Vernellia R. Randall
Professor of Law and
REFORMING AN UNJUST HEALTH
TO MEET THE
NEEDS OF AFRICAN-AMERICANS
3 Health Matrix 127-194 (Spring, 1993)
Copyright (c) 1993 Health Matrix: Journal of Law-Medicine;
Vernellia R. Randall
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.(311)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".(312)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.(313)
*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.
311. FN310. See, KNOWLES & PREWITT, supra note
15, at 96 (placing burden of mobilizing medical resources on health institutions
due to their relationship with medical community and patients).
312. FN311. Id.
313. FN312. This quote is taken from an article
about South Africa with merely name changes from South Africa to the U.S.
and Apartheid to Racism, it is equally true about the United States of
America. Elena Nightingale, et al., Apartheid Medicine: Health and Human
Rights in South Africa, 264 JAMA 2097, 2102 (1990