Race, Health Care and the Law
From: Vernellia Randall, On Being Hit Square in the face with a two-by-four or Why Diversity Inc's May Issue on HealthCare Disparities is Institutional Racism, Blackprof (May 11, 2006 (Last Visited: May 11, 2006).
I am often asked why I am so “hung up” on race. I am told to “chill out” because everything is not about race. But racism is like dust; it is everywhere and I find it in the most unexpected places. One of those places is among those who profess to do diversity work.
Oh, I’m not talking about the pseudo-diversity wannabe’s like my law school, University of Dayton, which this year hung a banner celebrating diversity after not interviewing one minority applicant for five faculty positions at the law school and which only admitted 10% (7) minorities, although the application pool was over 20% minority.
No, I am not talking about my school, which “Celebrate Diversity” with a big
banner, a party, food, drink - good times - but apparently doesn't care if it
actually has racial diversity. My school, like many institutions, is a
DiversityFake. From DiversityFakes, you understand that institutional and
systemic racism and maintaining white privilege is at the core of their
DiversityInc, is a leader in the field which has put out many thoughtful
articles about, race, gender, class, sexual orientation. I had come to expect
fair and insightful articles when dealing with complex issues that involve the
intersection of many concerns. So, when I received the May 2006 issue, which is
dedicated to Healthcare Disparities, I didn’t immediately expect that there
would be racism deeply embedded in the issue, even though its cover asked the
Healthcare Disparities: Does Class Trump Race?
I am hit square in the face with the two-by-four of racism as soon I read the
table of contents and the editorials.
The first feature article: “Does Class Trump Race,” declares in the table of
content secondary headline that although a gap exists in health insurance, “the
gap isn’t about race–it’s about class.”
The second article: “Biology or Society: Does Race Really Matter?” The
secondary headline asks and answers the questions, “Scientifically, probably
not,” but it is the accompanying picture of a black woman in a mirror that is
disturbing. One image has her holding a large hamburger, the other holding an
apple.. The clear message is that race doesn’t matter except for the “poor
choices” black people engage in.
In the “Publisher’s Letter,” Mr. Luke Visonti and Mr. Foulis Peacock,
partners and co-founders, entitle their letter “Viewing the Healthcare Crisis
Through an Honest Lens” - i.e. the clarity of classism, implying that a
discussion of health care base on race is dishonest.
Ms. Barbara Frankel, Senior Vice President, in her “Editor’s Letter,” “Confronting the Real Healthcare Issue,” asserts that “…the healthcare gap is not really about race. It’s about access and education.” Ignoring that access and education is about race or more importantly racism.
Throughout the issue DiversityInc insisted on making inappropriate comparisons to prove that class trumps race.. For instance, they compare a poor Hispanic to a middle class Hispanic; poor whites to upper-class blacks; and a poor white family in Appalachia to a poor black family in an inner city. None of these comparisons are appropriate for determining the role of race. The poor Hispanic to a middle class Hispanic or the poor white to upper class black is a class analysis and certainly in most cases, but not all, middle and upper class individuals will have better health care than the poor - classism. But saying classism exist does not say racism does not.
The only way to "rule out race" is to control for all other factors and see if racial disparities persist. Thus, the Appalachia to inner city comparison seems like an appropriate race comparison because it controls for class and compares poor whites to poor blacks. But it is not appropriate because it introduces an additional access variable - geography. To determine whether race is a factor, the appropriate comparison is a poor white family in Appalachia to a poor black family in Appalachia; or a poor black family in an inner city to a poor white family in the inner city. When you do that comparison whites have more access to and better quality of health care than similarly situated non-whites.
The legacy of slavery, segregation, and racism have ensured that in most socioeconomic areas, blacks continue to lag behind whites. Factors affecting health include socioeconomic status, biology, and environment. But in a racist society such as ours, the effect of race is paramount and pervasive. Race also affects the way that health care institutions provide services. Independent of economics, race affects access to and the type and quality of health care that is received. Consequently, to improve the health of blacks, it is not sufficient merely to remove economic barriers to access. Health care institutions must be more than affordable; they have to be based on equity and justice or distributive justice.
Class theory maintains that poverty is a major factor in determining individual health, and there is truth to this assertion. Certainly, poverty is a major factor in health. The poor are unable to afford the food, housing, clothing, and education which would allow them to be equal participants in American society. Certainly, access to health care services is limited by a person’s ability to pay, and ability to pay is related to access to health insurance. It is estimated that over 45 million Americans are uninsured. In fact, the amount of care an individual receives is related to whether the individual has health insurance. The spiraling costs of health care and health insurance mean that many people cannot afford to get sick. Consequently, many policy makers are suggesting health care reform proposals designed to minimize the effect of the individual’s ability to pay as a barrier to access to health care.The class theory, however, completely ignores the independent role of racism in American society. Black Americans with hypertension, regardless of their socioeconomic status, report less frequent visits to physicians, more difficulties in accessing the health care system, and greater dissatisfaction with both the availability and the quality of health care. Racism influences not only lifestyle, personal behavior, psycho-social behavior, physical environment, and biology, but also socioeconomic status. Racism has a dual influence. Racism in America erects barriers to health care institutions and to health care treatment. Those who advocate for the class theory alone ignore the fact that making the health care system better for everyone will not necessarily remove all disparities in health care. A generalized approach such as “health for all people” will continue to maintain differences unless specific attention is given to eliminating racial barriers.
Racial barriers to health care appear in two areas. First, institutional policies, practices, and procedures that prevent black Americans from having access to quality health care. Second, some practitioners tend to provide different medical treatment to black Americans based on their race not merely their socioeconomic class.The “Slave Health Deficit" has been compounded by racial discrimination and by institutional racism in health care that has affected both access to and the quality of health care. Despite efforts to eliminate discrimination and segregation over the past 40 years, there has been little change in the quality of, or access to, health care for black Americans. According to the United States Commission on Civil Rights, “despite the existence of civil rights legislation, equal treatment and equal access are not a reality for racial/ethnic minorities and women in the current climate of the health care industry. Many barriers limit both the quality of health care and utilization for these groups, including discrimination.” Racial discrimination in health care delivery, funding, and research continues to exist, and racial barriers to quality health care continue to manifest themselves.
In this case, DiversityInc‘s publication of the May 2006 journal is both institutional racism and systemic racism. By blatantly taking the position that race is not a major factor in healthcare disparities, they have used their position of power to promote a value even though the evidence is that it is both classism and racism. This position will have a disparate impact on racial minorities, therefore institutional racism.
What is disturbing, is this is not something DiversityInc did unintentionally.
If they did the research they said they did, it would have been impossible for DiversityInc to avoid the evidence that when you control for other factors (such as education, class and location) disparities in healthcare between whites and non-whites continue to exist. In fact buried in this same issue was a discussion by experts who repeatedly made that point:
To them the “honest lens” is classism; the “real healthcare issue” is classism. To them Racism Trumped by classism.
Such a position by DiversityInc will have a substantial negative impact on closing the racial gap in health care disparities, as colorblind racists everywhere use DiversityInc’s May 2006 issue to support their position - “there is no need to focus on racism in the healthcare system because it does not exist” and that is what makes the issue racist -
Sixty years old and I still haven’t learned – when it comes to institutional and systemic racism – it’s everywhere and it is just a matter of time before you’re hit in the face with a two-by-four.
Copyright @ 1993, 2008. Vernellia R. Randall