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Racism & Health: New Evidence
Posted by: | CommentsRacism is bad for your health, new evidence suggests. We’ve written before about the link between racism and health. Traditionally, scholars have conceptualized this in only one direction; that is, racism is bad for people of color. African Americans, Latinos, Asian Americans who are the targets of racism are worse off than whites in terms of their health on a wide range of measures. Some of this is about health disparities rooted in income inequality, but there’s a growing body of research that points to racism as a root cause for at least part of these differences. Now, some new research suggests that racism may also be harmful for white people.
Elizabeth Page-Gould discusses some of this in a recent piece at Alternet:
In one study, Wendy Berry Mendes, Jim Blascovich, and their colleagues invited European-American men into the laboratory to engage in social interactions with African-American men or with men of the same race as themselves. The participants were hooked up to equipment that measured the responses of their autonomic nervous system while they played the game Boggle with their white or black partners. When interacting with African-American partners, the white men tended to respond as to a physiological threat, marked by diminished blood pumped through the heart and constriction of the circulatory system. However, European Americans who had positive experiences with African Americans in the past responded as though the game posed a challenge—increased blood pumped by the heart and dilation of the circulatory system.
This doesn’t seem to be an isolated finding. Page-Gould conducted similar research and found that those who scored high on a measure of prejudice had increases in cortisol during the friendly interaction with a cross-race partner, but produced less cortisol when interacting with a same-race partner. Those who were low in prejudice were not stressed during either cross-race or same-race interactions. In other words, prejudiced individuals perceived partners of a different race as a physical threat, even though they were in a safe laboratory setting and engaging in a task that was structured to build closeness between the participant pairs.
While this research focuses on individual level prejudice, other research points to the harmful effects of structural, institutional racism for whites’ health.
The good folks at Sociological Images caught some new research by Philip Cohen of Family Inequality which demonstrates one of the many hidden costs of racism. In Cohen’s recent paper published in the Journal of the American Society of Nephrology, he illustrates that in any given neighborhood in addition to the traditional way we’ve understood racism and health – that black people are always less likely to get access to a kidney specialist before their kidneys fail – there’s also another trend that’s bad news for white folks. White people living in a neighborhood with a higher percentage of blacks are less likely than whites in a predominantly white neighborhood to see a specialist. In other words, whites also suffer from the institutional racism that structures residential segregation.
(Image from SocImages)
I think it’s important to point out the ways that racism also costs whites as a strategy for dismantling this American version of apartheid that continues here. Both of the pieces that report on this research frame the research in terms that are meant to appeal to whites’ self-interest. Page-Gould (Alternet) writes:
“In the urban metropolises of the United States and Canada, it is almost impossible to avoid talking to someone of another race. So imagine the toll it would take if every time you did, your body responded with an acute stress reaction: You experience a surge in stress hormones, and your heart pumps harder while your blood vessels constrict, inhibiting the flow of blood to your limbs and brain.These types of bodily reactions are helpful in truly dangerous situations, but a number of recent studies have found that racially prejudiced people experience them even during benign social interactions with people of different races. This means that just navigating the supermarket, coffee shop, or modern workplace can be stressful for them. And if the racist person then has to go through this every single day, the repeated stress can become a chronic problem, which places them at heightened risk for disease in later life. Harboring prejudice, it seems, may be bad for your health.”
The intended audience member here seems to be the prejudiced white reader who, unable to avoid encounters with people of color, should learn to react differently or risk harming their health. As powerful as the imperative to health is (especially among whites), I doubt this is going to shift anyone’s approach to cross-racial interactions. As an urban dweller in the U.S. in a reasonably diverse city, I can attest to the ways that people remain racial segregated and can quite easily never interact with someone of another race.
The persistence of racial segregation in housing is also part of the problem I have with the analysis of whites’ self-interest in the kidney failure study. It seems just as likely – maybe more – that whites would read that research by Cohen and conclude, “ah, note to self: do not live in predominantly black neighborhood.” Lisa, writing at SocImages, is more pointed in her framing of the research:
White people should worry about racism. They should worry about racism because it’s wrong. But if that’s not enough of a motivation, they should worry about it for their own damn good.
Yeah, they should. We should. I’m just skeptical that self-interest will triumph where an entire civil rights movement based on moral reasoning has failed.
No Post-Racial America: Racial Inequalities in US Medicine
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Over at diversityinc.com, Gail Zoppo has an important post—“Is There a Black, Latino Doctor in the House?”– on the huge problem of lack of people of color in U.S. medical schools and professions. Racial inequality remains central in the medical professions and facilities in this “post-racial America.” We still have relatively few black, Latino, and Native American medical students across the country. Zoppo underscores the slow pace of improvement, noting that three years these groups made up only 15 percent of the 40,000 applicants to U.S. medical schools, even as they make up a third of the U.S. population in their typical age range. (She does not discuss data on Asian Americans in her post.) This is a key result from this longterm reality:
That same year, only 8.7 percent of doctors were from these underrepresented groups, according to a study published in the Journal of Academic Medicine.
She then discusses where we are at in the recent American Association of Medical Colleges data, just slight changes since 2006:
Among the 42,269 med-school applicants in 2009, only 16 percent were Black, Latino or American Indian.
Other medical professions are also characterized by a lack of black, Latino, and Native American personnel:
… a mere 6.9 percent of people from underrepresented groups ended up as dentists in 2007, only 9.9 percent were pharmacists and just 6.2 percent were registered nurses.
One national issue is also that white medical personnel are much less likely to work in undeserved communities of color:
Black, Latino and American Indian/Pacific Islander physicians are nearly three to four times more likely than whites to practice in underserved communities, reports the AAMC.
On the positive side, Zoppo does discuss some important attempts to deal with this underrepresentation in medical schools and professions, such as the Rutgers University Office for Diversity and Academic Success in the Sciences (ODASIS)
How Diverse is the Dominant US Culture?
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Often when I am talking about how the dominant culture in the U.S. is white-centered, shaped, and maintained, someone usually pipes up with a comment about the “diverse” array of foods that are now central to our “highly diverse” general culture.
They like to cite Chinese food, Japanese food, Middle Eastern food, Asian-Indian food, Mexican food, and so on, to try to make the point that whites of European origin no longer dominate U.S. culture, and thus that the U.S. is a truly “diverse” culture. There is certainly some truth to this reality of diverse foods and some other cultural features, such as music, but the typical comments miss very important points.
One of these is how adulterated much of this “diverse food” really is. I have been reading former FDA Commisioner (and MD) David Kessler’s relatively new book, The End of Overeating, and at one point he makes this very important point:
Bottled teriyaki sauce … combines soy sauce and rice wine to mimic Japanese flavorings, putting an American spin on a classic Japanese cooking technique. The amount of added sugar makes it far sweeter than anything found in Japan. We’ve also invented new approaches to sushi classics—for example, mayonnaise-topped tempura shrimp now comes wrapped in rice as a sushi roll. . . . The dish we call ‘General Tso’s chicken’ is loaded with sugar, much to the consternation of the Taiwanese chef who created it. . . . Traditional Chinese cuisine also makes use of a lot more vegetables than are included in our versions.
Many other international foods are similarly adulterated with high fat, high sugar and/or high salt.. Kessler discusses throughout his book how U.S. food corporations have aggressively added sugar, fat, and salt to—and otherwise significantly altered–many food items from across the world. So, Chinese food is not really Chinese food, and Mexican food is not exactly Mexican food. And so on.
Working for top corporate executives in the food industry, who are aggressively seeking so much added profit that people are often harmed, thousands of U.S. workers are constantly redesigning the world’s foods to fit what Kessler calls “American desires.” Once again, as we often ask here, just who are the Americans who have disproportionate power to redesign the world’s foods — and then to successfully manipulate via advertising, the media and other avenues U.S. (and then overseas) consumers to eat them (and, increasingly, become obese)?
I have not seen any demographic data on these top food industry executives lately, but I’ll bet they are mostly white, male, and upper middle class and middle class. And the Us food culture is not as international and diverse as it is often made out to be.
The “Racism” in the Health Care Bill: Tanning Beds
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Think Progress posted this piece today:
The recently passed health care reform act includes a 10 percent tax on indoor tanning salons to help pay for expanded insurance coverage for millions of Americans. Radio host Doc Thompson, subbing in for Fox News host Glenn Beck on his radio show today, used the tax to make the absurd accusation that the health bill is somehow “racist”:
“For years I’ve suggested that racism was in decline and yeah, there are some, you know, incidents that still happen with regards to racism, but most of the claims I’ve said for years, well, they’re not really real. But I realize now that I was wrong. For I now too feel the pain of racism. Racism has been dropped at my front door and the front door of all lighter-skinned Americans. The health care bill the president just singed into law includes a 10 percent tax on all indoor tanning sessions starting July 1st, and I say, who uses tanning? Is it dark-skinned people? I don’t think so. I would guess that most tanning sessions are from light-skinned Americans. Why would the President of the United Stats of America — a man who says he understands racism, a man who has been confronted with racism — why would he sign such a racist law? Why would he agree to do that? Well now I feel the pain of racism.”
This sounds like a parody, but this fellow Thompson is quite serious about Obama doing racist stuff to whites. He of course ignores an important reason for such a modest provision in the legislation–to reduce some skin cancers.
If he were not serious, we could all laugh ourselves silly about such an commentary on a major radio show. Can the far-reaching imaginations of playwrights of the absurd even begin to match such societal reality today?
Counting Multiracial People in the Census: The Unfulfilled Wish for More Data
Posted by: | CommentsPeople who study the multiracial population are constantly confronted with the problem of small numbers to work with. A recent article I co-authored on the multiracial health (Bratter, Jenifer and Bridget K. Gorman. Forthcoming. “Does Multiracial Matter? A Study of Racial Disparities in Self Rated Health. Demography) required combining seven years of data from a health survey (over 1.7 million cases) to get 20,000 mixed-race folks for analysis. The 2000 Census, with its “check all that apply” race question, remains the database with the largest number of cases and the 2010 Census will be the first to count race the same way as the preceding installment. While this may sound like a mundane detail, this will allow us to gauge growth, decline, or stability of this population and whether this will affect the population bases of single-race communities. If the sheer anticipation doesn’t shake you to your core, perhaps you have forgotten the history of introducing this option into the Census.
Back in the 1990’s, deciding how to count the multiracial population was a hot political controversy, pitting two sides of a debate on race and identity against each other. According to Williams (Williams, Kimberley M. 2006. Mark one or More: Civil Rights in Multiracial America. Boston: Harvard University Press), multiracial organizations argued that the previous approach forced mixed-race children to choose one race and one side of themselves. Civil rights groups argued that this would weaken the population bases and the political power of monoracial groups, unnecessarily complicate the tracking of enforcement of civil rights legislation (which uses Census counts), and, unofficially provide an option for individuals who wished to abandon their race. Introducing “check all that apply”, not a single multiracial box, seemed like the perfect resolution. Multiracial people could be enumerated and be linked back to their component groups for tracking dynamics of monoracial communities.
Despite these hopes and fears, things remained pretty much the same. Although about 6.7 million persons (no small demographic potatoes) choose two or more races, it made the biggest difference for groups that had faced issues of mixed-heritage and identity for centuries – American Indians and Native Hawaiians. Meanwhile, there was little movement in the population base of the largest groups: Whites, Blacks, and to a lesser extent Asians. Also, approximately half of this group was under 18, which may mean that parents of multiracial children were declaring this as a race (Jones, Nicholas and Amy S. Smith. 2001. “Two or more Races Population : 2000.” [pdf] United States Census Bureau). As Reynolds Farley, declared in 2004, this was a “social movement that succeeded, but failed” to dramatically change our way of thinking about race (Farley, Reynolds. 2004. “Identifying with Multiple Races: A Social Movement that Succeeded but Failed?” Pp 123-128 in The Changing Terrain of Race and Ethnicity edited by Maria Krysan and Amanda Lewis. New York: Russell Sage Foundation). Maybe it’s just about timing, as many tell me. Including multiracial in any form is a recent development, the public has simply not gotten used to checking that box (or boxes). But alas, Farley’s estimates of inter-censual growth using the American Community Survey show a decline in the percentage of people selecting more than one race, from 2.4 to 1.9 percent (Farley, Reynolds. 2006. “The Multiple Race Population: Is it increasing or decreasing?” paper presented at the Annual Meeting of the American Sociological Association. Montreal, Canada).
This raises a bigger question – why haven’t things changed more? Aren’t we living in as multiracial society as we ever have? On one hand, multiculturalism seems to be everywhere, from mixed-race celebrities and high profile interracial couples, to growing racial/ethnic diversity. And ofcourse, there’s the rise of the nation’s first openly mixed-race U.S. President. But even Obama’s multiracial flag isn’t flown that high. He is universally touted as our first “Black” president, a racial identity he solidly embraces. And he’s not alone. Several studies using 2000 data show that selecting single races for biracial children is not uncommon. Since the U.S. Census ceased using enumerators, choosing a racial category goes far beyond simple ancestral accounting, which would place most everyone in the multiracial camp if they had the option. It reflects a sense of who we are and most importantly how we are treated.
Quantifying “treatment” is never an easy task, but any cursory look at social trends tells us that lives are lived very differently by race. The level of school segregation by race is nearly as high as it was in the 1960’s (Sikkink, David, and Michael O. Emerson. 2008. “School Choice and Racial Residential Segregation: The Role of Parent’s Education.” Ethnic and Racial Studies, 31:267-293), neighborhoods continue to be segregated by race (Wilkes, Irma and John Iceland, 2004.”Hypersegregatation in the 21st Century” Demography 41 (1): 23- 36), and while interracial marriage is increasing, its far lower than one would expect if race were not a factor (Qian, Zhenchao and Daniel Lichter. 2007. “Social Boundaries and Marital Assimilation: Interpreting Trends in Racial and Ethnic Intermarriage.” American Sociological Review 72:68-94). White per capita income continues to exceed Black per capita income by more than 12,000 dollars and Blacks can expect to die on average 5 years sooner than their White counterparts (Heron MP, Hoyert DL, Murphy SL, Xu JQ, Kochanek KD, Tejada-Vera B. Deaths: Final data for 2006. National vital statistics reports; vol 57 no 14.[pdf] Hyattsville, MD: National Center for Health Statistics. 2009). Despite declines in reporting overtly racist attitudes, minorities continue to report confronting racial prejudice and growing number of studies report that having these experiences is significantly detrimental to their health (U.S. Census Bureau, 2008. “Table 688. Per Capita Money Income in Current and Constant (2007) Dollars by Race and Hispanic Origin” in Income, Poverty, and Health Insurance Coverage in the United States: 2007, Current Population Reports, P60-235. Author tabulation of difference between the per capita income (in 2007 dollars) for Blacks (alone or in combination), which was $18,107, and non-Hispanic Whites (alone), which was $31,051).
How can one sustain an identity “in-between” races when so much of our lives are patterned by racial divisions? From this vantage point, the paltry percentages and small sample sizes are yet one more testimony that we believe we are a multicultural society and but really aren’t. However, what gets overshadowed is that race does not cease to matter just because one selects more than one. Living “in-between” races does not qualify one for a pass on discrimination. Population projections forecasting a coming white minority do not include as “white” those who select white alongside other races. And why should they, when the official policy of the Office of Management and Budget is to include those of partial minority and majority races among the minority group for civil rights purposes (Williams, David R., Harold Neighbors, and Jackson 2003. “Race/Ethnic Discrimination and Health: Findings from Community Studies.” American Journal of Public Health 93: 200-208). Other indicators follow suit. According to our recent findings on multiracial health, those selecting more than one race do not have substantially better health that their component populations, and, in the case of White-American Indians, they report their health as significantly worse than their White counterparts (Goldstein, Joshua and Ann J. Morning. 2002. “Back in the Box:The Dilemma of Using Multiple-Race Data for Single-Race Laws.” Pp. 119-136 in The New Census Race Question: How the Census Counts Multiracial Individuals, edited by J. Perlmann and M. C. Waters. New York: Russell Sage). While some read these trends as examples of the unique challenges faced by the mixed-race population, this is simply a shade of the same old story: race still matters – no matter how many you choose.
So here’s my plea, if you believe you are mixed-race at all, mark those races. You’re not abandoning your tribe, nor are you escaping race. You are just recording all your complexity, and making some researchers very happy.
~ Jenifer L. Bratter is Assistant Professor, Department of Sociology, Rice University and Program Director for Race Scholars at Rice Institute of Urban Research (IUR).
Racism and Health: Henrietta Lacks Revisited
Posted by: | CommentsThe life of Henrietta Lacks is the subject of a new book, The Immortal Life of Henrietta Lacks by Rebecca Skloot. Ms. Lacks is a notable historical figure for her unwitting “donation” of her cells to scientific study. David Strohecker wrote about Ms. Lacks’ here back in October, around the 50th anniversary of her death from cervical cancer. Dwight Garner gives Skloot’s new book a rave review in The New York Times (hat tip: Jessica in Austin), and here’s a longish clip from that review:
“The woman who provides this book its title, Henrietta Lacks, was a poor and largely illiterate Virginia tobacco farmer, the great-great-granddaughter of slaves. Born in 1920, she died from an aggressive cervical cancer at 31, leaving behind five children. No obituaries of Mrs. Lacks appeared in newspapers. She was buried in an unmarked grave.
To scientists, however, Henrietta Lacks almost immediately became known simply as HeLa (pronounced hee-lah), from the first two letters of her first and last names. Cells from Mrs. Lacks’s cancerous cervix, taken without her knowledge, were the first to grow in culture, becoming “immortal” and changing the face of modern medicine. There are, Ms. Skloot writes, ‘trillions more of her cells growing in laboratories now than there ever were in her body.’ Laid end to end, the world’s HeLa cells would today wrap around the earth three times.
Because HeLa cells reproduced with what the author calls a ‘mythological intensity,’ they could be used in test after test. ‘They helped with some of the most important advances in medicine: the polio vaccine, chemotherapy, cloning, gene mapping, in vitro fertilization,’ Ms. Skloot writes. HeLa cells were used to learn how nuclear bombs affect humans, and to study herpes, leukemia, Parkinson’s disease and AIDS. They were sent up in the first space missions, to see what becomes of human cells in zero gravity.
Bought and sold and shipped around the world for decades, HeLa cells are famous to science students everywhere. But little has been known, until now, about the unwitting donor of these cells. Mrs. Lacks’s own family did not know that her cells had become famous (and that people had grown wealthy from marketing them) until more than two decades after her death, after scientists had begun to take blood from her surviving family members, without their informed consent, in order to better study HeLa.
Ms. Skloot tells the story of Mrs. Lacks’s life, from those tobacco fields in small-town Clover, Va., to the ‘colored’ ward of Johns Hopkins Hospital in Baltimore in the 1950s, where she was treated for her cancer, and where her cells were harvested. She follows the members of Mrs. Lacks’s family to East Baltimore, where many of them live today, still struggling with her complicated legacy. As one of Mrs. Lacks’s sons says: ‘She’s the most important person in the world, and her family living in poverty. If our mother so important to science, why can’t we get health insurance?‘
…
Ms. Skloot writes with particular sensitivity and grace about the history of race and medicine in America. Black oral history, she points out, is full of stories about ‘night doctors,’ men who could pluck black patients off the streets to experiment on their bodies. There was some truth behind those tales.”
While I’m glad that Ms. Lacks’ story is getting the attention it deserves in this new book, it would be mistake to regard this compelling narrative as an anomaly in U.S. history. Rather, the experience of Ms. Lacks and her descendants is in many ways an archetypal story about racism and health in the U.S., as Harriet Washington documents in her thoroughly researched book Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.
We are allowing Poor Children to be Unjustly over Medicated? Duh!
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On the front page of the New York Times last Saturday (December 14, 2009), Duff Wilson reported on a federally funded team of researchers from the Universities of Rutgers and Columbia who revealed that children covered under Medicaid are prescribed antipsychotic medications at a rate four times that of children who are covered under their parent’s insurance. In fact the article reported that
Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.
The article goes further to ask whether these tactics of medicating children are simply a cost-effective technique to control the problems of poor children rather than using techniques and strategies created for children within a higher socioeconomic bracket. This is very important, for it validates what my research and book, released June 2009 and titled: White Prescriptions?: Black Males and the Dangerous Social Potential of Ritalin and Other Psychotropic Drugs critically discusses.
Within my book I looked at the Medicaid system in Illinois and Florida. More specifically I investigated a specific list of psychotropic medications as it related to Black males juxtaposed against the number of all other groups covered under the state systems. The data revealed that Black males were disproportionately medicated than all other groups prescribed these strong medications. A system of social control is in operation as it relates to children, specifically males of color within the U.S. The U.S. and the government have a history of diagnosing and medically treating marginalized children.
For example, on December 30, 1969, John D. Ehrichman, Domestic Affairs Advisor of then President Richard M. Nixon sent a request to the Secretary of Health, Education, and Welfare. The president wanted the Secretary’s opinion as to the advisability of setting up pilot projects embodying some of [the] approaches presented by Arnold A. Hutschnecker, M.D., in his 1,600 page memo which advised the government to conduct nation-wide testing on all children six to eight years old. Such children would be put in special camps, and attend counseling sessions and day care centers that specialized in correcting their violent, delinquent tendencies. his national testing approach would attempt to detect and treat children who possessed homicidal and other violent tendencies.
Hutschnecker, who was at the time engaged in psychotherapy, hoped his proposal for nation-wide testing would allow those children identified as having problems to be subjected to corrective treatment. This line of thought and focus on these children continues today with the federal government, in combination with pharmaceutical companies, is continuously trying to prove the safety of and advocating the use of antipsychotic and other behavioral stimulant drugs in the behavior treatment plans for school age children. For example, in the 1990s, the National Institute of Mental Health (NIMH) attempted to explain the occurrences of violence within the inner cities. Their basis was founded on the possible biological and genetic defects in Black Americans. They proposed to do numerous studies that would have involved intrusive measures such as spinal taps, brain studies, and blood tests. Strong opponents halted the initiative, which resulted in the later resignation of Fred Goodwin, former head of the NIMH. It has been reported [at opensecrets.org] that the total electoral contributions donated by pharmaceutical companies to state and federal electives in 1990 were $3,273,367. In 2006, the donations had blown through the roof to $19,598,807. In 2006, out of the 435 members of the U.S. House of Representatives, 388 received a total of $9,481,486. Out of the 100 Senators, 92 received a total of $4,592,729 in pharmaceutical contributions. In 2006, Senator Clinton was number fourteen on the top twenty list of senators who received contributions ($124,855). Within this period, the top six contributors were Pfizer, Inc. ($1,743,839), Amgen Inc. ($1,150,925), GlaxoSmithKline ($1,108,101), Johnson & Johnson ($747,215), Abbott Laboratories ($675,896), and Eli Lilly & Co. ($540,921). During the 2008 presidential primaries the top six were Amgen Inc. ($686,500), Pfizer, Inc. ($648,971), GlaxoSmithKline ($520,716), Johnson & Johnson ($480,921), Roche Group ($370,227), and Abbott Laboratories ($366,800). These are the makers of the behavioral stimulants like Paxil, Zyban, Wellbutrin XL, Cleocine Phosphate, Zoloft and etc. These contributions have had an undoubted effect on elected officials.
For example, in 2005, President George W. Bush launched an initiative for a nationwide mental health screening of all children K-12th grade. Due to the New Freedom Commission on Mental Health (NFC), which was an Executive Order issued on April 29, 2002, his primary goal to create an integrated system of care that established identification, screening, and finally responding to metal health problems early within child welfare, public schools, criminal, and juvenile justice systems was enabled. Simply put, every child in the U.S. would be screened for mental health issues and forced prescribed care treatments. As of 2005, these measures have already been implemented in the states of Alaska; Arizona; Arkansas; California; Colorado; Connecticut; Delaware; Florida; Georgia; Hawaii; Idaho; Illinois; Indiana; Kansas; Kentucky; Louisiana; Maryland; Massachusetts; Michigan; Montana; Nebraska; New Hampshire; New Jersey; New Mexico; New York; North Carolina; North Dakota; Ohio; Oklahoma; South Carolina; Tennessee; Texas; Utah; Virginia; Washington; West Virginia; Wisconsin; and Wyoming.
This is an issue that should not be ignored but further investigated due to the lack of scholarship on the issue of medicating children. This also an issue that calls for scholars who are not afraid to look further than SES (socioeconomic status), but both race and gender.
Ignoring Systemic Racism: The House and Senate “Health Care” Bills
Posted by: | CommentsLaw Professor, Vernellia Randall, author of Dying While Black, has sent out a commentary (see link here) on the major weaknesses in the Senate bill 3590 and House Bill 3960 (health care reform bills) that have not gotten any significant media attention. She points out how they do not deal with structural and individual discrimination in medical care:
Racial discrimination in medical treatment is a significant problem. For instance, Blacks of similar income, education and severity of illness as Whites get different health care treatment. . . . For example, studies have shown that as compared to Blacks:
• Whites are 22% more likely to be hospitalized for ischemic heart disease;
• Whites are 57% more likely to undergo coronary-artery bypass surgery;
• Whites are 49% more likely to undergo coronary angioplasty;
• Whites are 25% more likely to have a mammography;
• Whites are 57% more likely to undergo hip-fracture repair.. . . . The ultimate health care reform bill must provide for an adequate legal structure that has the potential to eliminate racial discrimination in medical treatment. . . . To be effective the Senate bill must:
- Must specifically prohibit both intentional and disparate impact discrimination. In Alexander v. Sandoval, the Supreme Court reaffirmed its longstanding position that Title VI addresses only intentional discrimination. This is disastrous since most discrimination in health care is not intentional. Most physicians, hospitals and other providers, don’t set out to purposefully discriminate. Rather, they adopt policies and practices or they rely on stereotypes and bias to make decision and the net effect (the disparate impact) is to discriminate based on race.
- Must authorize individuals to sue on both the law and the implementing regulations. This effect discrimination (also called disparate impact) is prohibited by law through implementing regulation. Unfortunately, in Alexander v. Sandoval, the Supreme court held that an individual cannot sue (that is does not have a private right of action) on effect discrimination that only an agency can enforce the regulation. Thus, a person who knows that he or she has been discriminated against based on effect, can only file a complaint with the Department of Health and Human Services and hope they follow through. The result has been that litigation based on racial discrimination in medical treatment is non-existent even though it is clear that it exists. The private right of action on implementing regulations must be clearly articulated in the law.- Must assure that all health care providers are responsible for non-discrimination. Title VI does not cover physician and other health care providers who do not take any federal financial assistance. They have been exempted by regulations which have provided that a payments to beneficiary for “contract of insurance”, such as Medicare B, are not federal financial assistance. Since some physicians do not take any other federal financial assistance, such as Medicaid, essentially these physicians and other providers are exempt from anti-discrimination law. This must be corrected – no provider should be allowed to discriminate without impunity. It is unfortunate that the Senate in its efforts to reform health care and make it more accessible and improve quality has failed to effectively address racial discrimination in medical treatment. This is unacceptable – you can’t improve the quality of health for all Americans and ignore racial discrimination in medical treatment.
You can see her full comments and sign a petition here. Also contact your senators and representatives about these serious omissions.
