October EDI Corner - Microaggressions and their impact on health and workforce

Microaggressions are "brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative slights and insults to the target person or group."1 The term "microaggression" was first coined in 1978 by Chester M. Pierce to describe subtle insults and dismissals against African Americans.2 In the 21st century, the concept expanded to include any socially marginalized group.3 While microaggressions may appear more subtle than overt forms of discrimination, they are still expressions of racism or discrimination.4

Key themes in microaggressions include assumptions about intelligence or skills, treating individuals as perpetual foreigners, denying differences or lived experiences, and oscillating between invisibility and hypervisibility.1 Sue et al. (2007) classified microaggressions into three main categories, each defined below with examples.

Microinsults: Comments or behaviors that convey negative assumptions toward someone's identity or heritage. Often, perpetrators are unaware of the offensive message conveyed.

Examples:

  1. “You speak English so well!” (directed to a Latina colleague)
    Message: Assumes Hispanic/Latino/a/x individuals don’t have English as a first language or are not from the U.S.
  2. An instructor calls on male students more frequently than female students.
    Message: Female contributions are undervalued.
  3. Asking Asian Americans, “Where are you really from?”

Message: Implies they are perpetual foreigners.

Microinvalidations: Dismiss or undermine someone's experiences, thoughts, or feelings tied to their identity.

Examples:

  1. "We don't need implicit bias training. We have one Black faculty member."
    Message: Tokenizes Black faculty members and dismisses an opportunity to enhance the inclusivity of the environment for faculty of color and other marginalized identities.
  2. “I don’t see color.”

Message: Invalidates unique lived experiences and challenges faced by people of different races.

  1. “You should try to soften your tone; it can be off-putting.” (referring to a female leader who is a direct communicator).

Message: Implies her authoritative leadership style is less acceptable than a more traditionally feminine approach.

Microassaults: Overt, deliberate discriminatory actions or verbal attacks intended to harm. Also called "old-fashioned" racism, they often involve direct derogations.

Examples:

  1. Using racial slurs or outdated terms like "colored" or "Oriental."
  2. "It's a shame you're having kids in residency; your research must not be that important to you."

Message: Suggests parents cannot balance children and career success.

  1.  “You only got that fellowship because you're a minority."

Message: Implies the person didn't earn the fellowship based on merit.

Impact on Health Outcomes

Microaggressions can have significant consequences for both mental and physical health. Dr. Brittany Bryant compares microaggressions to “a death by 1,000 cuts.”5 Repeated exposure to these subtle biases can lead to physical health issues, including high blood pressure, gastrointestinal problems, sleep disturbances, chronic stress, anxiety, depression, and even conditions like post-traumatic stress disorder (PTSD), which disrupts one's ability to function.5

Burnout, often exacerbated by microaggressions in academic and public health settings, can further compound these health issues, especially for those experiencing PTSD and other trauma-related conditions. Moreover, the oral health manifestations of PTSD, such as bruxism, temporomandibular joint dysfunction, and referred upper back pain, are important considerations for dental providers.6 The lack of attention to the emotional toll of microaggressions on professionals in these fields represents a missed opportunity to address how systemic inequities extend beyond patient care to the workforce itself.

In healthcare settings, patients who experience microaggressions often develop distrust toward healthcare professionals.7 This distrust can result in delayed care, reduced utilization of healthcare services, and poor adherence to treatment plans. Microaggressions can disrupt communication between patients and providers, leading to misunderstandings, compromised care, and decreased access to culturally competent healthcare. These negative interactions contribute to broader health disparities, perpetuating inequities in healthcare outcomes.

Similarly, in the education setting, microaggressions disrupt trust and the psychological safety that students have with faculty, staff, and their fellow students.8 Microaggressions may also be a sign that the climate of the academic institution needs improvement.9 Institutions should consider reviewing their policies regarding microaggressions, reporting processes, and ensuring that there are resources to support people experiencing microaggressions and to discourage people from committing microaggressions.

While this content intended to support learning about microaggressions, it is essential to also center the experiences of those receiving them. A more holistic approach is encouraged, ensuring that those affected are not overlooked. Additionally, this invites reflection on whether we, as writers and educators, are the most appropriate voices to tackle these topics, and if we are effectively considering for whom this information is intended.

Support strategies for people experiencing microaggressions:10,11

  • Decide if, and how, to respond: If comfortable, inform the individual - either immediately or in a follow-up conversation - about the impact of their words or actions on you. Additional aspects to consider in whether and how to follow up can be found here.
  • Process emotions: Seek support from trusted individuals or a healthcare provider to be able to talk openly and process your experiences.
  • Practice self care: Engage in practices that improve physical and mental health, which can enhance emotional resilience as a protective factor for future experiences of microaggression.
  • Document or report: If microaggressions are happening at work, school, or other professional settings, keep records with as much detail as possible in case a formal report takes place. Consider reporting your experiences to ensure that organizational leadership is aware and can take action if desired.

Strategies to reduce microaggressions: 5,12

  • Reflect on biases: We all have them! Reflect on your own stereotypes, expectations, and assumptions of marginalized groups.
  • Confront your hesitancies: What do you avoid discussing or asking about? Why?
  • Listen and learn:  Learn to separate your intention from the impact, and focus on understanding the impact.
  • Take time when making important decisions to avoid letting implicit biases influence your actions.
  • Avoid generalizations: Focus on the individual rather than their group identity to avoid making generalizations.
  • Expand views of success beyond traditional stereotypes
  • Engage with diverse backgrounds: Interact more often with people from different backgrounds to foster connections and reduce prejudices.
  • Commit to change: Make a conscious effort to improve.
  • If a microaggression is brought to your attention: acknowledge your bias, seek feedback from the person affected, say you’re sorry, and thank you for the feedback. Remember, the impact of your actions matters, not your intent.

References

  1. Sue DW, Capodilupo CM, Torino GC, Bucceri JM, Holder A, Nadal KL, Esquilin M. Racial microaggressions in everyday life: implications for clinical practice. Am psychol. 2007 May;62(4):271-286.
  2. Pierce, C. M., Carew, J. V., Pierce-Gonzalez, D., & Wills, D. An Experiment in Racism: TV Commercials. Education and Urban Society. 1977;10(1):61-87.
  3. Capodilupo, C. M., Nadal, K. L., Corman, L., Hamit, S., Lyons, O. B., & Weinberg, A. The manifestation of gender microaggressions. Microaggressions and marginality: Manifestation, Dynamics, and Impact. 2010;193-216.
  4. Kendi, Ibram X. How to be an Antiracist. New York: One World, 2019.
  5. UCSF News. Say What? Microaggressions, Your Health and What to Do About Them. UC San Francisco. 2024 May.
  6. Friedlander AH, Friedlander IK, Marder SR. Posttraumatic stress disorder: psychopathology, medical management, and dental implications. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jan;97(1):5-11.
  7. Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health. 2022 May 16;22(1):988.
  8. Fleming  E, Smith PD, Inglehart M. Dental and allied dental students’ cultural climate-related experiences and perceptions: How does ethnicity/race matter? JDE In Press.
  9. Ahmadifard A, Forouhi S, Waterhouse P, Muirhead V. A student-led qualitative study to explore dental undergraduates' understanding, experiences, and responses to racism in a dental school. J Public Health Dent. 2022 Mar;82 Suppl 1(Suppl 1):36-45.
  10. López González, L. Microaggressions, your health and how to cope. May 2024. Available here.
  11. Chung M. How to respond & deal with microaggressions. ND. Available here.
  12. American Association of Public Health Dentistry (AAPHD). Disrupting Unconscious Bias. 2023 Dec.

This EDI corner was authored by Sofía Iribarren DDS MS, Julie C. Reynolds DDS MS, Eleanor Fleming, PhD, DDS, MPH, and the AAPHD EDI Committee.