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Linking Perceived Unfairness to Physical Health: The Perceived Unfairness Model

Authors:
  • Harvard T.H. Chan School of Public Health

Abstract

Can perceiving unfairness influence physical health? To address this question the authors propose the Perceived Unfairness Model, synthesized from psychological and epidemiological research. The model starts from the premise that perceiving unfairness, directed at beings to which the perceiver is emotionally attached, activates a cascade of psychological and physical processes. This cascade may be experienced by low or high status group members, and by the target or observer of the perceived unfairness. With repeated episodes, the effects of perceiving unfairness may accumulate and compromise physical health. Whether perceiving unfairness is potentially toxic or benign is a function of two key components of social location: identity relevance and helplessness to redress the unfairness. The authors conclude by discussing directions for developing the model. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Linking Perceived Unfairness to Physical Health:
The Perceived Unfairness Model
Benita Jackson
Smith College
Laura D. Kubzansky
Harvard School of Public Health
Rosalind J. Wright
Brigham and Women’s Hospital/Harvard Medical School, and Harvard School of Public Health
Can perceiving unfairness influence physical health? To address this question the
authors propose the Perceived Unfairness Model, synthesized from psychological and
epidemiological research. The model starts from the premise that perceiving unfairness,
directed at beings to which the perceiver is emotionally attached, activates a cascade of
psychological and physical processes. This cascade may be experienced by low or high
status group members, and by the target or observer of the perceived unfairness. With
repeated episodes, the effects of perceiving unfairness may accumulate and compro-
mise physical health. Whether perceiving unfairness is potentially toxic or benign is a
function of two key components of social location: identity relevance and helplessness
to redress the unfairness. The authors conclude by discussing directions for developing
the model.
Health outcomes are increasingly recognized
as socially patterned. In 2001–2002, the leading
three causes of death in the United States were
heart disease, cancer, and stroke (Anderson &
Smith, 2005). Disproportionate rates of these
and other major diseases have been documented
in African Americans relative to other groups,
as well as among those with low versus higher
socioeconomic status (Adler & Ostrove, 1999).
The concept of weathering has been proposed as
one explanation for these disparities. Weather-
ing is the “the cumulative impact of repeated
experience with social, economic, or political
exclusion” and has been linked to premature
health decline in particular social groups
(Geronimus, 2001, p. 133). Material inequities
in access to nutritional food and good health
care, exposure to pollution and violence, and
unsafe neighborhoods account for some of these
disparities (Berkman & Kawachi, 2000b; Kawa-
chi, 2002). Psychological mechanisms related to
weathering undoubtedly play a role, too, but are
yet to be well explicated.
Recent scholarship has focused on under-
standing how social environments “get under
the skin” to influence health, and suggests that
psychological factors do play a fundamental
role (Taylor, Repetti, & Seeman, 1997). Per-
ceiving unfairness may be a critical psycholog-
ical variable that is socially patterned and also
influences physical health. The mere perception
of unfairness can have psychological conse-
quences: for example, powerlessness, anger,
guilt, and avoidance. Further, one’s social loca-
Benita Jackson, Department of Psychology, Smith Col-
lege; Laura D. Kubzansky, Department of Society, Human
Development, and Health, Harvard School of Public Health;
and Rosalind J. Wright, Channing Laboratory, Department
of Medicine, Brigham and Women’s Hospital/Harvard
Medical School, and Harvard School of Public Health.
During the preparation of this article, the authors were
supported by grants from the National Heart, Lung, and
Blood Institute (NHLBI) and Environmental and Health
Sciences (ES). Prior to her affiliation at Smith College,
Jackson was a post-doctoral fellow at Channing Laboratory,
supported by training grant HL07427; Kubzansky was sup-
ported by ES10932; and Wright was supported by K08
HL04187 and ES10932. Thanks to Eileen Zurbriggen, Jean
Twenge, and the reviewers for helpful comments on earlier
versions of this article. Earlier portions of this article were
presented at the annual meeting of the International Society
of Political Psychology in Boston (July 2003) and the Third
Annual Diversity Challenge Conference sponsored by the
Institute for the Study and Promotion of Race and Culture at
Boston College (October 2003).
Correspondence concerning this article should be addressed
to Benita Jackson, Department of Psychology, Clark Science
Center, 44 College Lane, Smith College, Northampton, MA,
01063. E-mail: bjackson@email.smith.edu
Review of General Psychology Copyright 2006 by the American Psychological Association
2006, Vol. 10, No. 1, 21– 40 1089-2680/06/$12.00 DOI: 10.1037/1089-2680.10.1.21
21
tion may amplify or buffer the potentially del-
eterious effects of perceived unfairness.
1
In this
article, we argue that with repeated episodes,
perceiving unfairness may eventually take a toll
on the perceiver’s physical health.
We propose that to understand these pro-
cesses effectively, the time is ripe to link social,
personality, and health psychology literatures
with literature from epidemiology (the science
of public health). Psychology and epidemiology
each have important, complementary contribu-
tions to make to the study of how perceiving
unfairness may be translated into health. To this
end, we introduce the Perceived Unfairness
Model, synthesize relevant research from psy-
chology and epidemiology, and outline direc-
tions for future interdisciplinary research.
There are but a few empirical studies in psy-
chology that examine the physical health con-
sequences of perceiving unfairness (Landrine &
Klonoff, 1996). Yet, there is a growing body of
psychological scholarship—theoretical and em-
pirical—that considers perceiving unfairness,
especially in the form of group discrimination,
as a potential source of psychological stress
(Allison, 1998; Clark, Anderson, Clark, & Wil-
liams, 1999; Foster, 2000; Klonoff, Landrine, &
Campbell, 2000; Landrine, Klonoff, Gibbs,
Manning, & Lund, 1995; Swim, Cohen, &
Hyers, 1998). The overwhelming evidence of
a link between stress and health and illness
(Baum & Posluszny, 1999; Kiecolt-Glaser,
McGuire, Robles, & Glaser, 2002; Krantz &
McCeney, 2002, 1998), suggests that perceiving
unfairness may have important implications for
health.
Interestingly, findings in the justice literature
suggest that people possess psychological
mechanisms for avoiding the perception of un-
fairness. For example, as shown in studies of
relative deprivation, people acknowledge that
members of their own group experience dis-
crimination, but tend to downplay personally
having experienced discrimination (Corning,
2000; Jackson, 1989). Also, as shown in re-
search on just-world theory, people’s responses
to innocent victims (helping, contempt, harm-
ing) may be attempts to reduce the threat of
confirmation that the world is unjust (Hafer,
2000). Avoidance or denial of perceived unfair-
ness may be a mechanism to deflect distress
(Crosby, 1984), in the short term. Why might
people have developed such varied psycholog-
ical mechanisms for avoiding the perception of
unfairness? What is the cost of perceiving un-
fairness? The Perceived Unfairness Model
holds that a key cost is to one of life’s most
precious goods: physical health.
Research in social epidemiology demon-
strates a link between social factors and health,
and thus is potentially informative for the de-
velopment of a model linking factors that are
shaped by the social environment—like per-
ceiving unfairness—with health. Social epide-
miology examines the distribution of health and
illness as a function of social status markers,
such as social class, race/ethnicity, age, and
gender (Berkman & Kawachi, 2000b). Some of
the guiding principles of social epidemiology
are: understanding the (macro) social context of
behavior, health, and illness; conducting con-
textual multilevel analyses; taking a develop-
mental and lifecourse perspective; and examin-
ing factors related to general susceptibility to
disease (Berkman & Kawachi, 2000a). A
strength of social epidemiology is that studies
are typically conducted with large-scale, com-
munity or population-based samples designed
to be ecologically valid. Often data are collected
at multiple time points, with many years of
follow-up, allowing for causal inferences about
social stratification and health outcomes using a
time frame that makes it possible to detect
changes in health status.
Though social epidemiology documents the
social patterning of health and disease, a crucial
remaining question is how factors outside the
body (e.g., socioeconomic status) may get under
the skin to influence health (Jackson, Wright,
Kubzansky, & Weiss, 2004). Psychology offers
1
”Social location” is a commonly understood term from
sociology and anthropology, referring to the interaction
among one’s social identities (e.g., gender, socioeconomic
status, race/ethnicity, sexual orientation, religion, age, etc.)
and accompanying roles and resources, in specifying an
individual’s place in the social hierarchy. The term is useful
because it encompasses a combination of social identities,
and not merely in an additive manner, but as an interaction.
For example, the experience of being a working-class fe-
male in the United States is not simply the addition of the
experience of being working-class and of being female;
there are unique features emerging from the interaction of
these identities (Tea, 2003). In addition to psychological
aspects of social identities and roles, social location in-
cludes the influence of material resources. For a psycholog-
ical perspective on social location, see scholarship by Ma-
halingam (2001, 2003).
22 JACKSON
much-needed conceptualizations of factors that
may enable social environments to become in-
ternalized and influence physical health. A
greater understanding of these mechanisms may
yield more insight into the nature of specific
psychological experiences, and also offer guid-
ance about how to address the toxicity of par-
ticular environments. Perceiving unfairness
may be an important mechanism by which ex-
ternal inequities become internalized and influ-
ence health. While there is relevant work in
both psychology and epidemiology in this area,
findings from the two disciplines have not yet
been conceptually integrated. Thus, we develop
a framework for determining the relevant fac-
tors (and their combination) that may modify
the deleterious health effects of perceiving un-
fairness, as well as the pathways by which per-
ceptions of unfairness may influence health.
The resulting Perceived Unfairness Model may
be a guide to empirical scholarship in this field.
The Perceived Unfairness Model:
An Overview
The Perceived Unfairness Model is presented
in Figure 1, and explained more fully in the
following sections. Fundamentally, the model
posits that the perception of unfairness activates
a cascade of psychological and physical pro-
cesses. Over long periods of time, recurrence of
such processes may eventually initiate the de-
velopment of disease. The Perceived Unfairness
Model does not address antecedents of per-
ceived unfairness, but focuses on the point at
which the perception occurs. Once unfairness
has been perceived, its effects may be experi-
enced by low or high status group members,
and by the target or the observer of the per-
ceived unfairness. Perceived unfairness is not
inevitably harmful. Perceptions of unfairness
may be associated with either a stress response
(i.e., toxic) or a benign response. Two key con-
sequences of social location may determine the
nature of the response to perceived unfairness:
identity relevance and perceptions of helpless-
ness to redress the unfairness. If a stress re-
sponse does occur, this contributes to biologi-
cal, social, and behavioral mechanisms that in-
crease physiologic wear and tear, which can
lead to serious health consequences over time.
Model Constructs
In this section we explicate the theoretical
components of the Perceived Unfairness Model
(see Figure 1) and identify relevant empirical
literature.
Benign
responses *
Helplessness
Perceived
unfairness
Stress
responses *
Coping
behaviors
Allostatic
load
Morbidity
Mortality
Identity
relevance
+
-
o
r
n
il
Figure 1. The Perceived Unfairness Model. *Both stress and benign responses have cog-
nitive, emotional, and motivational components; each type of response differs in content and
effect. Stress responses increase allostatic load; benign responses decrease or have a neutral
effect.
23PERCEIVED UNFAIRNESS AND HEALTH
Perceived Unfairness
What is perceived unfairness? We define
perceived unfairness broadly, encompassing a
breach of entitlements or of psychological con-
tracts (cf. Miller, 2001) related to group mem-
bership or to individual experiences. For exam-
ple, prejudice and discrimination are potent
forms of unfairness—in that they manifest on
both societal and individual levels—that are
related to group membership. There also exists
unfairness that is not a direct function of group
membership, such as a personal breach of either
formal or informal agreements between
individuals.
The simple perception of unfairness may
have deleterious effects, beyond or even with-
out the other more direct material effects of
unfairness. Hence, we use the term “perceived”
unfairness to underscore the impact of subjec-
tive experience on physical health. Our predic-
tion is that stronger, more frequent and longer-
lasting perceptions of unfairness will be associ-
ated with greater activation of the processes
outlined in the model. We also expect that the
processes detailed in the model will occur if the
target of unfairness is a being to which the
perceiver holds some attachment, whether that
is the self, friends, in-group members, or even
objects like natural environments (Merchant,
1980; Oskamp, 2000). We argue that the mere
perception of unfairness— even if one is not a
direct target of the perceived unfairness—may
eventually have health-related consequences.
The degree to which perceptions of unfairness
influence downstream factors in Figure 1, and
keep those processes activated, is a function of
the intensity, frequency, and duration of these
perceptions (cf. Larsen & Diener, 1987; Larsen,
Diener, & Cropanzano, 1987).
Perceived unfairness is a unique type of
stressor. A basic assumption in health psy-
chology and related fields is that stress plays a
role in the etiology and progression of a broad
range of physical diseases (Habib, 2001; Seph-
ton & Spiegel, 2003; Wright, Rodriguez, &
Cohen, 1998). However, evidence that stress
contributes to the pathophysiology of human
disease is thin, and, where evidence does exist,
a small proportions of the variance is explained
(Marsland, Cohen, Rabin, & Manuck, 2001).
This dilemma has led to the consideration of
stress potentiators or buffers. These are charac-
teristics that render individuals (or groups of
individuals) more or less vulnerable in the face
of stressful events (e.g., perceived unfairness)
and include psychological (Marsland et al.,
2001), social (Cohen et al., 1998), and biologi-
cal (Cohen & Hamrick, 2003) features. These
factors may vary depending on the stressor ex-
amined. Thus, it is important to develop theo-
retical frameworks better able to characterize
individual vulnerability and resilience with
greater success, so researchers can more defin-
itively understand the relationship between
stress and disease.
Perceived unfairness may be considered a
particular type of stressor, although it does not
fit neatly into current models of stress. There are
two important classes of stressors identified in
the stress literature: major life events and daily
hassles (Jones & Kinman, 2001). Perceptions of
unfairness share some commonalities with, but
also some important differences from these two
types of stressors. Perceptions of unfairness
may exert pervasive effects across life domains
(like major life events, and unlike daily hassles),
but occur frequently (like daily hassles, and
unlike major life events). Perceived unfairness
may be particularly insidious given that some
individuals and groups, especially those of low
status, experience it so frequently; recent re-
search suggests that the negative mental health
consequences of perceived unfairness (specifi-
cally, sexism) are most likely when it is be-
lieved to be pervasive (Schmitt, Branscombe, &
Postmes, 2003).
Psychological and social epidemiological
models of stress have differed in focus. Psycho-
logical models have tended to classify sources
of stress broadly, with more focus on under-
standing stress appraisals, central components
of the stress process (for a classic example, see
Lazarus & Folkman, 1984). This research al-
lows for understanding individual differences in
experiences of stress, and informs possible in-
dividual-level interventions. Social epidemio-
logical models have generally considered the
kinds of exposures that may contribute to a
toxic environment (e.g., Krieger, 2000). This
research allows for understanding social differ-
ences in the experiences of stress, and informs
an understanding of how the social environment
may influence health for intervention at the
macrosocial level.
In the biomedical literature on stress, every-
24 JACKSON
day acts of unfairness by and large have not
been conceptualized as stress-producing (for an
exception, see Steffen, McNeilly, Anderson, &
Sherwood, 2003), as are major life events (e.g.,
death of a loved one; divorce) and even the
accumulation of daily hassles (e.g., sitting in
traffic; waiting in a long line at the bank). How-
ever, recent psychological scholarship has be-
gun to document the deleterious effects of “ev-
eryday injustice” (Swim, Cohen, & Hyers,
1998; Swim, Hyers, & Cohen, 2001; also see
Corning, 2002; Fischer & Shaw, 1999; Waldo,
1999). Population perspectives, as those taken
in epidemiology, suggest that even small dele-
terious effects on individuals can, taken to-
gether across a population, have tremendous
public health consequences (Rose, 1992).
Though the observed effect may be modest at
the individual level, these experiences may con-
tribute significantly to the population burden of
preventable diseases given the pervasiveness of
the exposure. This suggests that an exploration
of perceiving unfairness and its effects may add
insight to why some social environments are be
more toxic than others, and why some individ-
uals are particularly vulnerable.
There may be times when individuals are able
to respond constructively, and mobilize positive
resources in the context of perceived unfairness.
At such times, a benign psychological response
may occur instead of a stress-related response
(see Figure 1). A benign psychological response
is comprised of positive or neutral emotions,
cognitions, and motivations. For example, in
their germinal paper on the protective effects of
stigma, Crocker and Major (1989) suggest that
when perceiving unfairness (in the form of dis-
crimination) membership in a stigmatized group
may protect an important facet of mental health,
self-esteem. Subsequent studies support this
idea (e.g., Major, Kaiser, McCoy, 2003; McCoy
& Major, 2003; Moradi & Hasan, 2004; Ro-
mero & Roberts, 2003). Burgeoning research on
how positive emotions may neutralize the ef-
fects of negative emotions or buffer stress sug-
gests the potency of benign responses in pro-
moting (Fredrickson, 2000) or even restoring
health (Smith & Baum, 2003). Understanding
when and why perceived unfairness does not
lead to stress-related responses is critical. The
Perceived Unfairness Model predicts that two
key factors shaped by social location—strong
identity relevance and high levels of helpless-
ness—produce the most toxic stress responses.
The occurrence of stress responses is in turn
related to risk of poor health outcomes.
Social Location I: Identity Relevance
Identity is one’s concept of self. It is con-
structed from idiographic experience (individ-
ual identity), and by group membership (social
identity). Under certain circumstances, individ-
ual and social identities are made salient, sepa-
rately or together. The more that something
perceived to be unfair is salient to one’s per-
sonal and/or social identities, the more it may
produce significant psychological effects (cf.
Wright, Aron, & Tropp, 2002). The Perceived
Unfairness Model states that social group rele-
vance is particularly potent in heightening the
effects of perceiving unfairness (cf. Mum-
mendey, Kessler, Klink, & Mielke, 1999). Be-
cause the perceiver imagines the impact of the
unfairness not just for the self, but also for all
those for whom the perceiver has positive re-
gard in the group, effects may be amplified (cf.
Ellemers, Spears, & Doosje, 2002).
A number of theories have proposed related
conceptualizations of stress originating from so-
cial status, although each theory has generally
focused on a particular social group. For exam-
ple, separate theories have considered stress in
relation to African Americans (Clark et al.,
1999), gay men (Meyer, 1995), people of color
(Krieger, 1999), women (Klonoff et al., 2000),
and Native Americans (Walters & Simoni,
2002). Personal and social identities are embed-
ded in a social hierarchy. While it is important
to study the historical, cultural, and geographi-
cal particularities that define all social identities,
we suggest that it will move research forward
also to acknowledge shared features of models
that link social identities, stress, and health. The
Perceived Unfairness Model is a first attempt to
extract the common features of such models and
see whether empirically testable links may be
posited in a single model that encompasses dif-
ferent social groups more parsimoniously than
separate identity-based models. Regardless of
identity, to the degree that these identities are
made relevant so is the social status of the
identity.
Notably, the psychological consequences of
perceiving discrimination have been shown to
be more severe for low status groups than for
25PERCEIVED UNFAIRNESS AND HEALTH
high status groups (Branscombe & Ellemers,
1998; Branscombe, Schmitt, & Harvey, 1999;
Schmitt, Branscombe, Kobrynowicz, & Owen,
2002). As Schmitt et al. (2002) point out, for
low versus high status group members there are
different social meanings, and greater resulting
immediate social costs, of perceived unfairness
directed toward one’s own group. This is at
least in part because unfairness directed toward
low status groups tend to be harsher, more eas-
ily legitimized, and more invisible than unfair-
ness directed toward high status groups.
Unfairness may be perceived by individuals
across social status groups. We argue, how-
ever, that perceived unfairness is not confined to
low status group members. Our model applies
more broadly to any individual who perceives
unfairness, of high or low status, beyond par-
ticular group membership. Higher status mem-
bers may perceive unfairness directed toward
their groups, and may be particularly vulnerable
to perceived unfairness if their status is threat-
ened, especially if they believe that they are
legitimately high status (Major, Gramzow, Mc-
Coy, Levin, Schmader, & Sidanius, 2002). For
example, affirmative action debates are often
fueled by the anger and underlying fear experi-
enced by high status people, who perceive a
potential threat to their entitlements. This un-
derscores a cost of privilege: the chronic mon-
itoring of the possible loss of rank (cf. Allan &
Gilbert, 2002). However, generally individuals
of high status likely experience lower levels of
perceived unfairness, relative to their lower sta-
tus counterparts, accounting for some differ-
ences in outcomes across the groups.
Unfairness may be perceived on behalf of in-
or out-group members. Individuals may also
perceive unfairness that is not directed toward
oneself or one’s own group(s), but toward an
out-group. We hypothesize that simply because
the observer and target of the perceived unfair-
ness are of different groups does not necessarily
preclude empathy across them. Social stratifica-
tion and intergroup conflict may make this less
likely than within-group empathy, but not im-
possible, as suggested by interventions that de-
velop empathy among individuals of different
social groups (cf. Aronson, 2002). In Figure 1,
as captured by the link showing identity rele-
vance moderating the effects of perceived un-
fairness, the Perceived Unfairness Model holds
that the severity of the psychological and ensu-
ing physiological consequences of perceiving
unfairness vary as a function of how close the
sense of unfairness is to one’s self. Indeed,
relative deprivation on behalf of others (Tougas
& Veilleux, 1990) and expanding one’s sense of
self to including others and groups (Wright,
Aron, & Tropp, 2002) may be stressful for the
perceiver because each increases the chances
for perceiving unfairness. In this way, then,
targets of perceived unfairness must be in-group
members insofar as they are deemed worthy of
moral consideration. Yet the self (however de-
fined in context) can be associated with phe-
nomenologically unpleasant consequences of
perceived unfairness in more ways that simply
being the target. For example, perceiving inter-
personal unfairness has been demonstrated as an
important component of experiencing guilt
(Berndsen, van der Pligt, Doosje, & Manstead,
2004; Iyer, Leach, & Crosby, 2004). High status
individuals— even when not personally in-
volved as perpetrators—may experience guilt
when they recognize that their group benefits
from the unjust treatment of lower-status groups
(Doosje, Branscombe, Spears, & Manstead,
1998). Guilt may constitute an emotional com-
ponent of the stress response (see below).
2
Perceptions of unfairness can negatively
harm people regardless of social status or
whether they are the target or observer of the
unfairness, though social status and target sta-
tus—which together contribute to identity rele-
vance—may moderate the effect of perceived
unfairness on the individual response to the
experience.
Social Location II: Helplessness
Why do perceptions of unfairness sometimes
catalyze an individual to act to redress the un-
fairness (Wright & Tropp, 2002) and other
times lead to paralysis? A large body of work
has suggested that stressors that are seen as
uncontrollable may have a particularly strong
long-term impact (Baum, Cohen, & Hall, 1983;
Lazarus & Folkman, 1984) with particularly
toxic effects on physical health (Lachman &
Weaver, 1998). While a separate literature has
examined the direct relationship between help-
2
We thank a reviewer for suggesting mention of guilt
among those of high social status.
26 JACKSON
lessness and health (Peterson & Seligman,
1987), here we are interested in the role of
helplessness as a potential moderator of the
relationship between perceived unfairness and
health.
As shown in Figure 1, we theorize that per-
ceptions of unfairness and subsequent responses
are modified by a sense of helplessness; data
support the notion of helplessness or low sense
of control in modifying responses to life stres-
sors more generally (Zakowski, Hall, Cousino
Klein, & Baum, 2001) and discrimination spe-
cifically (Moradi & Hasan, 2004). Individuals
who have experienced adverse events over
which they had no control show deficits in cog-
nitive, emotional, and motivational functioning
(Colligan, Offord, Malinchoc, Schulman, & Se-
ligman, 1994; Tennen, Affleck, & Gershman,
1986). Such deficits may make constructive re-
sponse to perceived unfairness extremely diffi-
cult, or out of the range of one’s behavioral
repertoire. Thus, a sense of helplessness might
be expected to exacerbate or potentiate effects
of perceiving unfairness, whereas less helpless
individuals may be better able to mobilize more
constructive responses.
As the model further suggests, helplessness
and identity relevance interact to moderate of
the effects of perceived unfairness; one useful
illustration of this is in the distinction between
individual and collective efficacy. Researchers
have found that whereas targets of group-based
unfairness may feel personally helpless, they
may be more empowered to change their cir-
cumstances through collective action (Hobfoll,
Jackson, Hobfoll, Pierce, and Young, 2002).
Consistent with an important premise of the
model—that perceived unfairness, as moderated
by identity relevance and helplessness, eventu-
ally may harm physical health—greater collec-
tive efficacy has even been associated with de-
creased mortality (Skrabski, Kopp, Kawachi,
2004).
The model also posits that helplessness mod-
ifies the relationship between coping behaviors,
and subsequent outcomes.
3
A great deal of re
-
search has suggested that a sense of helpless-
ness is associated with maladaptive coping
mechanisms after stressful events are experi-
enced (Peterson, Seligman, & Vaillant, 1988).
By the same token, individuals who feel less
helpless seem to be better able to mobilize ef-
fective coping behaviors.
We are particularly interested in understand-
ing consequences of perceived unfairness when
one feels helpless to redress the unfairness, and
when relevant personal or social identities are
salient. For example, individuals of lower social
status and those who are targets of unfairness
may have fewer resources and thus have a
greater (and perhaps more realistic) sense of
helplessness to respond to unfairness. Similarly,
a person in a high status position may perceive
unfairness and empathize with a person of low
status who is the target of such unfairness. If
this high status perceiver feels helpless to re-
dress the unfairness, and if the unfairness is
perceived repeatedly over time, he or she may
experience the ensuing negative psychological
and physical consequences of the mere percep-
tion of unfairness. More likely, however, is that
a high status observer has more resources to
enable coping and address unfairness, thereby
reducing the toxic nature of the exposure.
Stress Responses to Perceived Unfairness:
Cognition, Emotion, and Motivation
Perceiving unfairness may cause cognitive,
emotional, and motivational changes that to-
gether comprise a psychological stress re-
sponse. In this section we highlight stress-
related (rather than benign) cognitive, emo-
tional, and motivational responses to perceiving
unfairness. Like other theorists considering the
effects of stressors (cf. Allison, 1998; Clark et
al., 1999; Foster, 2000; Tomaka & Blascovich,
1994), we link perceived unfairness to models
of stress and coping.
Cognitive responses. Perceiving unfairness
may have cognitive consequences, particularly
because situations come to be framed as threat-
ening rather than challenging (Tomaka & Blas-
covich, 1994; Tomaka, Blascovich, Kelsey, &
Leitten, 1993). Threat has been associated with
a variety of cognitive effects such as decreased
problem-solving abilities (Thoits, 1994), and
narrowing of attention (cf. Fredrickson, 2000).
Indeed, a large body of research on stereotype
threat (for review, see Steele, 1997) has dem-
onstrated that even the slight threat of prejudice
3
Helplessness may be the outcome of perceived unfair
-
ness. However, for the purposes of the present discussion
we focus on the case when helplessness is primarily a
pre-existing factor.
27PERCEIVED UNFAIRNESS AND HEALTH
can influence, for example, test performance
and academic identities for lower-status groups
like African Americans and women (Steele,
1998). Similarly, it has been shown that cogni-
tive interference can occur as a function of
threat to and individuals’ belief in a just world
(Hafer, 2000).
Specific beliefs may also play a stress-buff-
ering role or affect responses to the social en-
vironment. Tomaka and colleagues (Tomaka et
al., 1993) demonstrated that individuals with
greater just world beliefs had more benign cog-
nitive appraisals of stress tasks and had more
adaptive autonomic reactions to stressors con-
sistent with challenge (vs. threat) patterns. Also
using a challenge versus threat paradigm,
Mendes and colleagues (Mendes, Blascovich,
Major & Seery, 2001) demonstrated that when
paired with attitudinally dissimilar partners
(compared to attitudinally similar partners) par-
ticipants displayed greater threat responses dur-
ing upward comparisons and a tendency toward
greater challenge responses during downward
comparisons. Thus, perceiving unfairness, espe-
cially in a relatively low social status position,
may result in cognitive stress responses.
Emotional responses. Perceiving unfairness
may have emotional consequences as well,
leading to specific negative emotions and affec-
tive states, including anger (Allan & Gilbert,
2002), anxiety (Dion & Earn, 1975), depression
(cf. Lipkus, Dalbert, & Siegler, 1996), fear
(Boeckmann & Liew, 2002), feelings of depri-
vation (Crosby, 1976), hostility (Kubzansky,
Kawachi, & Sparrow, 1999), and guilt (Iyer,
Leach, & Crosby, 2004). Adding complexity to
the picture is that as a function of social norms,
emotional consequences may be intricately re-
lated to emotion regulation, influencing whether
emotions are expressed, suppressed (con-
sciously inhibiting the expression of emotion),
or repressed (failing to attend to emotions)
(Hochschild, 1983). Social psychologists (Par-
kinson & Manstead, 1992) and social epidemi-
ologists (Kubzansky & Kawachi, 2000) alike
point out the social nature of emotion, with
roles in the social hierarchy shaping and con-
straining emotional experiences. As a result, the
experience and expression of certain negative
emotions may be systematically patterned ac-
cording to social status (Kubzansky et al.,
1999). This is particularly important given that
many of these negative emotions are posited to
be at the core of a stress response (Lazarus,
1991). Negative emotions may be an important
psychological mechanism by which perceived
unfairness becomes internalized to influence
health.
Motivational responses. Perceiving unfair-
ness may change two aspects of the perceiver’s
motivation: justice-specific motivation, and
general-level motivation. Motivation is the psy-
chological force by which “behavior gets
started, is energized, is sustained, is directed, is
stopped” (Jones, 1955, as quoted in McClel-
land, 1994, p. 4). Factors such as stable indi-
vidual differences (e.g., belief in a just world,
Lipkus et al., 1996; or legitimizing ideology,
Major et al., 2002), as well as situational primes
(e.g., mortality salience, van den Bos &
Miedema, 2000) or relative group status (Major
et al., 2002), may contribute to the motivation to
believe in a just world. These factors may be
important causes of perceived unfairness in the
first place, and as such are exogenous to the
Perceived Unfairness Model. But they also may
be important factors endogenous to the model.
Specifically, perceiving unfairness means ac-
knowledging that the world may not be as fair a
place as one believes; this realization may be
deeply stressful. Indeed, threats to one’s belief
in a just world are so aversive that they have
been theorized to motivate negative behavior
toward innocent victims, in order to maintain a
belief in a just world (Hafer, 2000; Hafer &
Olson, 1993; Lipkus et al., 1996).
Perceived unfairness may also have conse-
quences in the more general motivational cate-
gories of approach and avoidance (Elliot &
Sheldon, 1998). For example, perceiving unfair-
ness may motivate individuals to approach sym-
pathetic others to make emotional connections,
and eventually lead to collective action (Foster
& Matheson, 1998), but under certain condi-
tions perceiving unfairness also may cause in-
dividuals to distance themselves from other
people because of mistrust and fear (cf. Hafer,
2000). When one perceives an unfairness di-
rected toward oneself, this may motivate a shift
in identification from self to group, as has been
demonstrated experimentally (Jetten, Brans-
combe, Schmitt, & Spears, 2001), making it
easier to acknowledge and act to redress the
unfairness (Crosby, 1984; cf. Smith & Spears,
1996). Conversely, when one perceives unfair-
ness directed to one’s group, this may motivate
28 JACKSON
a shift in identification from group to self, as
theories of relative deprivation suggest (cf.
Corning, 2000). In sum, perceiving unfairness
may cause changes in one’s motivation—to
help others, to affiliate with others, to make
changes in the social environment—that, along
with cognitive and emotional responses, com-
prise a psychological stress response and may
influence allostatic load.
Allostatic Load
Recently theorists have suggested that social
experience resulting in psychological distress
can impact physiological functioning, and over
time, lead to premature aging and illness due
to weathering (Geronimus, 2001; McEwen,
1998a). Whatever the source, chronic stress
contributes to increased physiologic wear on
the body, or what has come to be known as
“allostatic load” (McEwen, 1998b; Taylor et
al., 1997). The concept of allostatic load lends
itself well to the study of perceived unfairness
because it accounts for cumulative effects of
seemingly small, harmless activation over time.
Differences in perceptions of and reactions to
the same event can provoke a variety of endo-
crine, cardiovascular, and immune responses
(Kiecolt-Glaser et al., 2002; Tomaka et al.,
1993). Biological stress research has found that
specific physiological systems may be activated
in response to psychologically or physically de-
manding environmental conditions (Blanchard,
Sakai, McEwen, Weiss, & Blanchard, 1993;
McKittrick, Blanchard, Blanchard, McEwen, &
Sakai, 1994). However, there is a physiological
cost to adaptation: while in the short term, ad-
aptation may have huge pay offs (i.e., getting
oneself out of imminent danger), in the long
term, repeated adaptation may ironically take a
large physiological toll. Whether from chronic
stress or simply the wear and tear of daily
living, behavioral, physiological, as well as psy-
chological responses are theorized to increase
allostatic load (McEwen & Seeman, 1999).
The Perceived Unfairness Model explicates
the psychological responses—for example, cog-
nitive, emotional, and motivational changes as
mentioned in the last section—that contribute
directly to allostatic load, and that these effects
are moderated by coping behaviors. The model
further suggests that with recurrent perceived
unfairness, there is greater allostatic load. Iden-
tification of the exact frequency and/or intensity
of perceptions of unfairness that is needed to
begin to initiate disease-related pathophysiolog-
ical process is as yet undetermined.
The allostatic load literature posits several
scenarios by which physiological wear and tear
may occur (see, e.g., McEwan & Seeman,
1999). Under ideal circumstances—whereby
there is no increase in allostatic load— each
unique exposure to a stressor (in this case, a
perception of unfairness) that leads to a stress
response (vs. a benign response), leads to some
amount of physiological activation, and then a
quick return to a physiological baseline. How-
ever, there are a variety of processes that may
lead to increasing levels of allostatic load. One
is that with repeated exposure to stress, there is
repeated elevation of allostatic processes (e.g.,
stress hormones) over long periods of time.
Another is individuals may fail to habituate or
adapt to stress exposure, or relatedly, fail to turn
off response of the allostatic systems, resulting
in an (unwarranted) prolonged physiological re-
sponse. A third process may be exhaustion; over
time physiological responses become inade-
quate (McEwen, 1998a).
Determining how and when (e.g., critical pe-
riods of exposure) each of these scenarios may
be manifested has yet to be empirically tested
either with perceived unfairness as the expo-
sure, or with other stressors more generally.
Still, the general notion of an accumulated wear
and tear in the human physiological system has
growing empirical support (Seeman, Singer, &
Ryff, 2002; McEwan, 2003).
Coping Behaviors
Individuals engage in numerous behaviors to
cope with stress or to fend off anticipated stress;
the Perceived Unfairness Model posits that cop-
ing behaviors moderate the link between stress
and allostatic load. For instance, proactive cop-
ing represents “the processes by which people
anticipate or detect potential stressors and act in
advance to prevent them or mute their impact”
(Aspinwall & Taylor, 1997, p. 417). One type of
proactive coping is through psychological dis-
engagement. Faced with perceived social
stigma or unfair evaluation, individuals have
been shown to psychologically disengage their
self-worth in that domain (Major, Spencer,
Schmader, Wolfe, & Crocker, 1998), which
29PERCEIVED UNFAIRNESS AND HEALTH
may protect one’s self-esteem and also reduce
stress. Group identification may also be an im-
portant strategy, proactively or reactively, for
coping with perceived unfairness. The rejec-
tion-identification model maintains that disad-
vantaged groups reduce some of the negative
impact of perceived unfairness by identifying
with their disadvantaged group (Schmitt et al.,
2002). Other research suggests that the salience
of group identity, especially under conditions of
collective disadvantage, makes individuals less
likely to explain disadvantage in personal terms
(Smith & Spears, 1996).
Some coping behaviors used to alleviate ex-
isting stress may themselves have direct effects
on health, including cigarette smoking (Guthrie,
Young, Boyd, & Kintner, 2001), alcohol con-
sumption (Cooper, Frone, Russell, & Mudar,
1995), eating (Jackson, Cooper, Mintz, & Al-
bino, 2003), and exercise (Jackson & Nolen-
Hoeksema, 1997). Other coping behaviors such
as self-focused rumination, repressive coping,
social support, and problem solving (Jackson &
Nolen-Hoeksema, 1997) may mediate the rela-
tionship between stress and health. For exam-
ple, Matheson and Cole (2004) demonstrated
that in reaction to an explicit social identity
challenge, emotion-focused coping predicted
sustained cortisol reactions, which may be
linked to physical health (McEwen et al., 1997).
Collective action (Wright & Tropp, 2002)—
that is, engaging in behaviors on behalf of an
in-group for positive social change—may be
considered a coping behavior (Foster & Mathe-
son, 1995) that buffers the effects of stress.
Collective action may amplify one’s sense of
control and positive emotions (cf. Seeman et al.,
1995), as well encourage the creation of more
healthy environments (Stokols, 1992). Studies
that examine positive effects of coping with
unfairness (e.g., Branscombe & Ellemers, 1998;
Foster, 2000; Gaines, 2001) have yet to be done
in relation to measuring significant health
changes over time. When constructive coping
occurs, the effects of perceived unfairness may
indeed be buffered. However, it is worth noting
that there are many instances when such con-
structive coping cannot be initiated in the first
place.
The process of collective action in response
to perceiving unfairness may not be without its
costs on the individual level. Laboratory-based
experimental studies suggest that those who are
seen attributing unfairness to discrimination be-
come the targets of further discrimination (Kai-
ser & Miller, 2001, 2003). These studies dem-
onstrate that being seen as a “whistler-blower”
may come with an important social cost. Engag-
ing in collective action means that that one’s
resources—psychological, social, and physi-
cal—are diverted to react to the perceived un-
fairness, instead of being spent on activities of
intrinsic interest that would have been other-
wise freely chosen. Over time, this constructive-
though-reactive coping may lead to psycholog-
ical and even physiological wear and tear if it
depletes an individual’s coping resources. That
is, it requires an expenditure of effort to ac-
knowledge oppression, even if one is doing
something to redress it in the longer term. As
Geronimus (2001) states about one particular
group,
High-effort coping and stress can fuel the progression
of chronic disease, making early health decline a phys-
ical price paid by African American women of all
socioeconomic groups who work actively to overcome
or change ideological, economic, and social barriers to
achievement and well-being. (p. 135)
Morbidity and Mortality
Health is a fundamental good in life because
it enables most all other activities. The Per-
ceived Unfairness Model outlines a pathway by
which perceiving unfairness influences not only
stress but also physical health.
A variety of research to date has considered
links between allostatic load and major health
outcomes (McEwen, Magarinos & Reagan,
2002; Seeman, McEwen, Rowe & Singer, 2001;
Seeman, Singer, Rowe, Horwitz & McEwen,
1997). McEwen and others have begun to ex-
plore how these effects occur, and have focused
a great deal of attention on effects of alterations
in hypothalamic-pituitary-adrenal (HPA) axis
(Wood, Young, Reagan, & McEwen, 2002).
The direction of the HPA response to chronic
stress may depend on the nature of the stressor
(i.e., with respect to severity, controllability,
and predictability). Though this field of research
is still in its infancy, it is widely believed that
the HPA axis may become either hyper- or
hypoactive under certain conditions of ongoing
or chronic stress, reflecting a physiological ad-
aptation of the HPA axis that is adaptive in the
30 JACKSON
short-term but maladaptive over the long-term.
Allostatic load theory suggests that some opti-
mal level of physiological activity is needed to
maintain a functional balance (McEwen & See-
man, 1999). When this balance is disrupted, too
many or too few glucocorticoids and cat-
echolamines allow other immune processes to
overreact, increasing the risk of autoimmune,
inflammatory, and cardiovascular disorders
(Sternberg, 1997), which in turn are related to
increased risk of premature mortality. Interest-
ingly, research using animal (Abbott 2003);
Bartolomucci et al., 2001) and human (Decker,
2000) models suggests that the balance of phys-
iologic activity is also socially patterned. For
example, Abbott et al. (2003) conducted a re-
view of the literature on social rank differences
in cortisol levels primates, and found that sub-
ordinates produced relatively higher levels of
cortisol when they experienced a higher rate of
stressors than their dominant counterparts. This
lends credence to the idea that a perceived un-
fairness may be a promising way to understand
the toxicity of social environments.
Model Summary
In summary, as we have denoted in detail
throughout the paper thus far, there is at least
some evidence for each single link of the
Perceived Unfairness Model. It is not surpris-
ing that there are not yet large bodies of direct
evidence for each link because researchers
have not conceptualized and integrated a the-
oretical model of the consequences of per-
ceiving unfairness in quite this way before.
What is new is the synthesis and configuration
of each of these links as captured by the
model overall. Specifically, viewing helpless-
ness and identity relevance as joint modera-
tors of the effect of perceived unfairness on
stress responses has yet to be tested empiri-
cally; the same is true for the interaction of
helplessness and coping behaviors in moder-
ating the effects of stress (and benign) re-
sponses on allostatic load. Thus, we intend it
as a model to spur new research, taken from
this somewhat novel perspective. Indeed, the
centerpiece of this model—allostatic load—is
a relatively new concept itself with direct
tests now only beginning to accrue.
Other Issues
Development Over the Life Span
The model as shown in Figure 1 may be
understood in a life span developmental frame-
work. Perceptions of unfairness, and ensuing
health consequences, conceivably occur starting
early in life (Chen, Matthews, & Boyce, 2002;
Repetti, Taylor & Seeman, 2002). The magni-
tude of impact on health may be a function of
whether such perceptions occur at particular
developmental windows. That is, at certain
times in life individuals may be particularly
vulnerable to the deleterious consequences that
come with perceiving unfairness (Chen et al.,
2002). We also posit that the effects of per-
ceived unfairness are cumulative. Thus, the ef-
fects of perceiving even seemingly small, dis-
crete unfairness may accrue to have major ef-
fects on health over the life span. Thus allostatic
load is a useful way to capture the relationship
between perceived unfairness, stress, and phys-
ical health, because inherent in the definition of
allostatic load is a cumulative component of
“wear and tear” on the body. As suggested by
allostatic load theory, there may be a cumula-
tive cost of adaptation (Seeman et al., 2001).
This is consistent with research on daily hassles,
suggesting that microstressors can cumulatively
influence health (Lazarus, 1984). As with mi-
crostressors, one could argue that frequently
perceiving unfairness may be harmless if the
exposure is brief. But research using animal
models paradoxically suggests that brief expo-
sures to stressors result in potent stress reac-
tions, because adaptation does not occur (Maier,
2001). Thus, perceiving unfairness over the life
span—whether as a prolonged exposure result-
ing in adaptation, or briefly and repeatedly—
may be harmful to health.
Understanding Perceived Unfairness in
Context
We want to guard carefully against using this
model as a justification for victim-blaming; that
is, attributing characteristics to an individual
(e.g., neurotic, paranoid, oversensitive) that are
better explained by also understanding situa-
tional factors (Steele, 1997). One might point
out that if indeed perceiving unfairness leads to
negative health consequences, the solution to
31PERCEIVED UNFAIRNESS AND HEALTH
avert these negative effects is to persuade peo-
ple to stop perceiving unfairness. This would
require that people somehow avoid consciously
processing or recognizing the occurrence of un-
fairness. Should such a strategy be possible, it
could hardly be endorsed, particularly in light of
objective unfairness, and research suggesting
the negative health effects of suppressing neg-
ative affect (Petrie & Booth, 1998; also see
Consedine, Magai, & Bonanno, 2002). Rather
than focusing on the individual, it may be more
useful—from theoretical, empirical, and inter-
vention perspectives—to consider how the so-
cial environment influences health (Berkman,
Glass, Brissette, & Seeman, 2000; Kawachi,
2002), and to recognize the importance of the
social context in shaping health outcomes
(Chen et al., 2002; Repetti et al., 2002; Stokols,
1992). Thus, we believe that the goal is in the
short term ought to be to empower individuals
to cope effectively, and in the longer term to
engage in collective action to bring about a
fairer society.
Positive Outcomes of Perceived
Unfairness
The examples we have reviewed to illus-
trate the Perceived Unfairness Model address
negative outcomes of perceiving unfairness.
Justice research in psychology has shown that
under certain conditions, perceiving unfair-
ness may also be associated with cognitions
like challenge (cf. Tomaka et al., 1993; To-
maka & Blascovich, 1994), emotions like loy-
alty (Ellemers et al., 2002), motivations like
approach (affiliation) (Foster, 2000; Leets,
2002), and coping behaviors like collective
action (Foster, 2000; Foster & Matheson,
1998). Research is needed to understand
when and how such benign or positive out-
comes may occur, and whether and how they
influence physiological processes. Findings in
the trauma and personal growth literature sug-
gest that sometimes, undergoing a major
stressor can lead to an upward spiral of cog-
nitive, emotional, motivational consequences.
Positive experiences may be a consequence of
finding new meaning and construing benefits
from the experience (Davis, Nolen-Hoek-
sema, & Larson, 1998). Similarly, research on
optimism and stressor-related immune change
suggests that optimists may pay short-term
physiological costs in their persistence to gain
long-term rewards (Segerstrom, 2001). How-
ever, precisely when the psychological
growth to be gained outweighs increases in
allostatic load and subsequent disease pro-
cesses remains an empirical question.
Though here we focus on negative effects
of perceiving unfairness, positive outcomes
as such are not incompatible with the model.
Positive cognitions, emotions, and motiva-
tions have a critical role to play in mediating
or moderating the effects of unfairness on
stress (Folkman & Moskowitz, 2000). Recent
research on perceived racial discrimination
and resulting distress suggest that for African
Americans certain dimensions of racial iden-
tity—racial ideology and public regard be-
liefs— buffers the effects of perceived racial
discrimination (Sellers & Shelton, 2003).
Other research suggests that social change
through collective action may come about
because of perceived unfairness on behalf on
groups rather than individuals (Postmes,
Branscombe, Spears, & Young, 1999). There
is growing interest in psychology to focus on
strengths and resilience, and not only on neg-
ative psychological characteristics (Peterson
& Seligman, 2004). Similarly, one of the ba-
sic tenets of social epidemiology is to exam-
ine the factors that create healthy populations.
To date, more research in psychology has
focused on negative rather than positive out-
comes; the research to fully support the links
in this model that include a “strengths” ap-
proach remain for future study.
Future Directions for Research
We propose five directions for future research
on the Perceived Unfairness Model. Because
few studies have directly considered perceived
unfairness in relation to health, evidence for a
number of the relationships hypothesized in our
model is often sparse. Thus, much of the evi-
dence cited is indirect. We hope that the pre-
sentation of this model will encourage direct
tests of the links set forth in Figure 1, model
refinement, and more generally a consideration
of public health perspectives in psychology and
vice versa.
32 JACKSON
Perceived Unfairness Versus
Discrimination
First, researchers need to examine whether
the effects of perceived discrimination differ
from other perceived unfairness. The Perceived
Unfairness Model is framed broadly enough to
include discrimination— unfairness based on
group membership of the target—as a special
case of perceived unfairness. It is also meant to
apply to more idiosyncratic perceived unfair-
ness that is not based on power differentials
between groups, or the degree to which an in-
dividual internalizes one’s group membership
as part of the self. To date some social epide-
miology research has focused exclusively on
the health consequences of discrimination, a
subcategory of unfairness regarding unfair
treatment as a function of (usually low status)
group membership. A recent chapter by Krieger
(2000) reviews social epidemiological views on
actual (v. perceived) discrimination and health.
She identifies key social pathways through
which discrimination may influence health (p.
42). The pathways involve exposure, suscepti-
bility, and biological and social responses to
economic and social deprivation; toxic sub-
stances and hazardous conditions; socially in-
flicted trauma (mental, physical, or sexual); tar-
geted marketing of legal and illegal psychoac-
tive substances and other commodities (e.g.,
junk food); and inadequate health care. How-
ever, starting from psychological perspectives
to distinguish the nature (perceived discrimina-
tion vs. personal slight) and source (distributive
vs. procedural domains, Tyler, 1994) of per-
ceived discrimination, and understanding their
differential health effects on health, remains an
empirical question.
Identity-Specific and -General
Components
Second, as part of model refinement, re-
searchers must establish which processes and
mechanisms of the models can be generalized
across social status groups, and which are tied
to specific identity groups. Which psychological
processes resulting from perceiving racism
(Clark et al., 1999), sexism (Klonoff et al.,
2000), or homophobia (Meyer, 1995) are simi-
lar and which operate differently (cf. Miller &
Major, 2000)? For example, Sellers and col-
leagues conceptualize African American racial
identity along several dimensions, including:
racial centrality (which captures the signifi-
cance of one’s racial identity), and racial ideol-
ogy and racial regard (which capture aspects of
the meaning of racial identity) (Sellers, Smith,
Shelton, Rowley, & Chavous, 1998). In a recent
study (Sellers & Shelton, 2003), racial central-
ity predicted perceived racial discrimination,
whereas racial ideology and racial regard mod-
erated the effect of perceived racial discrimina-
tion on psychological distress. Research is war-
ranted on the conditions under which identity
centrality, ideology, and regard can be general-
ized to other social identities (e.g., gender iden-
tities), including intersecting identities (e.g.,
middle-class Black men).
Integrating Methods Across Psychology
and Epidemiology
Third, to most effectively understand the
pathways between perceived unfairness and
health, there needs to be a broadening of meth-
ods used across disciplines. For example, the
prospective epidemiological research needs to
include more psychologically detailed mea-
sures, appropriate to measuring the problem that
researchers set out to examine (Krieger, 2000).
Investigators often cite a social epidemiology
study by Krieger and Sidney (1996) as a dem-
onstration of the effects of perceived racial dis-
crimination on health (in this case, as indexed
by blood pressure). One of the major findings
was that low perceived discrimination was
linked to elevated blood pressure for certain
groups (e.g., Black working class men and
women). These findings may be more widely
generalized than findings of typical experimen-
tal research, because of the strengths of the
study design. These include (a) it was a large
(N 4,086), (b) community-based study (c) of
a sample with diversity across gender (men and
women), race/ethnicity (Blacks and Whites),
and class (professional and working class), (d)
with blood pressure obtained by physical exam-
ination using standardized protocols to ensure
consistent measurement among all participants.
Importantly, one of the key interpretations of
the findings was based on the notion that effects
were due to denial of discrimination, and denial
was associated with physiological effort that in
turn adversely affected blood pressure. How-
33PERCEIVED UNFAIRNESS AND HEALTH
ever, it was unclear whether the investigators
considered denial to be analogous to conscious
or nonconscious processes, although this dis-
tinction has critical implications for the inter-
pretation of these findings. More importantly,
the health effects of denial, emotion suppres-
sion, or repression are not currently well under-
stood. And, in fact, the notion that denial could
explain these effects was largely speculative
because psychological measures of denial of
discrimination were not included the study. This
is an instance where experimental research in
psychology may usefully inform more epidemi-
ologically based findings. In turn, these epide-
miologic findings may inform further psycho-
logically based studies of perceived discrimina-
tion and health. For example, qualitative studies
may be more informative as well as more prac-
tical than large, standardized community-based
studies to capture meanings of perceived dis-
crimination. Quasi-experimental or daily diary
research might look at the links between failure
to perceived unfairness, emotion, and physio-
logical sequelae. New methods such as life his-
tory calendars (Lin, Ensel, & Lai, 1997) and
survival analysis to study event occurrence
(Willett & Singer, 1997) may be used by psy-
chologists and public health researchers alike to
examine the occurrence and effects of perceived
unfairness across the life course.
Upstream and Downstream Factors
Affecting Health
Fourth, to support the development of a the-
ory of perceived unfairness and health, addi-
tional research is needed to establish both up-
stream and downstream mechanisms affecting
health. For example, one essential concept for
understanding macrolevel factors may be the
notion of “fundamental causes” (Link & Phelan,
1995). Social epidemiologists have argued that
macrolevel factors such as socioeconomic sta-
tus (SES) are a fundamental cause of disease in
that they affect health through many pathways.
Such factors likely shape many individual-level
experiences including perceiving unfairness, as
well as other important moderators in the
model, like group identification, helplessness,
and coping. It is also important to study down-
stream, microlevel biological processes in rela-
tion to psychosocial factors (Seeman et al.,
1995; Seeman, 2001), in order to understand the
precise mechanisms by which perceived unfair-
ness becomes internalized (Taylor et al., 1997).
If some of these biological processes are also
accurate measures of subsequent disease devel-
opment (e.g., C-reactive protein as a marker of
heart disease; Ridker, Rifai, Rose, Buring &
Cook, 2002) then they could be utilized as tools
to determine how perceived unfairness influ-
ences those mediating processes, rather than
having to wait—often for decades—for dis-
eases to develop.
Intervention Research
Fifth, the task of social scientists goes beyond
documenting problems, but also testing solu-
tions. Psychologists use intervention research to
inform both theory and practice (Wandersman
& Nation, 1998). Intervention research may
help researchers figure out effective strategies
for promoting individuals to engage in effective
coping with unfairness—such as studying the
best way to foster proactive coping (Aspinwall
& Taylor, 1997)—while clarifying stress and
coping processes. Given that one of the basic
questions in social epidemiology is “Why is this
society unhealthy?” (Kawachi, 2002), research-
ers may also help promote collective action as a
form of health-promotion (cf. Glass, 2000;
Stokols, 1992). Finally, such solutions may
form an important basis for guiding public pol-
icy (see Raphael, 2002).
Conclusion
The Perceived Unfairness Model is a unique
and potentially useful research tool in that it (a)
brings together research from subfields of psy-
chology and public health, (b) may be applied
across social groups, and (c) demonstrates em-
pirically testable links. The model frames how
perceiving unfairness may have an impact on
one of the most crucial goods in life: one’s
health. Further, it makes a new contribution by
suggesting that allostatic load is a way to ac-
count for how deleterious physical effects may
accrue from seemingly minor, but repeated, per-
ceptions of unfairness.
Intervention is the cornerstone of public
health. We believe, as do others (cf. Clark et al.,
1999; Walters & Simoni, 2002), that to effec-
tively intervene to reduce disease burden, we
must understand the specific types of stressors
34 JACKSON
that contribute to morbidity, as well as the par-
ticular psychological landscapes that produce
stress. Thus, it may be important to approach
perceived unfairness as a unique and significant
type of stressor. We acknowledge that the rela-
tionships between the constructs are no doubt
more complicated (e.g., feedback loops, re-
verse-causality; cf. Foster, 2000; Grote & Clark,
2001), but also believe this model offers a good
starting point for positing testable relationships.
Future scholarship will entail further theoretical
development and refinement of the model, as
well as empirical tests of the model and com-
parisons with alternative models.
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40 JACKSON
... The potential importance to perfectionists' vulnerability to distress and health problems is clearly illustrated by broader research and theory on perceptions of fairness and how they impact people. For instance, the perceived unfairness model proposed by Jackson, Kubzansky, and Wright (2006) is built on the notion that social environments "get under the skin" and, more specifically, perceived unfairness is a form of stress that can set the stage for health problems. According to this model, unfairness is especially toxic if it reflects themes with high identity relevance and fosters a sense of helplessness. ...
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Perfectionism is a multidimensional personality construct with various components. Socially prescribed perfectionism (i.e., perceived social pressures and expectations to be perfect) is one key element. This trait dimension represents a chronic source of pressure that elicits feelings of helplessness and hopelessness at extreme levels. Unfortunately, at present, the destructiveness of socially prescribed perfectionism has not been fully recognized or extended conceptually despite the extensive volume of research on this dimension. To address this, we first trace the history and initial conceptualization of socially prescribed perfectionism. Next, we summarize and review findings that underscore the uniqueness and impact of socially prescribed perfectionism, including an emphasis on its link with personal, relationship, and societal outcomes that reflect poor mental well-being, physical health, and interpersonal adjustment. Most notably, we propose that socially prescribed perfectionism is a complex entity in and of itself and introduce new conceptual elements of socially prescribed perfectionism designed to illuminate further the nature of this construct and its role in distress, illness, dysfunction, and impairment. It is concluded that socially prescribed perfectionism is a significant public health concern that urgently requires sustained prevention and intervention efforts.
... Established models have outlined structural, social, psychological, and biological pathways by which the minoritized experience contributes to negative health outcomes and health disparities. 1,50,54,74,80,102 Critically, these models identify multiple hierarchical sources of injustice, including impacts at the cultural, structural, and interpersonal levels, that ultimately affect individual health outcomes. 102 However, this framework conceptualizing health disparities as the result and manifestation of multilevel injustice is not well reflected in contemporary approaches and assumptions about pain disparities. ...
... Moreover, it was suggested that individuals with lower social statuswho are more susceptible to unfair treatment-have limited resources. They, therefore, feel greater helplessness, which affects their psychological responses to unfairness [37], and that may cause depression. In relation to this, perceived sense of control can also be a factor explaining the associations of PSI and SSS with anxiety and depression as suggested by the previously noted association between low sense of control and clinical depressive symptoms, along with socioeconomic background in university students from 23 countries [12]. ...
... Members of stigmatized groups routinely experience discrimination and unfair treatment (Uhlmann et al., 2010). Over time, these negative social experiences accumulate wear on both mind and body (e.g., Jackson et al., 2006;Pascoe & Smart Richman, 2009;Schmitt et al., 2014;Williams & Mohammed, 2009). We refer to the negative emotions and psychological distress caused by these hurtful social experiences as social pain. ...
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