Addressing Racial Inequality
in Health Care
SARA ROSENBAUM AND JOEL TEITELBAUM
Focusing on the role of race in health policy is not easy. Any such analysis raises a host of complex issues that lie at the policy intersection of health care and civil rights. More fundamentally perhaps, such an exploration cannot proceed without confronting two matters that many might prefer to avoid. The first is the historical dominance of racially biased attitudes, beliefs, and customs in medicine no less than in other areas of life, such as education, employment, housing, transportation, public accommodations, and even marriage and family formation. The second, which follows on from the first, is the need for the medical system itself to be an equal player in a broad national undertaking, which includes active policy interventions when necessary, to find ways to erase discrimination's vestiges.
Some may believe that race is too profound a societal issue to lend itself to a public policy response. Research on health and health care unfortunately tends to bolster this perception by failing to push beyond statistical analysis of racial disparities to explore their underlying causes.1 Even more troubling are the disparity studies that conclude by speculating on the possible roles of patient attitudes and preferences without giving equal weight to the possible roles of systemic factors. There are far too few studies, such as that conducted by Schulman and colleagues (1999), which attempt to probe the role in health disparities that may be played by physician perception and clinical judgment. Furthermore, it is not uncommon to find that such evidence is either met with denial or whitewashed when it is presented (Geiger 2004).
In their watershed chronicle of race and health care, An American Health Dilemma, W. Michael Byrd and Linda A. Clayton present an almost overwhelming picture of a problem that lies at the juncture of culture and policy (2002). In the authors' view, the attitudes, preferences, and beliefs that must change are not those of individual patients but those of the health care system itself. This study depicts a threefold dilemma: a social expectation that minority Americans will experience substandard health status; a highly privatized health system that accords broad discretion to entrepreneurs and marginalizes poor and minority members;