Racism and its symptoms

Report of the National Monitoring of Discrimination and Racism with a focus on health

Who is particularly affected by experiences of discrimination and where do people experience discrimination? The health focus of the National Monitoring of Discrimination and Racism shows: Experiences of discrimination and/or racism are frequently reported for the area of healthcare - and not only by those potentially affected by racism.

The intensity and consequences of experienced discrimination are unevenly distributed in Germany. The most frequently affected population groups are those that are racially marked and whose belonging to Germany is repeatedly the subject of public debate: Black, Asian and Muslim people.

Prof. Dr. Naika Foroutan, Director of DeZIM Institute

The study

From June to November 2022, researchers from the DeZIM Institute investigated people's experiences of discrimination in Germany. More than 21,000 people in Germany took part in the extensive and representative survey.

This year's focus on health includes access to healthcare services, experiences of discrimination and racism in the use of healthcare services and their impact on healthcare provision.

Key Findings

Experiences of discrimination and/or racism are generally widespread: These experiences vary in their nature and frequency according to social groups, discrimination characteristics and social spaces, as shown by the new National Monitoring of Discrimination and Racism.

Black people are the most affected by discrimination. Subtle experiences of discrimination are more common overall and the differences between racially labeled people and non-racially labeled people are even more pronounced.

  • Overt discrimination: Almost one in five Black women (19%) state that they repeatedly experience threats or harassment, compared to 18% of Black men.
  • Subtle experience of discrimination: 37% of all Black men state that they are regularly met with fear. This is four times as often as for men who are not racially marked (9%). And one in five Black women (20%) report that they are repeatedly met with fear, compared to around one in 30 non-racist women (4%).

The groups surveyed include Black people, Muslim people, Asian people and non-racially marked people (by self-identification).

Examples of different characteristics:

  • Age, disability or chronic illness (ability)
  • Lack of language skills, migration to Germany, non-German-sounding names, religious affiliation or skin color (race)
  • Gender or sexual orientation
  • Class, income or unemployment (class)

 

Racially marked people experience discrimination mainly on the basis of racial characteristics, less in relation to ability, gender or class.

Sex, age and weight are the most common discrimination characteristics for non-racialized (white) women. For non-racialized (white) men, the most common discrimination characteristics are age, weight and income.

     

People can have discriminatory and racist experiences in different social spaces:

  • in public: on the street or on public transportation
  • in their leisure time: for example when accessing clubs or sports studios
  • in contact with banks, offices and authorities as well as the police
  • in the health sector: in hospitals or when visiting the doctor

 

Experiences of discrimination by social group:

  • Black people disproportionately report experiences of discrimination and/or racism in public and in contact with the police.
  • Muslim people experience discrimination and/or racism particularly frequently in public offices and authorities, with the police and in the health sector.
  • Asian people most frequently report experiences of discrimination and/or racism at public offices and authorities and in public.
  • Among non-racist (white) people, women report experiences of discrimination more frequently than men.

Focus on health

Experiences of discrimination and/or racism are frequently reported in healthcare - and not only by those potentially affected by racism. The focus of the National Monitoring of Discrimination and Racism asks: How are experiences of racism and discrimination related to health?

In this report, we have focused on the healthcare sector, where discrimination takes place in various places. For example, people who are racially marked receive fewer appointments and are less likely to have their complaints heard.

Prof. Dr. Frank Kalter, Director of DeZIM Institute

  • Who experiences discrimination in healthcare ? Women are more likely to have negative experiences than men: 39% of Black women, 35% of Muslim women, 29% of Asian women and 26% of non-racially marked women report unfair and poor treatment at least occasionally.

  • How does discrimination in the healthcare system manifest itself? Almost one in three racially marked people say that their complaints were not taken seriously. This is particularly true for women: Muslim women (39%) and Asian women (37%) have changed doctors because of this. For women who are not racially marked, the figure is around 29%.

  • Discrimination and racism go beyond the immediate consequences for those affected and can also indirectly harm society as a whole. The more frequently experiences of discrimination and/or racism are experienced, the stronger the indications of an anxiety disorder and depressive symptoms.

  • This can lead to a serious loss of trust, especially when discrimination occurs in institutions that are actually there to protect citizens and provide help.

Recommended actions

Discrimination and racism are intertwined on an individual, institutional and structural level. Therefore, action must be taken simultaneously at various levels in order to sustainably reduce discrimination and racism. The recommendations are aimed at stakeholders from politics as well as civil society and healthcare.

They are divided into three areas:

    •  

  • Mainstreaming: Addressing discrimination and racism comprehensively

  • Institutions: Establish research-based measures against racism and discrimination in institutional contexts

  • Knowledge: Reduce discriminatory knowledge in medical care through education and training

  • Language: Strengthen discrimination- and racism-sensitive language and images in healthcare and medical teaching

  • Intersectionality: making medical research more interdisciplinary - linking gender-based discrimination with research on racism

    •  

  • Politics: Reform the General Equal Treatment Act (AGG)

  • Advice: Expand reporting and advice centers nationwide

  • Care: Create more psychotherapeutic places, set up non-discriminatory appointments, design specific measures for asylum seekers and people without health insurance

  • Language: break down language barriers

  • Those affected: Strengthen communities

    •  

  • Research: Systematically develop and expand German-language racism and health research

  • Institutions: Enable and facilitate access to research

  • Intersectionality: Targeted research into multiple disadvantages

  • Language: Establish discrimination-sensitive language in research

  • Exchange: promote networking

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