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The impact of racial discrimination and income

The impact of racial discrimination and income

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New research describes the impact of racial discrimination and income levels on COVID-19 health outcomes. Angus Mordant/Bloomberg via Getty Images
  • Researchers have observed higher COVID-19-related hospitalization and mortality rates among racially minoritized groups and people with lower incomes.
  • A recent review describes how high poverty rates and racial discrimination led to these disparities in COVID-19-related health outcomes.
  • Preexisting medical conditions are more prevalent in individuals with a lower income and those who belong to historically marginalized groups, making them more susceptible to the negative health effects of COVID-19.
  • Factors associated with high poverty rates and racial discrimination, such as limited access to healthcare, residential segregation, overcrowding, poor housing conditions, and high risk work conditions, have also contributed to the disparities in COVID-19-related health outcomes.

The health effects of COVID-19 have disproportionately affected individuals belonging to low income and racially or ethnically minoritized groups. Studies have shown a higher number of COVID-19 cases, hospitalizations, and deaths among individuals belonging to Indigenous, Black, and Hispanic communities. Similarly, evidence suggests a higher risk of severe disease and mortality among individuals with lower incomes.

Early in the pandemic, the factors associated with the higher rates of hospitalization and mortality among these groups were not well-understood. In other words, it was unclear whether comorbidities, social determinants, or both contributed to these worse COVID-19-related health outcomes.

One study, for example, which researchers conducted early in the pandemic, found that both comorbidities and social factors likely contributed to the higher mortality in the Black patient populations.

Dr. Ladan Golestaneh, professor of medicine at the Albert Einstein College of Medicine in New York City and the study’s lead author, told Medical News Today:

“Our study did a careful analysis of the population of the Bronx who receives their care at our health system — a health system that has invested heavily in programs that serve our community of patients.[…]. We were able to show that despite adjustment for multiple comorbidities and risk factors — including area-level poverty and use of public transportation — hospitalized Black patients died at disproportionately higher rates than did white patients.”

Noting the role of social determinants, as the study suggests, Dr. Golestaneh said, “The worse severity of illness and mortality outcomes seen in racial/ethnic minorities have to do with low socioeconomic status, barriers to adequate high quality healthcare, and residential racial segregation, the latter resulting from a deliberate historical act by the U.S. government to separate residential communities by race and disinvest from Black residential communities.”

A recent review in The Lancet Regional Health — Americas now summarizes evidence delineating the underlying factors responsible for the more profound health consequences of COVID-19 in people belonging to lower income households or racially or ethnically minoritized groups.

Poverty levels were relatively high in the United States before the pandemic. Various factors, such as weak labor protections and an inadequate welfare state, enabled these high poverty rates.

Moreover, racial and economic inequalities tend to be interlinked and can be difficult to disentangle. Racial discrimination has had a significant impact on social welfare policies and labor laws in the U.S. Racial discrimination also influences educational and employment outcomes.

Thus, the systemic nature of racism has resulted in higher poverty rates for the targeted individuals. The 2019 Supplemental Poverty Measure published by the Census Bureau reported that the poverty rates among Black and Hispanic residents were more than 18{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} in the United States, whereas 8.2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of non-Hispanic white residents met the criteria for living in poverty.

Given the close association between race and poverty, the authors of the present review considered how these interconnected factors increased vulnerability to COVID-19-related health consequences.

Preexisting health conditions, such as cardiovascular disease, diabetes, cancer, and HIV, are more prevalent among individuals belonging to historically marginalized groups and those with low socioeconomic status. These preexisting conditions can worsen the effects of a SARS-CoV-2 infection, resulting in a higher number of hospitalizations and deaths.

Another closely related reason for the worse outcomes is limited access to healthcare.

Individuals belonging to low income and historically marginalized communities are less likely to have health insurance than higher income and white populations, respectively.

A 2020 study reported that 18.2 million individuals at high risk of COVID-19 due to older age and underlying conditions were uninsured or lacked adequate insurance. Notably, the study found that people with lower incomes and racially minoritized individuals were more likely to belong to this group of high risk uninsured or underinsured individuals.

State policy decisions have also contributed to the high number of underinsured individuals. For instance, 12 states have refused the expansion of Medicaid, which would extend coverage to individuals with incomes of up to 138{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the Federal Poverty Level. This has especially influenced the ability of low income marginalized groups to access healthcare.

Besides the high cost of healthcare, other obstacles hindering access to healthcare for these groups include the “earned” mistrust of healthcare institutions and clinicians, language barriers, and biases in the healthcare system.

These factors have also contributed to the low rate of vaccination in marginalized communities, especially during the initial period of the vaccine rollout. Distrust of the healthcare system due to historical reasons and recent experiences of racial discrimination in healthcare settings have led to vaccine hesitancy.

Healthcare professionals can play a vital role as trustworthy sources of information on vaccinations. However, the lack of adequate health insurance has limited access to these professionals, thus contributing to lower vaccination rates.

Residential segregation by race and socioeconomic status remains prevalent in the U.S. and is associated with racial disparities in health outcomes.

Studies suggest a similar impact of residential segregation on COVID-19 outcomes, with a higher number of COVID-19 deaths occurring in racially and socioeconomically segregated counties.

Other studies have investigated the role of housing quality in mediating the COVID-19-related health disparities.

Evidence suggests that housing quality factors, such as overcrowding and incomplete indoor plumbing, are associated with higher COVID-19 cases and death rates.

Overcrowding and multiple generations residing together are more prevalent in historically marginalized and low income households.

These housing quality factors facilitating the rapid spread of SARS-CoV-2 have contributed to the disproportionate impact of COVID-19 on low income and racially minoritized groups.

These individuals are also more likely to rent than own a home. The eviction of renters during the pandemic also resulted in a surge in COVID-19 cases among those displaced.

Residential location can also influence access to COVID-19 testing and vaccination and, subsequently, vulnerability to COVID-related health consequences. For instance, states with a larger Black population and higher poverty rates had lower SARS-CoV-2 testing rates.

Similarly, a study covering 94 counties found that Black individuals were more likely to have to travel more than 10 miles to the vaccination site than their white counterparts. Lack of transportation or access to the internet to schedule a vaccination appointment may also have contributed to the lower vaccination rates.

Another reason for the higher levels of severe COVID-19 cases among people with a lower income and racially and ethnically minoritized individuals includes employment in occupations associated with a high risk of SARS-CoV-2 infection.

Individuals from low income households constitute a significant proportion of essential workers, who are involved in vital sectors, such as healthcare, retail, education, food production, and transportation. Individuals earning less than twice the federal poverty levels constitute nearly 25{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of essential workers.

Similarly, individuals belonging to historically marginalized groups often make up a substantial share of workers in essential occupations. For example, 3 in 4 frontline workers in New York City belong to these groups.

The contagiousness of SARS-CoV-2 and the inability to work remotely meant that essential workers were at increased risk of contracting COVID-19. Moreover, the lack of adequate safety and health measures, such as the limited availability of personal protective equipment and difficulty enforcing physical distancing regulations at the workplace, further increased the risk of exposure to SARS-CoV-2.

The lack of access to paid leave or unemployment benefits also contributed to the increased vulnerability of essential workers to a SARS-CoV-2 infection.

Another contributing factor was lower vaccination rates, potentially due in part to a lack of flexibility in work schedules and unavailability of paid leave during the early phase of the vaccine rollout.

The studies that the review summarizes show how racial discrimination and high poverty rates have resulted in the disparities in the health consequences of COVID-19. Describing the impact of these structural inequities, Dr. Cary Gross, professor of medicine and epidemiology at Yale University, noted to MNT: “The COVID-19 pandemic has laid bare a hard truth about American society at large and the healthcare system in particular.”

“We see large health inequities across race and ethnic groups not because of a single shock to the system (COVID-19) but because of the very nature of the system itself — it is working exactly as designed. There is an entrenched hierarchy in which racism leads not only to differential wealth, but also differential power, prestige, and freedom. So differences across race groups in wealth and poverty are vital, but they don’t tell the whole story.”

– Dr. Gross

The review authors noted that research on the effects of COVID-19 on individuals with disabilities, members of LGBTQIA+ communities, and American Indian and Alaska Native individuals remains limited. These individuals are also often socioeconomically disadvantaged and thus may be at increased risk of negative health effects associated with COVID-19.

Although the median household income of Asian American households is higher than that of all U.S. households, there are considerable disparities in income levels within the Asian American community. For instance, individuals in the top 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of earners in the Asian community have 10.7 times the income of those in the bottom 10{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of earners.

Hence, more research is necessary to investigate whether vulnerability to COVID-19-related health consequences was more pronounced in Asian Americans with a low income.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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Social media: Benefits vs. negative impact

Over the last 20 years, social media has risen from relative obscurity to become a fully accepted and integrated part of everyday life. However, despite social media’s ubiquity, the research on how it affects mental health remains inconclusive.

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What do we really know about social media and mental health? Image credit: Colin Anderson/Stocksy.

So far, most research investigating the effects of social media on mental health has focused on the potential negative aspects.

For instance, a 2019 study involving 6,595 teenagers from the United States concludes that those who spend more than 3 hours per day on social media may have a higher risk of mental health problems than those who do not.

But the degree to which social media actually harms mental health is debatable. A recent review, available as a preprint, found that most studies investigating the link between social media and mental health demonstrate “weak” or “inconsistent” associations.

Another review found that while there may be a small negative association between social media use and mental health, the link is complex and depends on exactly how researchers define mental health and social media use.

Meanwhile, other research suggests that social media may even benefit mental health, especially for people belonging to LGBTQIA+ communities and those living with mental health conditions.

These conflicting findings make it challenging to navigate the research investigating the effects of social media on mental health and how best to use social media. With this in mind, Medical News Today sought the input of seven psychology experts at the intersection of social media and mental health.

“One promising area of research is the role of online peer networks, where it appears that connecting online with others who share similar mental health challenges can offer important benefits for feeling less alone, learning coping skills, and being able to offer/receive emotional or informational support from others,” Dr. John Naslund, Ph.D., an instructor in global health and social medicine at Harvard Medical School, told MNT.

Dr. Niklas Johannes, a postdoctoral researcher in the Adolescent Well-Being in the Digital Age program at the University of Oxford in the United Kingdom, agreed that social media might be linked to some mental health benefits. However, he added that more research is necessary to confirm the direction in which this connection lies.

“There’s a lot of research out there that suggests social media are a useful tool to stay connected to others. In fact, those who use social media more also report feeling more social support. However, all of this comes with a huge caveat: We simply don’t know about cause and effect. It’s just as plausible that heavy social media users make more friends or that those with a lot of friends use more social media. It’s also plausible that both are true,” he explained.

Other research suggests that “how” a person uses social media rather than “how much” may have a stronger association with mental health outcomes.

“There is evidence that routine social media use in the general population is positively associated with mental health and social well-being, as long as one is not ’emotionally invested’ in the media, in which case the outcomes are negative,” Dan-Mircea Mirea, a Ph.D. student in psychology and project coordinator at Mental Health for Romania, told MNT.

Dr. Gonneke Stevens, associate professor of social and behavioral sciences at Utrecht University in the Netherlands, agreed that “emotional investment” in social media use may be more indicative of mental health outcomes than how much a person uses it.

“[O]ur research suggests that not so much the intense use of social media, but social media use problems — that is, addiction-like symptoms such as feeling bad when social media use is restricted, loss of control over and preoccupation with social media, and conflicts with others because of the social media use — are associated with mental health problems.”

– Dr. Gonneke Stevens

“Indeed, we found that social media use problems predicted increases in mental health problems 1 year later — this was true for both depressive symptoms and ADHD [attention deficit hyperactivity disorder] symptoms,” she added.

“For children and teens, I think the most compelling evidence is the research regarding cyberbullying on social media,” said Dr. Kya Barounis, a senior mental health researcher at the University of California, San Diego. “Cyberbullying is associated with symptoms of depression and suicidality. It may be a particular problem for youth who identify as sexual or gender minorities.”

Dr. Barounis also noted that social media use could displace other behaviors, such as sleep and exercise, which are “important for maintaining good mental health.” Researchers study this process through what is known as “displacement theory.”

To give an example, she said:“If a youth is staying up late each night on social media and not getting enough sleep, the lack of sleep can lead to feelings of irritability or depressed mood the next day.”

She cautioned, however, that this does not mean that social media use causes mental health conditions, noting that the relationship between chronic sleep problems and clinical depression in youth is complicated.

Dr. Naslund agreed that social media can perpetuate “targeted hate from others” or cyberbullying, which can have a negative effect.

He added that although research related to social media and mental health is generally mixed, “exposure to hateful content online — such as viewing or being targeted by derogatory content targeting race, ethnicity, or gender — is associated with poorer mental health and feelings of distress.”

Beyond the risk of cyberbullying and exposure to hate content, others say that it is important to interpret with caution any studies related to more generalized social media use because they are often based on unreliable data.

“There are multiple observational studies that find that social media use is negatively associated with mental health,” said Mirea.

“However,” he added, “there are also studies looking at similar datasets, or sometimes the same dataset with different methods, that find no effect. One study found only small negative associations between mental health and using digital/electronic technologies, including social media — about as large as regularly eating potatoes!”

“It seems that the conclusions are very much affected by how researchers analyze their data, which makes it hard to draw a concrete conclusion about to what extent social media has negative effects on mental health. A plausible explanation for these unclear findings is that social media use affects some people more and others less.”

– Dan-Mircea Mirea

To give an example of how difficult it can be to interpret studies on the mental health effects of social media, Dr. Craig Sewall, a postdoctoral fellow at the University of Pittsburgh, told MNT:

“The strongest evidence indicating that social media can have negative effects on mental health — that I am aware of — comes from a randomized experiment that examined the impact of Facebook deactivation on well-being among a large sample of U.S. adults. This study found that, overall, the group that deactivated their Facebook account experienced increased levels of subjective well-being compared with the group that did not.”

“However, there are a couple of important limitations to this study. First, the ‘treatment effect’ — that is, the effect of deactivating Facebook — was very small. Second, the sample of participants was older, so it’s not clear how these results would apply to younger people,” Dr. Sewall noted.

“And, finally, it’s unclear whether the effects observed for deactivating Facebook would be consistent across other social media platforms, as there are many differences between Facebook and TikTok, for example.”

Best to look at the different aspects of social media separately

For some people, it is also difficult to establish whether social media has positive or negative effects on mental health because it is unclear to which platform or platforms the terms “social media” refer.

Dr. Jacob T. Fisher, assistant professor at the Institute of Communications Research and the College of Media at the University of Illinois Urbana-Champaign, told MNT:

“I just don’t really know that we have compelling evidence for ‘social media,’ in a general sense, having adverse effects on mental health. ‘Social media,’ as a descriptor, covers a vast range of platforms and services, each of which is very different from one another, enabling and incentivizing very different sorts of behaviors. To add to this, both social media platforms and how people use social media have changed drastically over the years.”

“In this sense,” he said, “trying to define the ‘effect [of] social media on well-being’ is a lot like trying to determine the ‘effect of food on health’ — the question is so broad so as to be essentially unanswerable.”

“In my opinion,” Dr. Fisher added, “a better approach would be to break apart the different features and design decisions that comprise social media platforms — how information is presented, how the algorithm amplifies or suppresses content, the behavioral engineering involved in how a platform solicits (or even demands) our attention — and start to investigate the influence of those things on well-being.”

“A central issue here is that social media platforms refuse to share data that can begin to answer these questions with researchers like my colleagues and me,” he explained.

“There are two completely different stories being told about the effects of social media on well-being,” said Dr. Sewall. “In the popular media — where the vast majority of people get their information on this subject — the story is often some version of ‘social media is bad, especially for younger people.’”

Yet, he cautioned, “[t]he evidence cited in these popular media pieces is often cherry-picked, oversimplified, and overinterpreted — giving the impression to readers that social media causes harm to well-being.”

“On the other hand, in the scientific literature — which has a much smaller, niche readership — the story is much more complicated. The fundamental complexity of the issue combined with a litany of methodological issues and contradictory findings make it difficult, if not impossible, to conclude anything with confidence,” Dr. Sewall added.

“If anything, our best evidence to date suggests that social media does not have a meaningful impact on well-being. However, this story — that it’s very complicated, and there’s a lot we don’t know — does not generate many clicks,” he explained.

Dr. Barounis added that much research on the topic is based on people having symptoms of mental health issues, as opposed to receiving a formal diagnosis. “It’s really important to distinguish between symptoms of mental health problems versus a diagnosis of a mental health problem,” he explained. “One can have a few symptoms without having a full diagnosis. So far, a lot of researchers have examined the relationship between social media use and symptoms of depression or anxiety (as measured on a survey) in typically developing youth.”

“It is a mistake to interpret a positive relationship in these studies’ results as evidence that social media use causes youth to meet all of the criteria for a diagnosis of clinical anxiety or depression. Also, there is a measurement issue. Self-reports of time spent on social media may not be very accurate,” she explained.

To help navigate through exaggerated claims and confusing literature, Mirea recommended four points to bear in mind when looking into the link between social media and mental health:

  1. Follow trustworthy sources (academic journals or trusted outlets): You shouldn’t have to play the detective every time you see a scientific claim. Fortunately, if your sources are reputable, most of the work is being done for you.
  2. Avoid clickbait-sounding headlines: Good reporting would never trade accuracy for the prospect of attracting your attention. Also, be cautious if an article uses words that a scientist (especially one in the social or clinical sciences) would never use — such as that something is “a fact” or that they “proved” something.
  3. Be wary of ideological content [and] your own biases: Ask yourself: “Do I want this to be true, or the opposite?” If so, then be extra careful when assessing the information.
  4. Ask an expert friend, if you have one: If you’re in doubt about the scientific aspects of a claim and you’re not sure how to assess it, think of someone you know that might be able to help (such as someone that majored in that field in college — e.g., biosciences for COVID-19 studies or psychology for mental health studies).

Dr. Barounis recommended that parents or caregivers of children and adolescents “talk with their children about cyberbullying and take steps to address it if it is occurring.”

She further explained: “Parents can also monitor their child’s use to see if it is displacing healthier behaviors, like sleep and exercise. Simple steps, like limiting use before bedtime and charging mobile devices outside the bedroom, can help prevent social media use from disrupting sleep.”

“In terms of the pandemic, parents should remind youth that a lot of their friends and followers on social media may be feeling slightly anxious or depressed during these uncertain times. Youth can support these friends and followers by refraining from posting content that could be misinterpreted in a negative way (i.e., a joking comment in reaction to someone’s post that might come across as mean-spirited) or content that could increase anxiety.”

– Dr. Kya Barounis

Due to a lack of consensus on whether and how social media relates to mental health, some experts say that it is difficult to make specific recommendations.

“Unfortunately, the scientific evidence isn’t strong enough to make specific recommendations,” said Dr. Johannes. “I’d advise, just like with any other activity, to observe what’s good for the user. If I feel like I’m comparing myself with others and it isn’t good for me, then take more breaks and maybe focus on different functions of social media. If I feel lonely and know that going on social media makes me feel connected, go for it. It’s rather obvious advice, I’m afraid.”

For others, using social media with an intention clearly in mind is key to avoiding getting swept up in any of its potentially harmful effects — from wasting time to damaging mental well-being.

“I’d suggest that the best way for people to use social media is to use it intentionally,” said Dr. Fisher. “Like lots of big businesses, social media platforms frequently incentivize mindlessness on the part of their users because it makes it easier for them to make money (both from showing you advertisements and collecting more data about you).”

“Curate who you follow, how much time you spend on the platform(s), etc., and do your best to cultivate a healthy relationship with the platforms you use,” he added.

“Something that is becoming clear from recent studies is that the effects of social media, or certain aspects of social media use, can differ significantly from person to person,” said Dr. Sewall. “So, there’s no one-size-fits-all approach.”

“However, in general, I’d say the best way to use social media is to make sure you are getting out of it what you are intending. That is, if you are intending to use social media as a way to stay connected with others, or as a form of entertainment, or whatever, try to be mindful about whether the way you are using social media in that instance is helping you meet that intention,” he concluded.

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The impact in low-income countries

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McDonald’s Instagram advertising and marketing could harm the health and fitness of younger people in low-revenue nations around the world, a examine indicates. Image credit history: NurPhoto/Getty Photographs.
  • A new analyze reveals that quick meals firms, these as McDonald’s, are focusing their promoting on small-money countries.
  • They do this applying well-known social media web-sites, these types of as Instagram (IG), and other electronic media platforms.
  • This report implies McDonald’s may possibly use IG advertising and marketing ads that target younger customers all over the world.

McDonald’s media outreach is worldwide — it operates in 101 nations. In accordance to a new report, the advertising and marketing adverts it uses to concentrate on young customers might play a function in the food usage styles that guide to health issues afterwards in lifestyle.

The study’s lead researcher, Dr. Omni Cassidy — assistant professor of Population Well being at New York University’s Grossman University of Medication — and her collaborators noted the effects in a paper that seems in BMJ Nourishment Avoidance and Wellness.

The examine randomly selected 15 countries to discover how McDonald’s markets its items on various continents. The researchers required to see if the company’s internet marketing techniques differed by the buyer environments in the preferred countries.

They concentrated their study on IG because it is a person of the most popular social media platforms amid adolescents and young grownups.

This review adopted randomly selected formal McDonald’s IG accounts for 4 months, from September to December 2019. In April 2020, it quantified the amount of followers, likes, remarks, and online video views affiliated with each and every account. The scientists posted their results in December 2021.

The researchers divided the international locations into three teams in accordance to 2019 Globe Financial institution Databases criteria. These were higher-revenue nations around the world (HIC), higher-middle-earnings nations around the world (UMIC), and reduced-middle-profits nations (LMIC). Their reason was to explore if McDonald’s marketing strategies different in accordance to the financial standing of a place.

The research confirmed that McDonald’s posted additional IG ads and applied cost promotions, giveaways, and youngster-concentrating on advertising ways in LMICs. These advertisements are effective where by the price tag of foods and drinks is vital in shopper paying for decisions.

Talking to Health care Information Right now, Dr. Cassidy remarked that: “Marketing on these platforms gives McDonald’s a way to develop ads that are engaging, ‘cool,’ and can be very easily tailor-made to suit the target audience. This is problematic for the reason that the sorts of merchandise they current market are generally people with a whole lot of fats, sugar, and salt, which we know are connected to poor eating plan and very poor well being.”

Dr. Cassidy went on to explain the authentic-earth implications of this, noting that “[t]hese varieties of advertisements contribute to an setting that makes it harder for adults and children to make wholesome meals possibilities.”

“These methods create young buyers who will continue to be loyal to their model during their lifespan,” she also added.

“For people dwelling in developing nations around the world,” she continued, “there is not only a condition danger for grownups and children but also a chance to the health care programs in the country who must have the large stress of dealing with infectious ailments and the increasing variety of noninfectious conditions (e.g., sort 2 diabetic issues, weight problems, hypertension).”

A diet plan significant in extra fat, sugar, and salt also will increase the possibilities of establishing cardiovascular sickness afterwards in existence.

The researchers captured McDonald’s Instagram screenshots in excess of 4 months ending in December 2019, then extra up the many types of viewer responses, which includes likes, responses, or movie views, in April 2020.

The 15 IG accounts retained a total of 10 million followers and created 3.9 million likes, 164,816 responses, and 38.2 million movie sights.

The review collected 849 IG internet marketing posts. These exposed that all through the 4 months of the review, IG posts for the UMICs and HICs numbered 227 and 298, respectively, although nations around the world in the LMIC group been given 324 posts.

Kid-concentrating on posts have been also a lot more various in LMICs, which have been approximately 1 in 5 posts, than in HICs, which were close to 1 in 8 posts.

In addition, the ads depicting a lot more healthy feeding on habits appeared in HICs (4.7{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}) extra than in those people of UMICs (2.6{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}) or LMICs (2.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}).

Another obvious big difference in advertising amongst countries with distinctive cash flow statuses was price promotions and free giveaways. McDonald’s available these incentives to 40{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of the LMICs and only 14{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of HICs.

“Other investigation has also demonstrated that firms often use price promotions [or] cost-free giveaways when internet marketing to lessen-profits communities, wherever price tag could be far more significant in their choice to buy foods [or] beverages,” Dr. Cassidy reported.

Dr. Cassidy instructed MNT: “These details guidance two primary approaches we can intervene. One particular way is as a result of well being guidelines that lessen or remove unhealthy food items and beverage advertising and marketing, in particular to young ones.”

“The 2nd is by developing avoidance and intervention applications that will assist grown ups and kids recognize these adverts and make meals choices that are extra aligned with their possess starvation signals, own values, and tradition. Digital and social media adverts are made to seem like ‘normal’ Instagram posts, which can make it tricky for grownups, small children, and even parents to acknowledge when they are observing an advert.”

– Dr. Omni Cassidy

“The most important strength of the analyze is that it is the initially to acquire a nearer glimpse at how McDonald’s, just one one speedy-meals company, employs more boy or girl-specific, value promotions,” the examine creator went on to say.

This observational study could not, nevertheless, create a induce-and-impact connection due to several restricting variables. These included the quantity of countries the researchers analyzed, the absence of target audiences’ eating habits, and the getting behaviors of people today who stick to McDonald’s IG advertisements.

The takeaway continues to be that fast-meals chains have promptly increased their social media existence globally, primarily in nations that have low-to-center money households. As social media advertisements grow in rapidly-foodstuff promoting, it may influence purchaser overall health.

In addition, internet marketing adverts that entice youthful fast-meals people could appreciably insert to the toll of existing and potential healthcare worries on the world’s most vulnerable nations.

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PCOS in Women of Color: Its true impact

In the United States and the United Kingdom, polycystic ovary syndrome (PCOS) affects 1 in 10 women. This condition disproportionately affects Women of Color. To find out more, Medical News Today spoke with three Women of Color living with this condition to learn how the disorder has affected their health. We also sought the opinions of two medical experts.

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How does PCOS affect Women of Color? We investigate. Image credit: Jasmin Merdan/Getty Images

Existing research indicates that PCOS, which is an endocrine system disorder, affects approximately 8–13{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of women of reproductive age worldwide.

PCOS can cause the ovaries to become covered with small cysts or fluid-filled sacs, sometimes leading to symptoms such as irregular periods, weight gain, and acne.

The variability in symptoms and how they present in different people means that up to 75{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of women with PCOS do not receive a diagnosis for their condition.

This is significant because PCOS is linked to other serious health conditions, such as metabolic and cardiovascular comorbidities, infertility, pregnancy complications, psychological disorders, and cancer.

Moreover, racial bias in medical settings, as well as sociocultural taboos around infertility and weight gain — two of the effects of PCOS on health — can also negatively affect the way in which doctors perceive PCOS and treat the condition in Women of Color.

Medical News Today has spoken with three women living with this condition to learn more about their experiences of getting a diagnosis and navigating PCOS despite receiving little or no treatment. We also found out about the subsequent impact on their health.

For an expert outlook on the misconceptions surrounding PCOS and how it affects certain people, we spoke with Dr. Cindy Duke and Dr. Dominique Warren, both of whom are certified obstetricians and gynecologists.

Many people regard PCOS as an invisible illness because it sometimes — particularly in Black and Asian groups —produces “silent” metabolic symptoms, such as insulin resistance and impaired glucose metabolism.

This can be an issue for these groups because, as some studies have shown, from a biological point of view, PCOS may manifest differently for them, which can complicate the process of receiving a correct diagnosis.

Dr. Duke explained to MNT: “There are many [doctors] who use metabolic syndrome as part of their criteria for diagnosing PCOS, which is inaccurate and goes against diagnostic guidelines. Those who may not demonstrate the usual [symptoms] or happen to be on the leaner side have what looks like normal glucose metabolism, and depending on the type of test you’re told to have done, you could be incorrectly told you don’t have PCOS.”

Without early interventions, PCOS can lead to serious long-term health conditions, partly due to the complexity that causes misdiagnosis and lack of care.

This is what happened to Monica, a 46-year-old Black woman from the U.S., who told us about her experience as a young adult:

“I visited the doctor after having sporadic periods […]. I wasn’t diagnosed with PCOS because then, it [irregular periods] wasn’t enough to be considered a characteristic of PCOS. You had to be overweight.”

Monica continued: “I went to a physician’s office. He handed me a [prescription] for birth control pills [and] told me to prepare for adoption.”

At the time, she weighed 110 pounds — approximately 50 kilograms — and doctors considered her to be underweight. She continued to have irregular cycles before seeking medical advice again at the age of 27.

“I had an adverse reaction to the medication […] and also gained 30 pounds in a month,” Monica told us.

Once a test detected high levels of estrogen, the doctor suspected PCOS and referred Monica to an endocrinologist for a formal diagnosis.

Obtaining a PCOS diagnosis has improved over the years since the Rotterdam Criteria established that a woman might have the disorder if she experiences any two out of the three major symptoms: polycystic ovaries, high androgen levels, and irregular menstrual cycles.

However, Dr. Warren commented, “some primary care doctors may find it difficult to understand the criteria and what to look out for,” as PCOS tends to present as a spectrum of symptoms, and it has had various descriptions over the years.

She explained that “you might have a person that has a period every 5 weeks, so they seem to be quite regular but are just outside the norm. Then, the other spectrum of people don’t have periods at all.”

“Those [with seemingly regular periods] may not realize there is an issue until they try to get pregnant. They [may] go to the [doctor] because they have an issue with acne, facial hair, or weight […] but may be told to go on the pill because they have regular periods.”

– Dr. Dominique Warren

MNT spoke with another contributor, 22-year-old Nikita, who is Asian and from the U.K. In line with Dr. Warren’s insight, she recounted how PCOS symptoms can vary and present differently among individuals.

Nikita had to wait for 7 years to receive a diagnosis.

At the age of 13, after speaking with a family member with diagnosed PCOS, she suspected that she had it, as she had symptoms such as irregular periods and excessive facial hair growth.

However, she stated, “[Over the next few years], I made numerous […] trips [to the doctor], and the doctors weren’t doing anything”. Doctors also told her that the issues with facial hair were due to puberty.

“At one point, I saw my doctor because I was having bad dizzy spells. He asked me what I wanted him to diagnose me with. I was so offended. Then, [at the age of 19], I went back for vaginal discharge issues, and that’s when they [the doctor] looked into it and found bacterial vaginosis.”

She added that “[t]hey did a cervix check and other tests,” which finally confirmed her PCOS diagnosis.

June-Ann, a 32-year-old Black woman, also from the U.K., was the only one of our contributors who received her diagnosis relatively quickly, at the age of 17, despite having regular cycles.

Her doctor referred her for a vaginal ultrasound to investigate the severe pelvic pain she was experiencing during ovulation.

“I was told there were cysts on my ovaries, and the blood test [indicated] PCOS,” she told us.

The experiences of two of the three women we interviewed are consistent with concerns about the impact of “healthcare gaslighting” — the repeated denial of someone’s reality in an attempt to invalidate or dismiss their health concerns.

A study published in Circulation: Cardiovascular Quality and Outcomes in 2015 suggests that delays in diagnosis can also occur as a result of women’s anxiety about doctors construing their complaints as trivial.

It could partly explain the low rates of recorded diagnoses of PCOS among women with at least two of the three Rotterdam criteria.

There is often a misconception that PCOS symptoms only affect physical health. As a result of cultural taboos and stigmas associated with body image and mental health in Communities of Color, metabolic symptoms tend to be overlooked due to their “invisibility.”

This affects how quickly these groups seek medical intervention and consequently increases the risk of other health conditions developing later in life.

Dr. Duke suggested, “[c]linicians themselves sometimes have weird cultural biases and cultural norms because PCOS is poorly or inadequately taught in medical school and training.“

“If you’re an OB-GYN [obstetrician-gynecologist], you may come across it again after medical school, […] but even for most OB-GYN, unless they’re going into a subspecialty that focuses on PCOS, many decide it’s too complicated because there are variations,” she pointed out.

A 2015 study showed that unconscious bias and other race-related disparities are associated with differences in access to care and the use of treatment.

The change in Monica’s experience since diagnosis is consistent with this finding. She reflected on her experience, noting, “[n]ow that I am overweight, my treatment is very different.”

Due to relocating several times over the years, Monica saw several physicians and revealed that “most were dismissive” of her health concerns and usually commented on her weight but did not provide the appropriate healthcare for her PCOS.

She sought care from an endocrinologist, assuming her treatment would be more robust due to their specialism: “[She] constantly berated me, telling me I needed to lose weight. I remember I went in for one visit […], and she told me I look[ed] like I was eating whatever I wanted to eat. I never went back to her again after that.”

Monica was a U.S. size 8 (U.K. size 12) at the time. “I’m a Black female. I had big thighs […]. I just had certain things that were part of my heritage that I couldn’t get rid of,” she said.

Women of Color frequently report incidents of weight bias during medical consultations. Healthcare professionals often make assumptions about their diets being poor and do not offer them helpful advice on nutrition or exercise.

June-Ann referred to a time she struggled to lose weight, despite making efforts to exercise. “My doctor insinuated that I’m not trying hard enough,” she recalled.

“I never went to the doctor about my sleep apnea because I was scared that they would also correlate it with being overweight [as opposed to PCOS being the cause],” she added.

Assumptions about Black women’s body weight and diet persist despite the fact that their weight is often actually within the range classified as healthy.

Dr. Warren pointed out that “Black women aren’t always associated with obesity. They can be what I would consider a ‘normal’ BMI [body mass index] but with PCOS […].”

This suggests that medical professionals are not always considering the medical history of their patients and the sociodemographic and lifestyle factors that contribute to their health status.

Data published in the Journal of Women’s Health investigated the disparities in the extent to which people belonging to different ethnic groups underestimate their weight. The authors conclude that these disparities are due to differences in weight perception or a knowledge gap in interpreting what constitutes excess body weight.

Dr. Duke reiterated that weight is not necessarily an indicator of PCOS. She further explained how misdiagnosis, when inappropriately applying weight as a diagnostic criterion, occurs.

“[W]omen who present with polycystic ovaries but nothing else [are correctly] told they do not have PCOS [in the eyes of some healthcare professionals] […], yet when [they are] overweight, the doctor decides [they have] PCOS even though they don’t meet any other actual diagnostic criteria,” she noted.

“It’s very complex [when it comes to associating body weight with a health diagnosis], due to what we call ‘phenotypes‘[…]. To keep up-to-date and informed, we need to also have what I call ‘multidisciplinary teams.’”

This involves input from physicians, culturally competent nutritionists, fitness professionals, and mental health practitioners, as the international PCOS guidelines propose.

The impact of PCOS on Women of Color — specifically the way in which it affects their body image, could sometimes also be due to how family members and others within their community perceive and treat them.

Nikita revealed how much emphasis is placed on taking care of your image in her Trinidadian culture. “Bodily hair is so frowned upon […], and [it comes across as] a woman is choosing to not look after herself,” she said.

After family members mocked her during a visit to Trinidad, she said: “I finally paid £1,000 for laser treatment [to remove body hair] […]. I was devastated [when it grew back] because I had saved that money for so long.”

Dr. Duke demystified how cultural taboos inform negative body constructs. “We all grew up knowing of women who have hairy faces […], and instead of a conversation about the [possible] underlying condition, there’s a tease,” she said.

In some cases, the cultural silence and stigma around these issues could be what causes disinformation and prevents Women of Color from seeking healthcare.

Nikita expressed the relief she felt on learning to embrace her facial hair through support from her mother, who had had a similar experience.

Dr. Duke endorsed the importance of normalizing conversations across generations to educate families and communities, emphasizing her hopes for a better-informed future: “30 years from now, I don’t want to hear that young women didn’t know about their PCOS until later.”

A study featuring in Nature Medicine, which looked at the transgenerational risks for PCOS, suggests that facilitating earlier lifestyle and medical interventions could reduce the risk of other health conditions in those with this condition.

The lack of satisfactory care after diagnosis is also a major barrier for women from historically marginalized groups who live with this condition.

All the contributors spoke with MNT about the lack of treatment and how it caused other issues, affecting their mental health and quality of life.

For her part, June-Ann complained: “There has been no aftercare. I had anxiety and depression, and I was just given medication [birth control pills].”

“I was warned, ‘You may not be able to have kids’ […] so come back [for advice] when you’re ready,” she also told us. As this was not June-Ann’s personal priority at the time, she was left to manage her condition on her own.

To do so, she focused on lifestyle changes such as exercise, dietary supplements, and therapy.

Another observation that all our contributors made was that doctors placed more emphasis on the reproductive problems attributed to PCOS, even though none of the women had mentioned this as a future health concern after diagnosis.

MNT asked both health experts why this was the case, and Dr. Warren suggested that it might be “because you can do something to treat that [infertility] with a baby as an outcome.”

Dr. Duke elaborated on this issue, saying:

“Most of [what] we use to treat PCOS is re-appropriated from other medical conditions. They’re not putting research and development into therapies specific for PCOS because there’s no money in it as a field, [but] there’s money if you’re infertile and you need treatment.”

There were parallels in the experiences of all our contributors, who talked about how the lack of satisfactory aftercare caused their depression.

Both Monica and Nikita, in particular, were transparent about how they experienced other long-term health issues due to the lack of treatment they received, which further decreased their mental well-being.

Nikita recalled the time she sought advice from her doctor, who referred her for cognitive behavioral therapy.

Nikita only had two sessions until she stopped attending. She described her counselor as “dismissive” and “insensitive” whenever she spoke about her period.

Like June-Ann, she is now relying on personal lifestyle adjustments to improve her mental health.

Our other contributor, Monica, referred to the start of the COVID-19 pandemic as the worst period of her depression, saying that “[t]he biggest part [of PCOS] that has affected me is the weight gain and the depression […].”

At the start of the pandemic, she noted, it was “through the roof, and I no longer cared about my health so didn’t seek help. That is how I developed hypothyroidism.”

Their experiences demonstrate that there needs to be a focus on how to support people with PCOS-associated mental health problems, with attention to weight, body image, and fertility, as these are often prevalent taboo topics.

All or most of the contributors who spoke with MNT mentioned healthcare gaslighting, the perpetuation of cultural taboos and stigmas, as well as the lack of treatment as causes behind the inadequate care that Women of Color who live with PCOS continue to experience.

MNT asked all our contributors how they think that PCOS care can be improved. The consensus was that educating the wider PCOS community, receiving empathy and compassion from support networks, and finally allowing people with the condition to feel heard could improve ongoing care.

The lack of support from the medical community would explain why 30{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of women with PCOS rely on online forums for support, according to some U.K. data.

Both of the medical experts we interviewed explained how beneficial online platforms can be, offering their own advocacy work as an example.

Dr. Warren is the founder of The Ovary Story, an online platform that empowers girls and women to educate themselves about their reproductive system and the health conditions that can occur from puberty through to postmenopause. The platform exists to encourage open conversation.

Dr. Duke talked about My Dynamic Uterus, her online movement reaching 18,100 members, which is “intended to explore the […] often unheard narratives of people born with a uterus or ovaries, or those who care for them, through diverse and guided perspectives; from expert professionals and affected individuals around the globe.”

June-Ann, who remarked that “there are a lot of [resources for] African Americans, but there [aren’t] a lot of British Black people talking about PCOS,” started her own successful Black Broke & Anxious Podcast, born out of her therapeutic journey.

Likewise, “suffering in silence” inspired Nikita to create her Instagram awareness page. Since sharing her journey, she has received messages from women worldwide who say they feel “less alone.”

Demonstrating that advocacy and awareness go beyond social media, Monica volunteers for PCOS Challenge: The National Polycystic Ovary Syndrome Association, a leading nonprofit organization that provides support and advocacy for people dealing with PCOS globally.

As a member of the patient advisory board, she is currently part of a project creating a registry to house data in one space so that research is more readily accessible for clinicians and researchers.

In speaking with MNT, she also strongly encouraged Black women to be more vocal about their health concerns: “To be taken more seriously […], we have to [reveal] doctors’ dismissiveness. [Otherwise], nothing’s ever going to change.”