Discrimination at work is linked to high blood pressure

Experiencing discrimination in the workplace — where many adults spend one-third of their time, on average — may be harmful to your heart health.

A 2023 study in the Journal of the American Heart Association found that people who reported high levels of discrimination on the job were more likely to develop high blood pressure than those who reported low levels of workplace discrimination.

Workplace discrimination refers to unfair conditions or unpleasant treatment because of personal characteristics — particularly race, sex, or age.

How can discrimination affect our health?

“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.

Yet multiple studies have documented that experiencing discrimination increases risk for developing a broad range of factors linked to heart disease. Along with high blood pressure, this can also include chronic low-grade inflammation, obesity, and type 2 diabetes.

More than 25 years ago, Williams created the Everyday Discrimination Scale. This is the most widely used measure of discrimination’s effects on health.

Who participated in the study of workplace discrimination?

The study followed a nationwide sample of 1,246 adults across a broad range of occupations and education levels, with roughly equal numbers of men and women.

Most were middle-aged, white, and married. They were mostly nonsmokers, drank low to moderate amounts of alcohol, and did moderate to high levels of exercise. None had high blood pressure at the baseline measurements.

How was discrimination measured and what did the study find?

The study is the first to show that discrimination in the workplace can raise blood pressure.

To measure discrimination levels, researchers used a test that included these six questions:

• How often do you think you are unfairly given tasks that no one else wanted to do?
• How often are you watched more closely than other workers?
• How often does your supervisor or boss use ethnic, racial, or sexual slurs or jokes?
• How often do your coworkers use ethnic, racial, or sexual slurs or jokes?
• How often do you feel that you are ignored or not taken seriously by your boss?
• How often has a coworker with less experience and qualifications gotten promoted before you?

Based on the responses, researchers calculated discrimination scores and divided participants into groups with low, intermediate, and high scores.

• After a follow-up of roughly eight years, about 26% of all participants reported developing high blood pressure.
• Compared to people who scored low on workplace discrimination at the start of the study, those with intermediate or high scores were 22% and 54% more likely, respectively, to report high blood pressure during the follow-up.

How could discrimination affect blood pressure?

Discrimination can cause emotional stress, which activates the body’s fight-or-flight response. The resulting surge of hormones makes the heart beat faster and blood vessels narrow, which causes blood pressure to rise temporarily. But if the stress response is triggered repeatedly, blood pressure may remain consistently high.

Discrimination may arise from unfair treatment based on a range of factors, including race, gender, religious affiliation, or sexual orientation. The specific attribution doesn’t seem to matter, says Williams. “Broadly speaking, the effects of discrimination on health are similar, regardless of the attribution,” he says, noting that the Everyday Discrimination Scale was specifically designed to capture a range of different forms of discrimination.

What are the limitations of this study?

One limitation of this recent study is that only 6% of the participants were nonwhite, and these individuals were less likely to take part in the follow-up session of the study. As a result, the study may not have fully or accurately captured workplace discrimination among people from different racial groups. In addition, blood pressure was self-reported, which may be less reliable than measurements directly documented by medical professionals.

What may limit the health impact of workplace discrimination?

At the organizational level, no studies have directly addressed this issue. Preliminary evidence suggests that improving working conditions, such as decreasing job demands and increasing job control, may help lower blood pressure, according to the study authors. In addition, the American Heart Association recently released a report, Driving Health Equity in the Workplace, that aims to address drivers of health inequities in the workplace.

Encouraging greater awareness of implicit bias may be one way to help reduce discrimination in the workplace. Implicit bias refers to the unconscious assumptions and prejudgments people have about groups of people that may underlie some discriminatory behaviors. You can explore implicit biases with these tests, which were developed at Harvard and other universities.

On an individual level, stress management training can reduce blood pressure. A range of stress-relieving strategies may offer similar benefits. Regularly practicing relaxation techniques or brief mindfulness reflections, learning ways to cope with negative thoughts, and getting sufficient exercise can help.

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Winter hiking: Magical or miserable?

By midwinter, our urge to hibernate can start to feel constricting instead of cozy. What better antidote to being cooped up indoors than a bracing hike in the crisp air outdoors?

Winter backdrops are stark, serene, and often stunning. With fewer people on the trail, you may spot more creatures out and about. And it’s a prime opportunity to engage with the seasons and our living planet around us, says Dr. Stuart Harris, chief of the Division of Wilderness Medicine at Massachusetts General Hospital. But a multi-mile trek through rough, frosty terrain is far different than warm-weather hiking, requiring consideration of health and safety, he notes. Here’s what to know before you go.

Winter hiking: Safety first

“The challenge of hiking when environmental conditions are a little more demanding requires a very different approach on a winter’s day as opposed to a summer’s day,” Dr. Harris says. “But it gives us a chance to be immersed in the living world around us. It’s our ancient heritage.”

A safety-first attitude is especially important if you’re hiking with others of different ages and abilities — say, with older relatives or small children. It’s crucial to have both the right gear and the right mindset to make it enjoyable and safe for all involved.

Planning and preparation for winter hikes

Prepare well beforehand, especially if you’re mixing participants with vastly different fitness levels. Plan your route carefully, rather than just winging it.

People at the extremes of age — the very old or very young — are most vulnerable to frigid temperatures, and cold-weather hiking can be more taxing on the body. “Winter conditions can be more demanding on the heart than a perfectly-temperatured day,” Harris says. “Be mindful of the physical capabilities of everyone in your group, letting this define where you go. It’s supposed to be fun, not a punishing activity.”

Before setting out:

• Know how far, high, and remote you’re going to go, Dr. Harris advises, and check the forecast for the area where you’ll be hiking, taking wind chill and speed into account. Particularly at higher altitudes, weather can change from hour to hour, so keep abreast of expectations for temperature levels and any precipitation.
• Know if you’ll have access to emergency cell coverage if anything goes wrong.
• Always share plans with someone not on your hike, including expected route and time you’ll return. Fill out trailhead registers so park rangers will also know you’re on the trail in case of emergency.

What to wear for winter hikes

Prepare for extremes of cold, wind, snow, and even rain to avoid frostbite or hypothermia, when body temperature drops dangerously low.

• Dress in layers. Several thin layers of clothing are better than one thick one. Peel off a layer when you’re feeling warm in high sun and add it back when in shadow. Ideally, wear a base layer made from wicking fabric that can draw sweat away from the skin, followed by layers that insulate and protect from wind and moisture. “As they say, there’s no bad weather, just inappropriate clothing,” Dr. Harris says. “Take a day pack or rucksack and throw a couple of extra thermal layers in. I never head out for any hike without some ability to change as the weather changes.”
• Protect head, hands, and feet. Wear a wool hat, a thick pair of gloves or mittens, and two pairs of socks. Bring dry spares. Your boots should be waterproof and have a rugged, grippy sole.
• Wear sunscreen. You can still get a sunburn in winter, especially in places where the sun’s glare reflects off the snow.

Carry essentials to help ensure safety

• Extra food and water. Hiking in the cold takes serious energy, burning many more calories than the same activity done in summer temperatures. Pack nutrient-dense snacks such as trail mix and granola bars, which often combine nuts, dried fruit, and oats to provide needed protein, fat, and calories. It’s also key to stay hydrated to keep your core temperature normal. Bonus points for bringing a warm drink in a thermos to warm your core if you’re chilled.
• First aid kit. Bandages for slips or scrapes on the trail and heat-reflecting blankets to cover someone showing signs of hypothermia are wise. Even in above-freezing temperatures, hypothermia is possible. Watch for signs such as shivering, confusion, exhaustion, or slurring words, and seek immediate help.
• Light source. Time your hike so you’re not on the trail in darkness. But bring a light source in case you get stuck. “A flashlight or headlamp is pretty darn useful if you’re hiking anywhere near the edges of daylight,” Harris says.
• Phone, map, compass, or GPS device plus extra batteries. Don’t rely on your phone for GPS tracking, but fully charge it in case you need to reach someone quickly. “Make sure that you have the technology and skill set to be able to navigate on- or off-trail,” Harris says, “and that you have a means of outside communication, especially if you’re in a large, mixed group.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon