Unequal Care, Unequal Health: Healthcare Discrimination and Self-Reported Health Among Young Adults

Background and Purpose: Healthcare social workers are at the forefront of addressing medical disparities among vulnerable populations, including young adults who are at heightened risk for poor health outcomes and low utilization of healthcare services. Among the factors contributing to these disparities, discrimination in healthcare settings is linked to poorer health outcomes, healthcare avoidance, and disruption of care. While prior scholarship has examined the health-related impacts of discrimination among adults, research focused on the impact of healthcare discrimination among young adults is less robust. Our study addresses this gap by assessing if healthcare discrimination is associated with young adults’ self-reported health by testing the following hypotheses:

H₀: There is no statistically significant association between healthcare discrimination and self-reported health among young adults

H_a: There is a statistically significant negative association between healthcare discrimination and self-reported health among young adults

Methods: This study used data from the 2023 Well-Being and Basic Needs Survey, a nationally representative survey of 7,821 adults aged 18 to 64 in the United States with an oversample of households with income under 150% of the federal poverty level. Our sample was limited to participants aged 18-34 yielding a final sample of 1,825 young adults. The analysis was conducted using survey weights to account for the low-income oversample. A multiple linear regression was conducted to assess whether healthcare discrimination was associated with poorer self-reported health while controlling for demographic and socioeconomic factors. Self-reported health was measured on a 5-point Likert scale with higher scores indicating better health. The primary predicator was operationalized as a single binary indicator denoting whether respondents reported experiencing discriminatory treatment at a doctor’s office, clinic, or hospital due to race, ethnicity, or disability in the past year.

Results: We find that healthcare discrimination is a significant predictor of poorer self-reported health among a sample of young adults. Our model was statistically significant (F = 33.45, p <.001) and accounted for approximately 19% of the variance in self-reported health. After controlling for demographic factors, food insecurity, unmet medical needs, and health conditions, healthcare discrimination was associated with significantly lower self-reported health among young adults (b = -.238, p<.001).

Conclusions and Implications: These findings have direct implications for social work practice and policy. In practice, healthcare social workers should advocate within healthcare systems to ensure young adults are connected to affirming and culturally responsive services. Addressing discrimination as a part of routine social work assessments in healthcare settings would improve health outcomes and reduce patterns of healthcare avoidance among young adults. Our findings also underscore the need to implement federal and organizational policies that eliminate healthcare discrimination. Doing so requires social workers to advocate for anti-racist and anti-ableist institutional norms. Future research should examine the mechanisms that link healthcare discrimination to health outcomes among young adults and evaluate the effectiveness of interventions aimed at eliminating discrimination-related barriers to healthcare.