Understanding and addressing racial disparities in health care

D R Williams, T D Rucker, D R Williams, T D Rucker

Abstract

Racial disparities in medical care should be understood within the context of racial inequities in societal institutions. Systematic discrimination is not the aberrant behavior of a few but is often supported by institutional policies and unconscious bias based on negative stereotypes. Effectively addressing disparities in the quality of care requires improved data systems, increased regulatory vigilance, and new initiatives to appropriately train medical professionals and recruit more providers from disadvantaged minority backgrounds. Identifying and implementing effective strategies to eliminate racial inequities in health status and medical care should be made a national priority.

References

    1. Allen J. A Remedy for Unthinking Discrimination. Brooklyn Law Review. 1995 Winter;61:1299–1345.
    1. Anderson MJ. The American Census: A Social History. New Haven, CT.: Yale University Press; 1988.
    1. Anderson M, Feinberg SE. Black, White, and Shades of Gray (and Brown and Yellow) Chance. 1995;8(1):15–18.
    1. Blendon R, Aiken L, Freeman H, Corey C. Access to Medical Care for Black and White Americans. Journal of the American Medical Association. 1989;261(2):278–281.
    1. Bobo L, Kluegel JR, Smith RA. Laissez Faire Racism: The Crystallization of a “Kinder, Gentler” Anti-Black Ideology. In: Tuch SA, Martin JK, editors. Racial Attitudes in the 1990s: Continuity and Change. Westport, CT.: Praeger; 1997.
    1. Bobo L, Zubrinsky CL. Attitudes on Residential Integration: Perceived Status Differences, Mere In-Group Preference, or Racial Prejudice? Social Forces. 1996;74(3):883–909.
    1. Bonilla-Silva E. Rethinking Racism: Toward a Structural Interpretation. American Sociological Review. 1996;62(3):465–480.
    1. Bunker JP, Frazier HF, Mosteller F. The Role of Medical Care in Determining Health: Creating an Inventory of Benefits. In: Amick BCI, Levine S, Tarlov AR, Walsh DC, editors. Society and Health. New York: Oxford University Press; 1995.
    1. Carlisle DM, Gardner JE, Liu H. The Entry of Underrepresented Minority Students Into U.S. Medical Schools: An Evaluation of Recent Trends. American Journal of Public Health. 1998;88(9):1314–1318.
    1. Cleeland CS, Gonin R, Baez L, et al. Pain and Treatment of Pain in Minority Patients with Cancer: The Eastern Cooperative Oncology Group Minority Outpatient Pain Study. Annals of Internal Medicine. 1997;127(9):813–816.
    1. Cole RE, Deskins DR., Jr Racial Factors in Site Location and Employment Patterns of Japanese Auto Firms in America. California Management Review. 1988;31(1):9–22.
    1. Council on Ethical and Judicial Affairs. Black-White Disparities in Health Care. Journal of the American Medical Association. 1990;263(17):2344–2346.
    1. Davis JA, Smith TW. General Social Surveys, 1972-1990. Chicago: National Opinion Research Center; 1990.
    1. Devine PG. Prejudice and Out-Group Perception. In: Tesser A, editor. Advanced Social Psychology. New York: McGraw-Hill; 1995.
    1. Devine PG. Stereotypes and Prejudice: Their Automatic and Controlled Components. Journal of Personality and Social Psychology. 1989;56:5–18.
    1. Duff R, Hollingshead A. Sickness and Society. New York: Harper and Row; 1968.
    1. Economic Report of the President. Washington, DC.: U. S. Government Printing Office; 1998.
    1. Editorial. Affirmative Action. Lancet. 1999;353(9146):1.
    1. Fix M, Struyk RJ. Clear and Convincing Evidence: Measurement of Discrimination in America. Washington, DC.: Urban Institute Press; 1993.
    1. Geiger HJ. Race and Health Care - An American Dilemma? New England Journal of Medicine. 1996;335(11):815–816.
    1. Hall JA, Roter DL, Katz NR. Meta-Analysis of Correlates of Provider Behavior in Medical Encounters. Medical Care. 1988;26(7):212–229.
    1. Hannan EL, van Ryn M, Burke J, et al. Access to Coronary Artery Bypass Surgery by Race/Ethnicity and Gender Among Patients Who Are Appropriate for Surgery. Medical Care. 1999;37(1):68–77.
    1. Harris DR, Andrews R, Elixhauser A. Racial and Gender Differences in Use of Procedures for Black and White Hospitalized Adults. Ethnicity and Disease. 1997;7(2):91–105.
    1. Harvard Law Review. The Impact of Managed Care on Doctors Who Serve Poor and Minority Patients. 1995 May;108:1625–1642.
    1. Hillman A. Financial Incentives for Physicians in HMOs. Is There a Conflict of Interest? New England Journal of Medicine. 1987;317(27):1743–1748.
    1. Hilton JL, von Hippel W. Stereotypes. Annual Review of Psychology. 1996;47(250):237–271.
    1. Horner RD, Oddone EZ, Matchar DB. Theories Explaining Racial Differences in the Utilization of Diagnostic and Therapeutic Procedures for Cerebrovascular Disease. Milbank Quarterly. 1995;73(3):443–462.
    1. Johnson SL. Unconscious Racism and the Criminal Law. Cornell Law Review. 1988 Jul;73:1016–1037.
    1. King G. Institutional Racism and the Medical/Health Complex: A Conceptual Analysis. Ethnicity and Disease. 1996;6(1,2):30–46.
    1. Kirschenman J, Neckerman KM. “We'd Love to Hire Them, But…”: the Meaning of Race for Employers. In: Jencks C, Peterson PE, editors. The Urban Underclass. Washington, DC.: The Brookings Institution; 1991. pp. 203–232.
    1. Komaromy M, Grumbach K, Drake M, et al. The Role Of Black And Hispanic Physicians In Providing Health Care For Underserved Populations. Black and Hispanic Physicians and Underserved Populations. 1996;334(20):1305–1310.
    1. Krieger N. Embodying Inequality: A Review of Concepts, Measures, and Methods for Studying Health Consequences of Discrimination. International Journal of Health Services. 1999;29(2):295–352.
    1. Krieger N, Williams DR, Moss N. Measuring Social Class in U.S. Public Health Research: Concepts, Methodologies, and Guidelines. Annual Review of Public Health. 1997;18:341–378.
    1. Lavizzo-Mourey R, Clayton LA, Byrd M, et al. The Perceptions of African-American Physicians Concerning Their Treatment By Managed Care Organizations. Journal of the National Medical Association. 1996;88(4):210–214.
    1. Lawrence CRI. The Id, the Ego, and Equal Protection: Reckoning with Unconscious Racism. Stanford Law Review. 1987 Jan;39:317–38.
    1. Leape LL. A Systems Analysis Approach to Medical Error. Journal of Evaluation in Clinical Practice. 1997;3(3):213–222.
    1. Libby DL, Zhou Z, Kindig DA. Will Minority Physician Supply Meet U. S. Needs? Health Affairs (Millwood) 1997;16(4):205–214.
    1. Massey DA, Gross AB, Shibuya K. Migration, Segregation, and the Geographic Concentration of Poverty. American Sociological Review. 1994;59(3):425–445.
    1. Massey DS. The Age of Extremes: Concentrated Affluence and Poverty in the Twenty-First Century. Demography. 1996;33(4):395–428.
    1. McBean AM, Gornick M. Differences by Race in the Rates of Procedures Performed in Hospitals for Medicare Beneficiaries. Health Care Financing Review. 1994;15(4):77–90.
    1. McClellan FM. Is Managed Care Good for What Ails You? Ruminations on Race, Age and Class. Villanova Law Review. 1999;44:227–255.
    1. McLafferty S. Neighborhood Characteristics and Hospital Closures: A Comparison of the Public, Private, and Voluntary Hospital Systems. Social Science Medicine. 1982;16(19):1667–1674.
    1. Murphy-Berman VA, Berman JJ, Campbell E. Factors Affecting Health-Care Allocation Decisions: A Case of Aversive Racism? Journal of Applied Social Psychology. 1998;28(24):2239–2253.
    1. National Center for Health Statistics. Health, United States and, Socioeconomic Status and Health Chartbook Hyattsville, MD. U.S. Department of Health and Human Services; Washington, DC.: 1998.
    1. National Committee on Vital and Health Statistics. 1. Diversity and Health Care Data Base: A Preamble for Policymakers. 1993. pp. 3–19. DHHS Publication PHS 93-1205.
    1. Neckerman KM, Kirschenman J. Hiring Strategies, Racial Bias, and Inner-City Workers. Social Problems. 1991;38(4):433–447.
    1. Nickens HW, Cohen JJ. On Affirmative Action [Policy Perspectives] Journal of the American Medical Association. 1996;275(7):572–574.
    1. Noah BA. Racial Disparities in the Delivery of Health Care. San Diego Law Review. 1998 Winter;35:135–178.
    1. Oppenheimer DB. Negligent Discrimination. Vol. 141. University of Pennsylvania Law Review; Jan, 1993. pp. 899–972.
    1. Pauly MV, Hillman AL, Kerstein J. Managing Physician Incentives in Managed Care: The Role of For-Profit Ownership. Medical Care. 1990;28(11):1013–1024.
    1. Peterson ED, Shaw LK, DeLong ER, et al. Racial Variation in the Use of Coronary-Revascularization Procedures--Are the Differences Real? Do They Matter? New England Journal of Medicine. 1997;336(7):480–486.
    1. Potosky AL, Breen N, Graubard BI, Parsons PE. The Association Between Health Care Coverage and the Use of Cancer Screening Tests. Results from the 1992 National Health Interview Survey. Medical Care. 1998;36(3):257–70.
    1. Randall VR. Impact of Managed Care Organizations on Ethnic Americans and Under Served Populations. Journal of Health Care for the Poor Underserved. 1994;5(3):224–226.
    1. Reschovsky JD, Kemper P, Tu HT, et al. Do HMOs Make a Difference?: Comparing Access, Service Use and Satisfaction Between Consumers in HMOs and Non-HMOs. Issue Brief: Findings From Health System Change. 2000 Mar;28:1–8.
    1. Robins LS, Fantone JC, Hermann J, et al. Culture, Communication, and the Informal Curriculum: Improving Cultural Awareness and Sensitivity Training in Medical School. Academic Medicine. 1998;73(10):S31–S34.
    1. Schlesinger M. Paying the Price: Medical Care, Minorities, and the Newly Competitive Health Care System. Milbank Quarterly. 1987;65(2):270–296.
    1. Schuman H, Steeh C, Bobo L, Krysan M. Racial Attitudes in America: Trends and Interpretations. Rev. Edition. Cambridge, MA.: Harvard University Press; 1997.
    1. Sharpe R. In Latest Recession, Only Blacks Suffered Net Employment Loss. Wall Street Journal. 1993 Sep 14;:A-1.
    1. Smith DB. Addressing Racial Inequities in Health Care: Civil Rights Monitoring and Report Cards. Health Politics, Policy, and Law. 1998;23(1):75–105.
    1. Stangnor C, McMillan D. Memory for Expectancy-Congruent and Expectancy-Incongruent Information: A Review of the Social and Social Development Literatures. Psychological Bulletin. 1992;111(1):42–61.
    1. Tekian A. A Thematic Review of the Literature on Under Represented Minorities and Medical Training, 1981-1995: Securing the Foundations of the Bridge to Diversity. Academic Medicine. 1997;72(10):S140–S146.
    1. Todd KH, Lee T, Hoffman JR. The Effect of Ethnicity on Physician Estimates of Pain Severity in Patients With Isolated Extremity Trauma. Journal of the American Medical Association. 1994;271(12):925–928.
    1. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia. Journal of the American Medical Association. 1993;269(12):1537–9.
    1. Trevino FM, Moyer ME, Valdez RB, Stroup-Benham CA. Health Insurance Coverage and Utilization of Health Services by Mexican Americans, Mainland Puerto Ricans, and Cuban Americans. Journal of the American Medical Association. 1991;265(2):233–237.
    1. van Ryn M, Burke J. The Effect of Patient Race and Socio-Economic Status on Physicians' Perceptions of Patients. Social Science & Medicine. 2000;50(6):813–828.
    1. Wallace SP, Enriquez-Haass V, Markides K. The Consequences of Color-Blind Health Policy for Older Racial and Ethnic Minorities. Stanford Law and Policy Review. 1998;9(2):329–346.
    1. Warner K. Cigarette Advertising and Media Coverage of Smoking and Health. New England Journal of Medicine. 1985;312(6):384–388.
    1. Weissman NW, Allison JJ, Kiefe CI, et al. Achievable Benchmarks of Care: the ABC's of Benchmarking. Journal of Evaluation in Clinical Practice. 1999;5(3):269–281.
    1. Wenneker MB, Epstein AM. Racial Inequalities in the Use of Procedures for Patients with Ischemic Heart Disease in Massachusetts. Journal of the American Medical Association. 1989;261:253–257.
    1. Whiteis DG. Hospital and Community Characteristics in Closures of Urban Hospitals, 1980-87. Public Health Reports. 1992;107(4):409–416.
    1. Whittle J, Conigliaro J, Good CB, Lofgren RP. Racial Differences in the Use of Invasive Cardiovasular Procedures in the Department of Veterans Affairs. New England Journal of Medicine. 1993;329(9):621–626.
    1. Williams DR. Race and Health: Basic Questions, Emerging Directions. Annals of Epidemiology. 1997;7(5):322–333.
    1. Williams DR. Race/Ethnicity and Socioeconomic Status: Measurement and Methodological Issues. International Journal of Health Services. 1996;26(3):483–505.
    1. Williams DR. Race, SES, and Health: The Added Effects of Racism and Discrimination. Vol. 896. Annals of New York Academy of Sciences; 1999. pp. 173–188.
    1. Williams DR, Jackson JS, Brown TN, et al. Traditional and Contemporary Prejudice and Urban Whites' Support for Affirmative Action and Government Help. Social Problems. 1999;46(4):503–527.
    1. Zweifler J, Gonzalez AM. Teaching Residents to Care for Culturally Diverse Populations. Academic Medicine. 1998;73(10):1056–1061.

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