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    RACIST HEALTH CARE:
    REFORMING AN UNJUST HEALTH CARE SYSTEM 
    TO MEET THE
    NEEDS OF AFRICAN-AMERICANS

    Vernellia R. Randall(*)
    3 Health Matrix 127-194 (Spring, 1993)
    Copyright (c) 1993 Health Matrix: Journal of Law-Medicine; Vernellia R. Randall
    PRELUDE 

    "Racist" and "racism" are provocative words in American society. To some, these words have reached the level of curse words in their offensiveness. Yet, "racist" and "racism" are descriptive words of a reality that cannot be denied. (2) Ethnic-Americans(3) live daily with the effects of both institutional and individual racism. Race issues are so fundamental in American society that they seem almost an integral component. Some Americans believe that race is the primary determinant of human abilities and capacities. (4) Some Americans behave as if racial differences produce inherent superiority in European-Americans.(5) In fact, such individuals respond to African-Americans(6) and European-American(7) differently merely because of race.(8) As a consequence, many African- Americans are injured by judgments or actions that are directly or indirectly racist. 

    Much of the attention of the last 20 years has focused on individual racist behavior.(9) However, just as individuals can act in racist ways, so can institutions. Institutions can behave in ways that are overtly racist (i.e., specifically excluding African-Americans from services) or inherently racist (i.e., adopting policies that while not specifically directed at excluding African-Americans, nevertheless result in their exclusion). Therefore, institutions can respond to African-Americans and European-Americans differently. Institutional behavior can injure African-Americans; and, when it does, it is nonetheless racist in outcome if not in intent. 

      Endnotes
    *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. ).


FN1. See generally, STOKELY CARMICHAEL & CHARLES E. HAMILTON, BLACK POWER: THE POLITICS OF LIBERATION IN AMERICA 2-32 (1967) (detailing the effect of race relations on African Americans politically, socially, and economically in the United States. "[Racism] has represented daily reality to millions of black people for centuries, yet it is rarely defined perhaps just because that reality has been such commonplace." Id. at 3.) 

FN2. The remainder of this paper will refer primarily to African-Americans because my academic research focuses on African-Americans. However, it is important to note that other ethnic Americans (Native-Americans, Latino- Americans, Asian-Americans) have similar or greater health care access problems and are similarly plagued by the effects of institutional racism in the health care system. 

FN3. See generally, R. J. Hernstein, Still An American Dilemma, 98 PUB. INTEREST 3-17 (1990) (criticizing the methods and conclusions of A COMMON DESTINY: BLACKS AND AMERICAN SOCIETY (1989) for ignoring the possibility that different outcomes, between African-Americans and European-Americans may be the product of psychological and intelligence differences between the two races. The author argues that costs to society of attempting to benefit African- American disproportionately may outweigh the benefits); RONALD TAKAKI, BRAINS OVER MUSCLES: THE MEANING OF INTELLIGENCE AND RACE IN AMERICAN HISTORY (1984) (explaining how intelligence has been viewed historically in the United States, and how the "idea of intelligence" has "influenced and been influenced by the idea of race in American history."); See also, PAUL R. EHRLICH & SHIRLEY FELDMAN, THE RACE BOMB: SKIN COLOR, PREJUDICE, & INTELLIGENCE (1977); ANDRE JOSEPH, INTELLIGENCE, IQ & RACE: WHEN, HOW & WHY THEY BECOME ASSOCIATED (1977); DANIEL LAWRENCE, RACE, INTELLIGENCE AND CULTURE (1975) (reviewing critical books published between 1969-1974 in Great Britain and the United States that support the idea of racial differences in intelligence); ELIZABETH WATTS, RACIAL DIFFERENCES IN INTELLIGENCE: AN ANTHROPOLOGICAL APPROACH, HUMAN MOSAIC 47-53 (1973-1974) (discussing controversial views concerning the existence of population differences in mental ability); Josephine Schuyler, Race, Diet and Intelligence, 76 CRISIS 207-10 (1969) (criticizing Arthur R. Jensen of the University of California who holds that intelligence is determined by heredity). 

5. FN4. In a national poll, when asked, "What are your personal feelings about . . . people who believe whites are racially superior to all other races" 1% were extremely favorable, 4% were favorable and 23% were neither favorable or unfavorable. National Opinion Research Center February, 1990 available in Westlaw, Poll (Sept. 1993). 

6. FN5. For purposes of this Article, I use the term "African-American" as a synonym for the terms "colored," "Negro," "Afro-American," and "Black." 

The predicament of African-Americans cannot be overstated. We arrived as "Africans" and were slaves to be sold. We were given Anglo names and became their "negroes" - their property. After Reconstruction there was a push by African-American leaders to give dignity to the name by capitalizing it. So "negroes" became "Negroes". Even still, in the 1900 "Colored" competed with "Negroes". Many thought that "colored" showed that we were no longer possessions. "Afro-American" was first proposed in 1880, but it never caught on. Through the social unrest of the 1960's we became "Blacks". We wanted respect. We wanted opportunity. We wanted to be proud of our heritage. The change to "African-American" denotes double consciousness and dual cultural heritage. It comes close to describing who we are as a people. See generally, Jewell Holmes Guinn, From African to Black, An American Evolution, PHOENIX GAZETTE, Feb. 27, 1989. 

Each change in label represents a change in attitudes of African-Americans toward ourselves and toward others. Ultimately, the changing names of descendants of African slaves represents a continuing struggle by us to gain the power to define ourself. It represents a struggle to gain social and political power. While powerful groups do not appear to care about how they are labeled (i.e. Americans of British descent and Jews), powerless groups frequently try to relabel themselves. Powerful groups who are unwilling to give up power often meet these efforts with ridicule and hostility. "The power to name is frequently also the power to define. The power to name a group can be the power to position it socially and politically". Charles Paul Freud, Rhetorical Questions: The Power of, and Behind, a Name, WASH. POST, Feb. 7, 1989, at A23. 

7. FN6. I use the term "European-Americans" to denote individuals usually called "white". Historically, ethnic Americans have been designated in a hyphenated name: "Black-Americans" "Asian-Americans" "Native-Americans" "Hispanic- Americans". Presumption seeming to be that you would know that these individuals would not be recognized as Americans unless we designate them as such. On the other hand, "white" persons need no designation because they are presumed to be Americans. Consequently, linguistically "white" persons maintain a position of power. 

White people didn't bother to define themselves racially in any particular way until rather recently. According to usage historian Stuart Berg Flexner, general references to 'white men' entered the language only in the 1830s, and didn't gain wide usage until the Civil War. What did whites call themselves until then? They called themselves "people" or "citizens." In other words, they occupied, unchallenged, the center of their racial universe, and needed no further definition of the sort assigned to such outsiders as Indian "savages" or black slaves. "White" became an important term at the time of Emancipation; a reaction to the power threat presented by another racial group. 

See, e.g., Freud, supra note 5, at A23. 

Similarly, I reject the designation of "minorities" because of its connotation of subordination. It would be "nice" if no designations at all were needed, but the reality of the situation requires us to discuss the needs of specific ethnic groups. I used the term European-American rather than Anglo- Saxon to provide balance with the other designations; that is, designations which identifies the geographic region from which the original ancestors migrated. 

8. FN7. See generally, Andy Dabilis, Racial episodes decried in Medford, Winchester, BOSTON GLOBE, Jan. 16, 1993, at 34 (maintaining "We're for the white race. We believe in separation because mixing doesn't work, We are miles apart in culture and intelligence. They are a couple of notches below us."); MICHAEL KRONENWETTER, UNITED THEY HATE: WHITE SUPREMACISTS IN AMERICA (1992); Jill Hodges, A Surge of Hate: Number of Racist Incidents on rise STAR TRIB., Feb. 2, 1992, at 1B; John Carmody, Is U.S. Racist?, LOS ANGELES TIMES, Feb. 12, 1990, at P7, P8, C6 (surveying 204 stories about race relations that were aired on the three major networks shows that one out of three sources interviewed said America is racist); The Doug Wilder Solution, WASH. TIMES, Jan. 11, 1990, at F2 (asserting that the United States has gotten itself into a first-class race-relations mess because many otherwise intelligent, decent, good-hearted people have dedicated their lives to giving moral and legal force to racial stereotypes); Jonathan Kaufman, The Color Line, BOSTON GLOBE, June 18, 1989, at 16 (maintaining that whites have become disillusioned with blacks and lack interest in race relation); KEVIN FLYNN & GARY GERHARDT, THE SILENT BROTHERHOOD: INSIDE AMERICA'S RACIST UNDERGROUND (1989) (asserting that the movement has gathered a large majority of ordinary people. They see the underground's survivalist creed as the way whites can protect their race from "living off of welfare"); Mary Katherine Joeckel, A Critical Study of Ideologies of Women in Contemporary White Supremacy, Dissertation, The University of Nebraska--Lincoln (1989) (maintaining that White supremacy is enjoying a new era of appeal in the United States. Today's white supremacists differ from their ancestors in that they agitate for demolition of rather than changes in the existing social order); C. N. Hallman, L. F. Lister, White Supremacy and its Associated Groups: An Associated Bibliography; 17 REFERENCE SERVICES REV. 7-18 (1989) (reviewing recent scholarly and popular periodical literature, as well as recent books, reports, and curriculum guides about white supremacy and white supremacist groups in the U.S. Included are reports on the Ku Klux Klan, and neo-Nazi groups like Aryan Nations, and skinheads); Courtland Mulley, Racism Alive, Thriving, WASH. POST, May 23, 1985, at D1 (maintaining that race relations, is a matter of overwhelming concern among these African- Americans. The students raised questions about reports they had heard about the Aryan nation and the rise of white supremacist groups and racial violence). 

In a national poll, when asked "In general, how do you think people in the United States feel about people of other races?", 35% indicated that many white persons disliked blacks and 2% indicated that almost all white persons disliked blacks. Gallup Poll, May 10, 1992. On another question, when told that "on the average (negroes/blacks) have worse jobs, income, and housing than white people" and asked if they thought these differences were due to discrimination 40% said yes. National Opinion Research Center, April 1991. 

9. FN8. See generally, John T. Harvey, Institutions and the Economic Welfare of Black Americans in the 1980s, 25 J. ECON. ISSUES 115-35 (1991) (explaining that the overall system that has developed since the civil rights movement has taken racism underground. The growing black underclass is still trapped in a circle of discrimination); Darnell F. Hawkins, The "Discovery" of Institutional Racism: An Example of the Interaction Between Law and Social Science, 6 RES. IN RACE & ETHNIC REL. 167-82 (1991) (discussing public policy implications of the distinction between individual and institutionalized forms of racial bias in the 1990s); Richard Lowy, Yuppie Racism: Race Relations in the 1980's, 21 J. BLACK STUDIES 445-64 (1991) (maintaining that Yuppie racism refers to the assumption by young urban professionals that the civil rights movement of the 1960's has corrected racial injustice in the US. The author argues that racism remains a major problem because young adults are ignorant of history and perpetuate the structural inequalities in American society); Benjamin P. Bowser, Race Relations in the 1980s: The Case of the United States, 15 J. BLACK STUDIES 307-24 (1985) (asserting that contrary to many social scientists' assumptions, ending overt prejudice and legislated segregation has not assured racial equality in the United States. Studies show how discrimination serves white self-interest as elite white groups protect their historic privilege through institutional racism and internal colonialism); Jenny Williams, Redefining Institutional Racism, in ETHNIC AND RACIAL STUDIES 323-48 (1985) (arguing that the historical use of the term "institutional racism," is a simplistic and misleading label for a complex situation); Eugene Victor Wolfenstein, Race, Racism and Racial Liberation, 30 W. POL. Q. 163-82 (1977) (maintaining that institutional racism results when the charismatic group effect is routinized. Racial conflict of this sort prevents black and white workers from uniting); Charles S. Bullock, Harrell R. Rodgers Jr., Institutional Racism: Prerequisites, Freezing and Mapping 37(3) PHYLON 212-23 (1976) (arguing that even though blatant forms of discrimination have been banned by law, but subtle forms continue to exist. Discrimination still persists especially through the use of institutional subordination); Terry Jones, Institutional Racism in the United States, 19 SOC. WORK 218-25 (1974) (examining the concept of institutional racism and some of the ways that these systems develop and maintain themselves). 

10. FN9. For instance, according to the computerized legal search program Nexis, between January 1, 1990 and August 30, 1991 there was more than 6,000 articles which discuss health care reform. 

 
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Home ] Up ] [ Prelude ] Introduction ] Disparity in Health Status ] Institutional Racism and Health ] Health Policy and Race ] Conclusion ]
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Home ] Racist Health Care ] Using Civil Rights Law to Eliminate Health Disparities ] Racist laws which effect Hispanic Health Care ] Minorities Health Access ] Access to Health Care and Minorities ] Discrimination and Inaccessibility ] Why Race Matters? ] Discrimination and Quality ] Racial Profiling in Health Care ] Self-Perpetuating Mythology - the Degenerate Black Patient ] Health and Civil Rights: Unfinished Agenda ] Lawyers Seek Remedies for Health Care Disparities ] Race Medicine and HealthCare in LA County ]
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Professor Vernellia R. Randall
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The University of Dayton School of Law
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