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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

Need another jolt of motivation to shore up a resolution to shed weight, sleep more soundly, boost nutrition or exercise levels, or cut back on alcohol? Then you'll be pleased to learn that any (and all) of these efforts can also add up to better brain health.

An international study led by researchers at the McCance Center for Brain Health at Massachusetts General Hospital devised and validated a Brain Care Score (BCS) card that makes it easy to total up what you're doing well and where you might do better. The prize is a healthier brain — specifically a lower risk for dementia and strokes.

Designed to predict how current habits might impact future brain health, the user-friendly scorecard is apparently the first of its kind, says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

"It's a real service that the researchers have developed a scale like this and completed the first study to determine if scoring worse on this scale raises your risk for dementia and stroke," says Dr. Budson, who wasn't involved in the analysis. "On one hand, no one's done something quite like this before. On the other, however, it's really wrapping together health factors everyone has known for a number of years in new packaging."

What's included on the scorecard?

Called the McCance Brain Care Score, the card tallies points from 12 physical, lifestyle, and social-emotional domains.

Physical components relate to

• blood pressure
• blood sugar
• cholesterol
• body mass index (BMI).

Lifestyle components include

• nutrition
• alcohol intake
• smoking
• aerobic activities
• sleep.

Social-emotional factors inquire about

• stress management
• social relationships
• meaning in life.

Each response is given a score of 0, 1, or 2, with the highest possible score totaling 21. Higher scores suggest better brain care.

"All these physical and lifestyle factors can contribute to the risk of dementia to some extent through strokes," Dr. Budson says. "Those that aren't a risk through strokes are usually related to the fact that a healthy brain is a brain that's using all of its parts. Engaging in healthy relationships and meaningful activities helps us maintain good brain structure and function."

What did the analysis involve?

The study was published online in Frontiers of Neurology in December 2023. It involved nearly 399,000 adults ages 40 through 69 (average age 57; 54% women) who contributed personal health information to the UK Biobank.

During an average follow-up period of 12.5 years, participants recorded 5,354 new cases of dementia and 7,259 strokes. Researchers found that participants with higher Brain Care Scores at the study's start had lower risks of developing dementia or strokes over time.

These threats to health and independence take a stunning — and growing — toll on people in the US. Dementia affects one in seven Americans, a rate expected to triple by 2050. Meanwhile, more than 795,000 people in the United States suffer a stroke each year, according to the CDC.

What did the study find?

Each five-point step higher in the BCS rating assigned when the study began was linked to significantly lower risks of dementia and stroke, with those odds varying by age group:

• Participants younger than 50 at the study's start were 59% less likely to develop dementia and 48% less likely to have a stroke with each five-point higher score on BCS.
• Participants 50 through 59 at the study's start were 32% less likely to develop dementia and 52% less likely to have a stroke with each five-point higher score on BCS.

But those brain disease benefits appeared to diminish for those older than 59 at the study's start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score on BCS. Study authors theorized that some of these participants may have already been experiencing early dementia, which is difficult to detect until it progresses.

"I feel very comfortable that the study's conclusions are entirely correct, because all the factors that go into its BCS are well-known things people can do to reduce their risk of stroke and dementia," Dr. Budson says.

What are the study's limitations?

However, Dr. Budson notes that the study did have a couple of limitations,. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking meaning-of-life questions. So its scores ranged from 0 to 19, not up to 21. "It's a practical limitation, but it should be acknowledged that so far, there have been no studies to validate the actual 21-point scale they're recommending we use," he says.

The analysis also evaluated participants' scores at just one point in time instead of several, Dr. Budson says. Future research should determine whether people can lower their stroke and dementia risk by improving their BCS over time with behavior and lifestyle changes.

How can you play this game at home?

While better brain health may be the clear prize of a higher score, it's far from the only benefit. That's because improving any health component of the BCS also benefits our overall well-being.

"By improving these factors, not only will people help their brain, but they'll also help their heart and reduce their risk of cancer," Dr. Budson adds. "These factors will absolutely also improve your psychological health, which is certainly an important part of brain health."

The scale's simple breakdown of health factors also makes it easy to focus on tweaking one or two without getting overwhelmed.

"Let's say someone's nutrition isn't perfect — and they know it — but they're not willing to change their diet. Fine. They can then decide to do more aerobic exercise, for example, or to stop drinking, or to get the sleep their body needs," he says.

What one change could put you on a path to better brain health?

If he had to choose just one factor to improve brain health, Dr. Budson would focus on meaning of life, "which means you generally feel your life has meaning or purpose," he says. To do that, he suggests giving deep, quiet thought to what you wish your life's purpose to be, whether you expect to live a long time or just a few years.

"Once you have a purpose, then you have a reason to follow through with assessing all the other items on the BCS scale and seeing what you can do so you'll be around longer, and be competent and capable longer, to help fulfill the meaning and purpose of your life," he says.

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

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