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Go to: Race, Health Care and the Law 

Racial Discrimination 
in Access, Research, and Quality 
and how it affects American Minorities.
An Annotated Bibliography

NATHANAEL J. BYERLY
The University of Dayton School of Law
Spring 1998


Introduction

 This annotated bibliography attempts to provide an overview of the problem of racial discrimination in the present health care system and the effects that discrimination has on American minorities. The studies in the articles below serve as evidence for the fact that this type of discrimination exists. They reveal that past attitudes continue to evidence themselves in the present way minorities are treated by health care providers. Unfortunately, the present health care system of America exemplifies the discrimination faced by minorities. After reading the materials in this bibliography, the reader will be made aware that despite all the changes that have been made in the system discrimination still exists and must be resolved. 

This bibliography also contains sources that address the more subtle forms of discrimination. Others address incidents where no discrimination is evident but the out come is the same. While some of the prejudice is clear, there are more examples of subtle discrimination against minorities. The location of a new hospital well away from inner city area or another minority neighborhood is an example of this subtle form of discrimination. Whether outright and public or subtle and hidden, the result is the same, the minority population of America goes untreated or treated with sub-standard inferior care. 

In the article, the studies show that minorities in America suffer from the poorest health. Yet, the same studies go on to show that those minorities are denied access to health care and representation in medical resaerch. Even when minorities do receive access to health care they are denied certain treatments that other white patients are afforded. Whatever the source they face discrimination. Unless minorities are provided with better access, representation in research, and the same quality of care as that received by white patients, attempts to produce an equitable system will fail.


The following articles are included in this bibliography:

Addressing racial inequalities in health care: Civil rights monitoring and report cards. 23 J. Health Pol. Pol'y & L. 75 (1998). 

Black-white disparities in health care. 263 JAMA 2344 (1996) 

Civil rights in a changing health care system. 12 Health Affairs 6 (1997). 

Effects of discrimination and racism on health care. 266 JAMA 2674 (1991) 

HCFA study: Race income factors in access to health care 48 AMEDNEWS 10 (1995) 

Health Care in the inner city: Asking the right question. 71 N.C. L. Rev. (1993). 

How white and African-Americans view their health and social problems: Different experiences different expectations. 273 JAMA 341 (1995). 

Race, ethnicity, and hospital care: The need for racial and ethnic data. 30 HOSPLW 125 (1997) 

Racist health care? 48 Fla. L. Rev. 357 (1996). 

Racist health care: Reforming an unjust health care system to meet the needs of African-Americans. 3 HEALTH MATRIX 127 (1993). 

 Breaking the barriers of access to health care: A discussion of the role of civil rights litigation and the relationship between burdens of proof and the experience of denial. 60 Brook. L. Rev. 517 (1996) 

Title VI Challenges by private parties to the location of health care facilities: towards a just and effective end. 37 B.C. L. Rev. 517 (1996).
 

 


Annotations
 


Racist Health Care: Reforming an unjust health care system to meet the needs of African-Americans. 3 HEALTH MATRIX 127 (1993). 

In this article, Professor Vernellia Randall points out that while the present debate on health care reform focuses on the need to control costs and to improve access, the needs of minorities, specifically African Americans, are overlooked. Using statistical evidence, she reveals the disparity in the medical treatment of European Americans and African Americans. She shows that despite being in a worse state of health and suffering from a higher death rate, the African American community receives less care than the healthier European American community. In conclusion, Professor Randall proposes several ideas to improve the present system making it more equitable. 

Professor Randall organizes her article into three distinct parts. Part I reveals and discusses the disparity the health status of the African American Community and the European American community. Part II discusses the institutional racism that exists in the health care system. Part III discusses changes that will improve the health care system and make it an equal one. 

After reading this article, the reader will be made more aware of how the element of race affects the access to treatment and the quality of care received by minorities in general and specifically the African American community. The article blends a discussion of the discriminatory issues surrounding health care and the statistics that prove such practices exist. 

Professor Randall gives a convincing presentation about the presence of racial discrimination in the health care system. She intertwines strong statistical evidence with her arguments producing a well-supported position. Then in conclusion, she proposes suggestion that if applied can solve many of the problems of today's system. After reading this article, the reader will have a better understanding of what minorities face, as well as what it will take to fix the present system.



Addressing Racial Inequalities in health care: civil rights monitoring and report cards. 23 J. Health Pol. Pol'y & L. 75 (1998). 

In this article, Mr. David Smith describes the discrepancies that exist between minorities and whites in access to health care, quality of medical treatment, and insurance coverage. 

In addition, Mr. Smith proposes some changes to the proposed report card approach to monitoring the performance of the institutions and providers in the system. 

First, the article presents a historical account of the Civil Rights movement in health care. Then, it deals with the current standing and limitation of the present attempts by Title VI to control racial discrimination. Finally, it explores ideas that will strengthen the present system. 

Mr. Smith proposes a comparative report card approach that would compare the treatment of racial categories with each other to assure they are receiving the same level of treatment. The implementation of this approach as proposed by Mr. Smith would improve the health care system in three areas. 

Mr. Smith provides an excellent presentation of his ideas and improvements for the present system. His organization is superb as he begins with the history to show that progress that has been made and concluding by showing where progress needs to and must continue.



Racist Health Care? 48 Fla. L. Rev. 357 (1996). 

In this essay, Ms. Barbara Noah presents evidence that the race of an individual can adversely affect access to health care and the quality of care that individual may receive. She further reveals that while this discrimination is not in an overt form, this discrimination still poses a serious problem. 

Ms. Noah breaks her essay into three parts. Part I address the use of Medicare services and how discrimination continues even where care is supposed to be provided. Part II addresses the discriminatory treatment of recipients for transplants. Part III addressees the lack of minority representation in the area of medical research. 

The essay presents data that suggests that African Americans receive a lower quality of care. Examples include the study that show that minorities, especially African Americans, wait longer to obtain a kidney or some other organ transplant. Other examples include the statistics that show that new drug trials and other types of biomedical research frequently fail to include subjects from minority groups and communities. Ms. Noah maintains that the health of theses groups cannot be improved if they are not included in the search for treatment and cures. 

This essay provides the reader with insight into the treatment of minorities at every level in the health care system. Ms. Noah employs a great degree of skill in making it clear that minorities are not receiving the same access to health care from the beginning stages of research to the actual treatment of illness.



Title VI Challenges by private parties to the location of health care facilities: towards a just and effective end. 37 B.C. L. Rev. 517 (1996). Total pages read:16 

In this article, Daniel Hampton insists that health care facilities in areas inaccessible to minority communities discriminate against those communities. He suggests that Title VI can be used an effective challenge to this subtle form of discrimination. 

This article addresses three different points. First, it presents a general discussion of the background of Title VI. Second, it presents the history and current state of the law in Title VI actions as it relates to the specific issue of the discriminatory location of health care facilities. Finally, it presents Mr. Hampton's idea that the burden on plaintiffs in Title VI actions regarding the discriminatory location of health care facilities should be decreased. 

Mr. Hampton employs the use of statistics to show that minorities have grater health needs than do whites. Yet, the minority communities are unable to get the necessary treatment because there are few or no facilities to provide treatment in their immediate area. Facilities are unwilling to relocate and providers are unwilling to build in these areas producing a discriminatory result. Mr. Hampton maintains that present Title VI actions are not successful. His proposed suggestion is that the courts need to lower the burden placed on the plaintiffs in these cases. 

This article presents a different approach to the fight against discrimination in the area of access to health care. it does an excellent job of revealing the types of discrimination that exists and how this adversely affects minority communities. However, this article goes farther as it proposes a possible legal solution to the present problem. These ideas can be argued in front of a court in an attempt to protect minority communities from being denied access to the health acre they so desperately need. But in the end, the decision rests with the courts that must recognize the subtle discrimination and end it. 

 



Symposium: Breaking the barriers of access to health care: A discussion of the role of civil rights litigation and the relationship between burdens of proof and the experience of denial. 60 Brook. L. Rev. 517 (1996) 
 

In this article, Ms. Marianne Englmeann Lado shows that the health acre system in America is multi-tiered. The greatest and best benefits of medical care are reserved for selected segments of society. She further states that the courts as well as society in general are in a state of denial about the discrimination that exists in the health care system. This denial prevents a solution or any improvement of the problem. Half the battle of defeating a problem is admitting you have one. 

The article addresses several points. First, it focuses on the need to ensure that barriers to health care for minorities will be removed. Then it discusses the role of civil rights litigation in addressing these barriers to health care for minorities. Finally, it addresses the denial of discrimination by courts and society in general as a barrier to the solution of the problems. 

This article presents a unique view of the debate by presenting that the courts and society are in a state of denial concerning this issue. The article also points to despite all the efforts by admirable people things have actually gotten worse. Ms. Lado is firm in her statement that it is difficult to fight a problem when people will not admit it exists. This article is a noble effort to open the reader's eyes to the problems that do exist. Ms. Lado also includes excellent real life accounts and examples of discrimination faced by minority individuals in these situations. The article is a skillful presentation. 

 



Civil Rights in a changing health care system. 18 Health Affairs 16 (1997). 

The authors of this article emphasizes that the adoption and implementation of a new health care system will not be helpful to minority communities if the same policies of discrimination based on race and national origin continue. They show that even managed care providers may perpetuate past discriminatory practices in new ways. They voice concern and show how the repeat of present discrimination can be avoided. 

The article is constructed in an organized fashion. Part I deals with an overview of Title VI of the Civil Rights Act. Part II and Part II examine past health care institutional practices that have been identified as discriminatory under fee for service system and consider the counterparts in managed care. 

This article presents a strong warning that a change in the system is no good if the same attitude and practices are employed in that new system. This presentation makes it clear that a mere change in the system is not enough., More safe guards to protect minorities must be developed. The excellent use of statistics by the authors of this article present a firm foundation to the assertion that the present system is bad and the next one will be too if challenges are not made. The proposal of presented by the authors should be given consideration as potential improvements.



Health Care in the Inner City: Asking the right question. 71 N.C. L. Rev. (1993).  

In this article, Professor Sidney Watson reveals the mistakes made by the health care reformers. Professor Watson maintains that while the questions being asked are how do we lower costs and how do we pay for the high costs, the question should be how do we improve the health of Americans. The article shows that while African Americans are suffering from poor health the facilities closed served twice as many African American patients as this did that stayed open. Professor Watson that while an increase in health care access will help the African American community, other socio-economic strategies need to be employed to be sure that the African American community is improved. 

The article addresses four areas. Part I presents the problem of race and health care. Part II deals with health care financing. Part III suggest ideas to enable the inner city community to attract health care providers. Part IV addresses the enforcement of civil rights to battle lingering discrimination. 

This article does a marvelous job in drawing the attention of the reader from the misguided questions being asked by many in the health care debate to the truly important ones that must be answered. A superb demonstration of how the present discriminatory practices will be carried over to the next system whatever it may be is presented. The article does an excellent job of intertwining statistics with examples of the present situation to unveil a discriminatory system. In addition, a fine presentation of alternatives to the system is made. 

 



Race, ethnicity, and Hospital Care: The need for racial and ethnic data. 30 HOSPLW 125 (1997) 

In this article, Professor Sidney Watson shows that while reported disparities in access and treatment between minorities and whites are striking, insufficient evidence exists to conclude the scope and role each factor plays. Professor Watson states that this problem exists because little is known about what occurs in individual hospitals. Waston urges that individual hospitals need to learn more about how they can improve their treatment of minority patients. He insists they can do this by collecting and compiling race and ethnicity. While they do not do it now, it is never too late to start. 

The article is divided into three parts. Part I presents an overview of recent studies that document the fact that racial and ethnic minorities receive less medical attention than similarly situated white Americans. Part II explains when racial and ethnic disparities in hospital access and treatment may be actionable under Title VI of the 1964 civil Rights Act. Part III defines the data needed to reveal the present problem. 

This article does a noteworthy job of presenting major mistakes with the way data is collected and used in the present system. The article present excellent ideas on how to solve the problem. 



Effects of discrimination and racism on health care. 266 JAMA 2674 (1991). 

In this article, Lois Sullivan declares that racism does limit the access of minorities to health care. Secretary Sullivan states that because minorities are often eliminated from access that our country denies access to health care to millions of Americans. He also maintains that our country can overcome racism by their formation of a culture with mutual respect and personal responsibility for each other. 

The article address several issues in an organized fashion. First, it addresses the disparities in the present system. It discusses the discrimination that occurs in the research lab and follows that discrimination all the way to the actual health care setting of treatment. Then, it suggests ideas for overcoming racism. It maintains that all Americans must have access to affordable and quality care. 

This article presents an excellent array of statistics that show the troubling state of today's health care system. The article also contains a noble presentation of how to improve the system and what steps need to be taken. 



How white and African Americans view their health and social problems: Different experiences different expectations. 273 JAMA 341 (1995). 

This article reveals that despite all the increases in social programs and expenditures, racial disparities persist in many aspects of American society. The authors maintain that the health of our nation's population differs greatly by race. they show that part of this poor health is directly related to the lack of access for minority communities. In support, they produce numerous studies that show that African Americans are more likely to receive less access to health care. This is also reflected in the lower assessment given the health care system by the African American community than that given by the European American community. 

The article addresses health and health care related financial problems. Included in these are current and future concerns about paying for the basic necessities of life, the impact of public safety sector safety net and problems related to employment, education, discrimination. The article also includes perceptions of how well US health and social institutions address the problem minority Americans face. They than address what should be done to reduce disparities in the future. 

This study is an excellent source for the reader who is interested in obtaining statistics that show the existence of discrimination ion the health care system. This study highlights many aspects of tat discrimination. The importance of correct data is underscored as well it should be. The author gives an excellent presentation. 

 



Race income factors in access to health care. 48 AMEDNEWS 10 (1995)

This article presents a study done by whom for what purpose. This article states that even in Medicare where virtually everyone is covered race and income are still barriers to care. The study further points to the finding that there is a lower use of physician services and emergency department among blacks than low-income whites. The article and study address the causes of the differences in the treatment of the different races. 

The article relating the findings of the study is divided into several parts. Part I presents the difficulties present in trying to measure the access people have to medical treatment. While most data includes race, it does not include income. This lack of information makes access difficult to monitor. Part II addresses the cause of the discrepancies. This article states they are lack of providers, lack of knowledge, cultural barriers, and provider bias. These are explained briefly in the article. 

This article presents excellent insight into the differing views of the white and African American on the health care system. It does an excellent job in unveiling the different perceptions of Americans and why those different perceptions exist. It does a noble job in trying to alert physicians to the actions they commit that can be perceived by the public as discriminatory. 

 



Black-white disparities in health care. 263 JAMA 2344 (1996).

This article is based on the council on Ethical and Judicial Affairs of the American Medical Association. The report reveals that recent studies have suggested that even when blacks gain access to the health acre system, they are less likely than whites to receive certain surgical or other therapies. The studies have dealt with several areas ranging from kidney transplants to obstetrics. 

The article is divided into three parts. Part I presents evidence of disparities in medical treatment. Part II discusses the reasons for racial disparities. Part III addresses the significance of the disparities and what the response should be to resolve these discrepancies. 

The report emphasizes the need for grater access to necessary health care for black Americans, greater awareness among physicians of existing and potential disparities in treatment and the continued development of practice parameters including criteria that would preclude or diminish racial disparities in health care decisions. 

This report produces suggestions full of insight that can resolve the problems in the present system. The report emphasizes the need of physicians to be aware of their practices. This emphasis on subconscious racism helps draw attention to the problem from a totally different angle, an angle that could help solve the problem.


                                                    
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The University of Dayton School of Law
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Email: randall@udayton.edu

 

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