Does social cohesion moderate health risks of discrimination? Evidence from Germany, 2024

Background

Self-rated general health (SRH) is negatively associated with the frequency of experiencing discrimination, while social support and the sense of belonging to society are considered health resources. This study analyzes whether receiving social support and a strong sense of belonging moderate the association between discrimination and SRH.

Methods

Analyses were based on data of the 2024 panel survey “Health in Germany” (n = 26,645). Using Poisson regression predicting poor SRH, interactions between discrimination and social support as well as sense of belonging were analyzed, adjusting for demographic, socioeconomic and migration-related characteristics. Predicted prevalences, prevalence ratios (PR) and their 95% confidence intervals (CI) were reported for poor SRH.

Results

Poor SRH was reported by 36.4% [95% CI 35.4-37.5] of those with, and 30.1% [28.3-31.8] of those without experiences of discrimination. Among respondents with strong social support, SRH differences were smaller between those with (25.6% [23.8-27.3]) and without experiences of discrimination (22.0% [19.8-24.3]) than among those with low social support (47.9% [46.0-49.7] vs. 31.6% [27.2-36.0]). Accordingly, the regression model showed a significant interaction between social support and discrimination. An interaction between discrimination and sense of belonging was not found; however, both main effects additively predicted SRH: PR for discrimination was 1.27 [1.17-1.38] and for sense of belonging PRs ranged between 1.31 [1.15-1.49] (partly) and 2.02 [1.65-2.46] (barely/ not at all).

Conclusions

The findings suggest that discrimination combined with low social support is associated with worse SRH. Both, receiving social support and experiencing a strong sense of belonging to the society appear to attenuate health risks of discrimination.

Key messages

• Social cohesion needs to be strengthened in times of multiple crisis.

• Discrimination must be addressed on structural and societal level.