Back | Project: Racism and Public Policy
Abstract of Paper by Varnellia Randall
- Project from: 2000 to 2001
Race, Health Care and the Law: Regulating Racial Discrimination in Health Care
Equal access to quality health care is a crucial issue facing racial minorities. The need to focus specific attention on the racism inherent in the institutions and structures of health care is overwhelming. Minorities are sicker and dying at significantly higher rates than the majority populations of their countries. Furthermore, people in developing countries are sicker than people in developed countries, and these disparities track racial lines. There are many examples of disparities in health status between ethno-racial groups. For instance, infant mortality rates are two and a half times higher for blacks, and one and a half times higher for American Indians than for white Americans; the death rate for heart disease for blacks is higher than for whites; individuals from racial and ethnic minority groups account for more than 50 per cent of all AIDS cases, although they only account for 25 per cent of the population of the United States; the prevalence of diabetes is 70 per cent higher among blacks and twice as high among Hispanics as among whites; Asian Americans and Pacific Islanders have the highest rate of tuberculosis of any ethno-racial group; cervical cancer is nearly five times more likely among Vietnamese American women than white women.
The current health disparity issues are not isolated health system problems. In fact, health disparity is the cumulative result of both past and current forms of public policies. For instance, because of institutional racism, in general racial minorities have less education and fewer educational opportunities; minorities are disproportionately homeless and have significantly poorer housing options; and minorities disproportionately work in low-pay and high-health-risk occupations.
Despite significant health care status disparities, individuals are denied equal access to quality health care on the basis of race, ethnicity and gender. This denial of health care does not occur only as overt racism, but also as a result of institutional racism. Institutional racism grows because of the disparate impacts of practices and public policies, inadequate laws and regulations, ineffective enforcement of existing laws and regulations, cultural incompetence of health care providers and institutions, and socioeconomic inequities that are disproportionately distributed along racial lines.
Within a country, racial barriers to quality health care may manifest themselves in a number of ways: lack of economic access to health care; racial barriers of entry to hospitals and health care institutions; racial prejudice of physicians and other health care providers; racial disparities in medical treatment; racially discriminatory policies and practices; lack of language and cultural sensitivity; disparate impact of the intersection of race and gender; lack of data and standardized collection methods; inadequate inclusion of disadsvantaged groups in health care research; and the racialized conduct of scientists, professionals and other public figures on matters relating to scientific experiments, clinical trials, industrial products and safety standards.
Racial prejudice and hidden biases may influence the choices of scientists and industrialists in selecting sites, individuals or groups for experiments and clinical trials. There are a number of cases in which scientists have abused their professional codes of conduct and caused harm to populations that look different from the scientists.
Inequality and discrimination will persist as long as national and international laws are inadequate for addressing issues of institutional racism generally, and health care specifically. Laws and regulations must address issues of racial discrimination that result from individuals acting on biases and stereotypes, and from institutions that implement policies and practices that have a significant disparate impact.
Effective regulation of racial discrimination in health care will require that governments take a proactive role in uncovering where institutional racism exists. Among the actions that need to be considered include the routine and systematic collection of health status and health care data based on race, gender and socioeconomic status. Such data should not be limited to census and vital statistics, but should include data on access and quality (particularly service delivery, diagnosis and treatment, facility availability, provider availability and other related health activities and services). Further, there needs to be a recognition that traditional mechanisms of protecting individuals, such as ‘informed consent’, are inadequate in the face of the racialized conduct of scientists, professionals and other public figures on matters relating to scientific experiments, clinical trials and safety standards.
It has been argued that racial inequality in health care might persist because laws are inadequate for addressing issues of institutional racial discrimination, or because legislation often goes unenforced. Current inequities might spring from past prejudice and long-standing economic differences that are not entirely reachable by law; or laws might fail to reflect, and thus to correct, the barriers faced by people of colour. But without systematic evaluation and monitoring, who would know?