The world in general and workplaces in particular are becoming a difficult place to be. A recent study published in Journal of the American Heart Association (JAMA) in April 2023 seem to suggest that those who experienced workplace discrimination developed high blood pressure.

One of the risk factors for high blood pressure is discrimination at work.

“The daily hassles and indignities people experience from discrimination are a specific type of stress that is not always included in traditional measures of stress and adversity,” says sociologist David R. Williams, professor of public health at the Harvard T.H. Chan School of Public Health.

The discrimination could be on the basis of race, religion, region, nationality, colour, gender, appearance – just about anything. All these creates a toxic workplace and the company policy should spell out very clearly about the actions that could be taken on employees who discriminate.  

In a sample study of 1246 US workers, the researchers found that those who experienced discrimination on the job were 54% more likely to develop high blood pressure compared to those workers who had minimum exposure. The 2023 study published in JAMA is the first study to demonstrate that discrimination in the workplace can raise blood pressure.

Most of the participants were middle-aged, white, and married. They were mostly non-smokers, drank up to moderate amounts of alcohol, and did moderate or more exercise. No one had high blood pressure at the start of the study.

Employees who felt discriminated developed high blood pressure at a rate of about 4% each year compared to 2.5% per year in people who had minimum encounters to discrimination.

Lead researcher, Jian Li, professor at the University of California, Los Angeles said, “Our findings suggest workplace discrimination as a potential risk factor for high blood pressure.”

The study followed workers for a long time, showing that the high blood pressure diagnosis was after they started to experience discrimination.

The researchers used the following 6 questions:

  • How often were tasks given to you that no one else wanted to do
  • How often are you under watch compared to fellow coworkers
  • How often did your line manager use slurs (ethnic, racial, sexual) or jokes at you
  • How often did your coworkers use slurs (ethnic, racial, sexual) or jokes at you
  • How often did you feel ignored by your line manager
  • How often did a coworker with lesser experience and/or qualification got a promotion before you

Discrimination leads to stress that activates body’s fight-or-flight response which results in faster heart beats and narrowing of the blood vessels that causes a temporary rise blood pressure. If the stress response is triggered often, it can lead to blood pressure remaining high and requiring treatment.

Chronic stress reduces the ability of the body to recover from stressors. The ongoing stress may take a toll indirectly by making people to cope in unhealthy ways (smoking, drinking etc.), disrupting sleep and in the process making it difficult to have an exercise regime.

In the past studies have tried to establish a connection between chronic stress and physical health, however, recently research has started to focus on health effects of racism. And even less is known about discrimination at work.

Sickness at workplace not only affects one worker but all those who are doing similar jobs or encountering unpleasant work-related issues in the same location.

People should be aware that even words they consider “jokes” can have lasting effects on others, Sanchez, CMO for Prevention at AHA said.

Depending on degree of workplace discrimination, the risk of developing high blood pressure increased accordingly.

The researchers had factored in many variables, such as age, race, income and education level, and exercise, smoking and drinking habits etc.

Dr Eduardo Sanchez, chief medical officer for prevention at the AHA (American Heart Association) said that given that people spend so much of their lives at work, it is very important to study the health effects of job exposures.

Not only high blood pressure, multiple studies in the past have documented that experiencing discrimination increases risk for developing a range of factors linked to heart disease, which also includes chronic low-grade inflammation, obesity, and type 2 diabetes.

The author of this article is of the view that health effects of job exposures must be studied not just in factories but in corporate offices too. Many business owners and even employees are often of the view that a corporate office is a safe place for health, but it isn’t. In fact, no workplace is safe, it has to be made as safe as practically possible.

Analysing job exposures at workplace is not only good for the employees but for businesses too as healthy, happy employees are more productive than when sickness strikes.

In fact, discrimination at work is nothing new, in 1997 David Williams, Professor at Harvard TH Chan School of Public Health, created the Everyday Discrimination Scale which is the most widely used measure of effect of discrimination on health.

Sickness at workplace not only affects one worker but all those who are doing similar jobs or encountering unpleasant work-related issues in the same location. Hence work-related (occupational) health risk assessments (OHRA) are so useful and often the first important step to protect employee health.   

One of the risk factors for high blood pressure is discrimination at work. Hence if discrimination is reported or felt by a group of employees in any organization, it must be immediately and appropriately addressed by the management. However, at the organizational level, no studies have directly addressed this issue. 

Is there a role for the Occupational Health physicians who are doctor employed in the industry (either full-time or part-time)?

The Occupational Health physician employed in the industry does have a role as they deal with worker health. Just as fear of working with inadequate or poor safety systems at workplace can affect mental health, similarly, discrimination being a subtle yet powerful stressor can affect health as noted in the above paragraphs.

Many business owners and even employees are often of the view that a corporate office is a safe place for health, but it isn’t.

In fact, physicians in the industry may start asking a leading question about discrimination at work if they record high blood pressure in an employee as part of their examination. Based on this data, at an organizational level, it must be appropriately and immediately addressed as per company policy.

At a personal level, affected employees may be advised stress relieving methods like deep breathing, relaxation techniques, mindfulness, regular exercise, adequate sleep etc. to cope with the negative thoughts that often arise due to discrimination.

Affected employees should be advised to refrain from coping the effects due to discrimination by starting to or increasing to smoke, drink etc. as it is often counter-productive.

Lastly, as the world and the workplaces evolve in the next few years, the fear is about legal costs and reputational risks due to discrimination. It’s time the senior management in companies take the issue of discrimination at workplace urgently!

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Dr Ajay Sati is an Occupational Health physician who prefers to describe himself as an Occupationist, to denote, ‘an expert in diseases and other concerns of occupations.’ Dr Sati has managed health and wellness programs in industries he worked, like the atomic energy, and energy (oil & gas) in India and overseas. An experienced virtual consultation expert he was involved in many greenfield and brownfield projects providing inputs from health point of view.