V. CONCLUSION
Health care institutions have a social responsibility to identify and delineate all causes of disease and disability in a population and then to mobilize the medical resources necessary to attack those causes. Since it has been shown that the health of African-Americans is markedly lower than European-American, it necessarily follows that “this situation would have to be called, in part, a racist consequence of the actions and structure of those health institutions”.
Getting rid of the effects of institutional racism is a task for which European-American institutions must accept the responsibility, along with the burden of identifying effecting solutions. Doing nothing is an unacceptable option. It would allow the continuation of economic and social apartheid based on race. Reform efforts which call for expanded insurance coverage are inadequate not only because it is possible that only a small minority of African-Americans will continue to be uncovered; more importantly, it does nothing to relieve racial barriers to access based on the availability of culturally relevant services in the community or medical treatment disparities. While special health services could be targeted to African-Americans, fiscally and politically this alternative is very unlikely. Furthermore, it still fails to deal with the inadequacy of the system in dealing with racism. Finally, litigators could use Title VI to eliminate racist practices in health care delivery and health care education. This would do little to assure economic access. But more importantly, the courts have adopted a position which makes the use of Title VI politically difficult. However, as the courts' composition changes over the next several years this option may become more viable.
No single approach will adequately address the multi-faceted problem of improving the health care status of African-Americans. It is also clear that the health care system is undergoing enormous changes designed to make it more just. If that reform is to include better health care for African-Americans it will need to do more than assure economic access through expanding insurance. It will need increased availability of providers through Title VI and decreased treatment disparity through Title VI. Strengthening Title VI such that it becomes politically feasible to use through both the administrative and civil process should be the quid pro quo for accepting cost containment restrictions. No system can be just so long as vestiges of racism remain. Strengthening Title VI is the only mechanism available to assure that health care in America is no longer racist.
[Racism remains a] prime cause of the unequal and racially discriminatory provision of funds for health services; of the over-crowding of the ill-equipped black hospitals and the underutilization of white hospitals; of miserable housing, gross pollution, poor sanitation, and lack of health care . . . .
[Racism] in consequence, is the underlying structure causing the dreadful burden of excess morbidity and mortality, much of it preventable, that is borne by the black population. These health-specific effects are superimposed on the more general consequences of [racism] which bars the majority of [ [ [African-american] citizens from participating in decisions on the allocation of resources for health or other needs. We believe that the . . . [American] health care system is, in consequence, fundamentally flawed. Fragmentation and duplication of services . . . . is costly and inefficient. . . . For the majority of the black population, the whole spectrum of health services (but most urgently, primary care) is inadequate. Entire generations suffer through much of their life-times. . . . Even if. . . [racism] ended tomorrow, their effects on health would persist for years, in part because of the health consequences of the profound poverty . . . that [racism] itself has engendered and in part because widespread attitudes that encourage racism, elitism, sexism, a colonialist mentality, and prejudice against the poor take time and commitment to change. . . Clearly, . . . [America] has the ability to reduce markedly, if not eliminate, the serious health problems that exist among the black population. It can, if it chooses, eliminate the institutionalized system of racism and discrimination that have made the country, for decades, a symbol of human rights violations. The task facing. . . [us] is to continue to extend the process that [civil rights reforms] have begun, until profound and lasting improvements in health care . . . are a reality.
Assistant Professor of Law, University of Dayton, School of Law, B. S.N. 1971 University of Texas, M.S.N. 1978 University of Washington, J.D. 1987 Lewis and Clark College Northwestern School of Law.
Nothing is ever done in isolation. The success of this project is due in large measure to the unwavering support of many individuals. I am thankful to Maxwell J. Mehlman, Director, Law-Medicine Center, Case Western Reserve University School of Law, and Dean Francis Conte, University of Dayton for financial support needed to complete this project. I am grateful to my colleagues Professors Vincene Verdun, Patrica Rousseau, Sean Murray and Teri Geiger for their thoughtful comments on a draft manuscript. I especially want to acknowledge the prompt and untiring research, comments, and help of research assistants Joy Walker and Lisa Feelings. I must acknowledge my sons, Tshaka Civunje and Issa Lateef, whose support and confidence kept me going. Finally, I must recognize the editorial assistance of Elizabeth S. Gioiosa and the editorial staff of Health Matrix, Journal of Law-Medicine.
