered a notable increase in the expression of prejudicial and xenophobic attitudes that threaten the wellbeing of minority groups and contribute to the overall public health toll of the virus. However, while there is evidence documenting the growth in discrimination and xenophobia, little is known about how the COVID-19 outbreak is activating the expression of such negative attitudes. The goal of the current paper therefore was to investigate what aspects of the COVID-19 pandemic may be contributing to this rise in expressions of prejudice and xenophobia. More specifically, this study used an experimental design to assess the effects of using stigmatized language to describe the virus as well as the threat to physical health and economic wellbeing posed by the virus on COVID-19 prejudice. Data were collected from a national sample of 1451 adults residing within the United States. Results from 2 × 2 x 2 between-subjects analyses of covariance demonstrated that emphasizing the connection between China and COVID-19, rather than framing the virus neutrally, increased negative attitudes toward Asian Americans, beliefs that resources should be prioritized for Americans rather than immigrants, and general xenophobia. Emphasizing the severity of the economic impact of the virus also increased beliefs that Asian Americans are a threat to resources and general xenophobia. In contrast, messages which emphasized the serious health risks of COVID-19 did not increase bias toward Asian Americans or xenophobia. Our findings suggest that specific types of public health messaging related to infectious diseases, especially framing the virus in terms of its country of origin or its likely economic impact, may elicit prejudice and xenophobia. Public health campaigns that emphasize the severity of the virus, however, are not likely to trigger the same negative attitudes. Implications for public health responses to health crises are discussed.

An outbreak of xenophobia: Perceived discrimination and anxiety in Chinese American college students before and during the COVID-19 pandemic.

Since the outbreak of the novel coronavirus (COVID-19) pandemic, reports of xenophobic and racist incidents directed at Chinese Americans have escalated. The present study adds further understanding to potential psychosocial effects of the COVID-19 pandemic by comparing self-reported questionnaire data from two groups of Chinese students attending a public university in western United States: the group who participated in the study before the outbreak of COVID-19 (Pre-COVID, N = 134), and the group who participated at the beginning (during-COVID, N = 64). The aim of the study was to: (a) compare mean differences in perceived discrimination and anxiety between the two groups, (b) test whether COVID-19 moderated the link between perceived discrimination and anxiety, and (c) examine whether media exposure portraying Chinese individuals negatively mediated relations between COVID-19 and discrimination. Results showed that the During-COVID group reported higher perceived discrimination and anxiety than the Pre-COVID group. The link between perceived discrimination and anxiety was stronger for the During-COVID group. Mediation analyses suggested that negative Chinese media exposure partly accounted for the group difference in perceived discrimination. Results suggest that future studies on the psychosocial implications of the COVID-19 pandemic should consider the role of discrimination in understanding the mental health of Chinese American college students.

Perspectives on xenophobia during epidemics and implications for emergency management.

Coronavirus disease 2019 (COVID-19) is an infectious disease that traces its earliest known cases to the Hubei region of China in late 2019. As the COVID-19 pandemic has spread across the globe wreaking unprecedented disruption, increasing levels of xenophobia and racial discrimination have been documented against those of Asian descent. We investigate the historical connections between disease and rise of xenophobia as described in the peer-reviewed literature addressing prior epidemics, such as Ebola and the Hong Kong Flu, in conjunction with concurrent cases of prejudice toward certain groups of people. Attempts to better understand why such attitudes emerge are examined in the context of xenophobic actions during pandemics. Prevailing views suggest that xenophobia ultimately leads to increased stigmatization of those afflicted by disease, which in turn leads to decreased trust in the medical system, resulting in a negative feedback loop. Accurate disseminated information and improved public education on sources and modes of transmission of infectious diseases are essential to check xenophobic tendencies, reduce negative effects and foster greater cooperation.

Connection, Contagion, and COVID-19.

Anthropologists have long known how perceptions of contagion play out along the lines of xenophobia and racism. Months after the beginning of the global Cover-19 pandemic, predictions by anthropologists of xenophobic ideologies and actions have come to pass. In the United States people understand the global pandemic not as biology, but as the manifestation of political affiliation, difference, connection, and disconnection. COVID-19 is, according to public perception, dangerous because it maliciously mutates to attack. It is "a guy we don't know." Relationships between the mysteriousness of the virus and heightened visibility of longstanding inequality in the United States form new contexts for existing social tensions. These dynamics provide a backdrop against which the ongoing commitment to uprisings connected to the Black Lives Matter movement unfold. Here I draw on analysis of 50 semi-structured interviews we conducted from March to August of 2020 demonstrating how understandings of the biology of a virus are woven into perceptions of politics, inequality, and the fractures of a divided nation. To understand social and political responses to the global pandemic it is essential that we continue to investigate xenophobia, inequality, and racism alongside the biological impact of SARS-CoV-2.

COVID-19 Racism and Mental Health in Chinese American Families.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has fueled xenophobia against Chinese Americans. We examined the rates of 6 types of COVID-19 racism and racial discrimination experienced by Chinese American parents and youth and the associations with their mental health. METHODS: We recruited a population-based sample of Chinese American families to participate in this self-reported survey study conducted from March 14, 2020, to May 31, 2020. Eligible parent participants identified as ethnically/racially Chinese, lived in the United States, and had a 4- to 18-year-old child; their eligible children were 10 to 18 years old. RESULTS: The sample included 543 Chinese American parents (mean [SD] age, 43.44 [6.47] years; 425 mothers [78.3%]), and their children (N = 230; mean [SD] age, 13.83 [2.53] years; 111 girls [48.3%]). Nearly half of parents and youth reported being directly targeted by COVID-19 racial discrimination online (parents: 172 [31.7%]; youth: 105 [45.7%]) and/or in person (parents: 276 [50.9%]; youth: 115 [50.2%]). A total of 417 (76.8%) parents and 176 (76.5%) youth reported at least 1 incident of COVID-19 vicarious racial discrimination online and/or in person (parents: 481 [88.5%]; youth: 211 [91.9%]). A total of 267 (49.1%) parents and 164 (71.1%) youth perceived health-related Sinophobia in America, and 274 (50.4%) parents and 129 (56.0%) youth perceived media-perpetuated Sinophobia. Higher levels of parent- and youth-perceived racism and racial discrimination were associated with their poorer mental health. CONCLUSIONS: Health care professionals must attend to the racism-related experiences and mental health needs of Chinese Americans parents and their children throughout the COVID-19 pandemic via education and making appropriate mental health referrals.