Race Is in the Eye of the Beholder: Perceived Race As the Invisible Enemy for Veteran Health Disparities

Background and Purpose: Scholars have discussed the ways in which racial discrimination has impacted health among veterans. Researchers have found that white veterans diagnosed with PTSD are more likely to receive therapy at Veteran Affairs (VA) facilities than veterans of color. Other researchers have found that among veterans with mental health and substance abuse disorders, those who identified as racial/ethnic minorities reported worse experiences at the VA than whites in the categories of access to care, comprehensiveness, communication, and office helpfulness/courtesy. Since race is a social construct, racial discrimination depends one’s perceived race. However, no study has explored the impact of perceived race on veterans’ health.   

Methods: Within a veteran subsample of the 2012 and 2014 Reactions to Race module of the Behavioral Risk Factor Surveillance System (BRFSS, N= 16,778), this study examines the moderating effects of self-identified and perceived race on the relationship between perceived discrimination in healthcare or the workplace and mental health and heavy drinking. The BRFSS asked how the respondent thinks people in the U.S. classify their race as well as their self-identified race. This variable was split into four categories: Self-identified White perceived as White (WW), self-identified non-White perceived as White (NWW), self-identified White perceived as non-White (WNW), and self-identified non-White perceived as non-White (NWNW). Univariate analyses describe the sample, followed by a series of Chi-Square tests used to test the association between self-identified and perceived race and reactions to racial discrimination. Logistic and OLS regressions were run to test moderating effects. 

Findings: Five percent of NWNW veterans reported being treated worse than other races in healthcare compared to 1.5% of WW veterans and 15% of NWNW veterans reported being treated worse than other races in the workplace compared to 4% of WW veterans. Of note, 98% of NWW veterans report being treated the same as other races in the workplace. Only veterans perceived as non-white (WNW and NWNW) report experiencing a physical reaction (4% and 5% respectively) and 14% of NWNW veterans report having an emotional reaction to their treatment based on race. Veteran status moderated the relationship between racial identity on mentally unhealthy days, indicating that veteran status is not protective for people of color.  

Veterans who are WNW were 6% more likely to report fair or poor health and 5.42 times more likely to report heaving drinking than WW veterans. Also, NWNW veterans had 3.19 greater odds of reporting heavy drinking days than WW veterans. Findings suggest that self-identified and perceived race moderate the relationship between perceived discrimination in healthcare or the workplace and heavy drinking, whereby being perceived as white is a protective.  

Conclusions and Implications: Although race is a social construct, the impact of perceived can be as serious as life or death. Among veterans, perceived white racial identity seems to be a protective factor, while perceived non-white racial identity seems to negatively impact health and likelihood of heavy drinking. Perceived race creates a new racial hierarchy: WW at the top, then NWW, WNW, and NWNW on the bottom.