Vernellia R. Randall

Overview

Equal access to quality health care is a crucial issue facing the United States. For too long, too many Americans have been denied equal access to quality health care on the basis of race, ethnicity, and gender. Cultural incompetence of health care providers, socioeconomic inequities, disparate impact of facially neutral practices and policies, misunderstanding of civil rights laws, and intentional discrimination contribute to disparities in health status, access to health care services, participation in health research, and receipt of health care financing.

The need to focus specific attention on the racism inherent in the institutions and structures of health care is overwhelming. Minorities are sicker than White Americans; they are dying at a significantly higher rate. These are undisputed facts. There are many examples of disparities in health status between racial/ethnic groups and between men and women: infant mortality rates are 2� times higher for blacks, and 1� times higher for American Indians, than for Whites; 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 percent of all AIDS cases although they only account for 25 percent of the U.S. population; the prevalence of diabetes is 70 percent 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 racial/ethnic group; cervical cancer is nearly five times more likely among Vietnamese American women than White women; women are less likely than men to receive life-saving drugs for heart attacks; more women than men require bypass surgery or suffer a heart attack after angioplasty.

Yet, despite these significant health care status disparities, many Americans have been denied equal access to quality health care on the basis of race, ethnicity, and gender. Cultural incompetence of health care providers, socioeconomic inequities, disparate impact of facially neutral practices and policies, misunderstanding of civil rights laws, and intentional discrimination contribute to disparities in health status, access to health care services, participation in health research, and receipt of health care financing.

Drs. Micahel Byrd and Linda Clayton lay out clear the long history of racism and medicine in their seminal work: An American Dilemma: A Medical History of African Americans and the Problem of Race, Beginnings to 1900". In their work, Drs. Byrd and Clayton clear show that the problem of minority health status and minority health care access is a part of a long continuum of racism and racial discrimination dating back almost 400 year. Since colonial times, the racial dilemma that affected America also distorted medical relationships and institutions. There are has been active assignment of racial minorities to underfunded, overcrowded, inferior, public health-care sector. Furthermore, medical leadership has helped to establish the slaveocracy, create the racial inferiority myths, build a segregated health subsystem, and maintain racial bias in the diagnosis and treatment of patients. Only after 350 years of active discrimination and neglect, were efforts made to admit minorities into the "mainstream" health system. However, these efforts were flawed and since 1975 minority health status has steadily eroded and continue to experience racial discrimination in access to health care and quality of health care received.

Yet, the current health disparity issues are not isolated health system problems. In fact, the current health disparity is the cumulative result of both past and current racism throughout the American culture. For instance, because of institutional racism, 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, high health risk occupations (i.e., migrant farm workers, fast food workers, garment industry workers).

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Vernellia R. Randall
Professor Emerita of Law

The University of Dayton
School of Law
Dayton, OH 45469-2772
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