| The need to focus specific attention on the racism inherent in the
institutions and structures of health care is overwhelming. Racial minorities
are sicker than White Americans and are dying at a significantly higher rate.
These are undisputed facts. There are many examples of disparities in health
status, both between racial/ethnic groups and between men and women: infant
mortality rates are 2 1/2 times higher for African-Americans,(38) and 1 1/2
times higher for American Indians, than for Whites;(39) the death rate from
heart disease for African-Americans is higher than for Whites;(40) 50% of all
AIDS cases are among a minority population that comprises only 25% of the U.S.
population;(41) the prevalence of diabetes is 70igher among African-Americans
and twice as high among Hispanics than it is among Whites;(42) Asian-Americans
and Pacific Islanders have the highest rate of tuberculosis of any
racial/ethnic group;(43) cervical cancer is nearly five times more likely among
Vietnamese-American women than among White women;(44) women are less likely than
men to receive lifesaving drugs for heart attacks;(45) more women than men
require bypass surgery or suffer a heart attack after an angioplasty.(46)
Yet, despite these significant health status heathcare disparities, many
Americans have been denied equal access to quality health care on the basis of
race, ethnicity, or gender. Cultural incompetence of health care providers,
socioeconomic inequities, disparate impact of facially neutral practices and
policies, misunderstanding of civil rights laws, and intentional
discrimination all contribute to disparities in health status, access to
health care services, participation in health research, and receipt of health
care financing.
Doctors Michael Byrd and Linda Clayton clearly laid out the long history of
racism and medicine in their two-part seminal works entitled "An American
Dilemma: A Medical History of African Americans and the Problem of Race:
Beginnings to 1900" and "An American Dilemma: A Medical History of African
Americans and the Problem of Race: 1900 to *52 2000."(47) In their work, Drs.
Byrd and Clayton show that the problems of minority health status and minority
health care access are a part of a long continuum of racism and racial
discrimination dating back almost four hundred years.
Since colonial times, the racial dilemma that affected America also
distorted medical relationships and institutions.(48) There has been active
assignment of racial minorities to an underfunded, overcrowded, and inferior
public health care sector.(49) Furthermore, medical leadership has helped to
establish the slaveocracy, create the racial inferiority myths, build a
segregated health subsystem, and maintain racial bias in the diagnosis and
treatment of patients.(50) Only after 350 years of active discrimination and
neglect were efforts made to admit minorities into the "mainstream" health
system.(51) However, these efforts were flawed, and since 1975 minority health
status has steadily eroded, and continues to experience racial discrimination
in both access to health care and in the quality of health care received.(52)
However, current issues in health disparity are not isolated to problems in
the health system. They are the cumulative result of both past and current
racism throughout U.S. culture. For instance, because of institutional racism,
minorities have less education and fewer educational opportunities.(53)
Minorities are disproportionately homeless and have significantly poorer
housing options.(54) Due to discrimination and limited *53 educational
opportunities, minorities disproportionately work in low pay, high health risk
occupations (e.g., migrant farm workers, fast food workers, garment industry
workers).(55) Historic and current racism in land and planning policy also plays
a critical role in minority health status.(56) Minorities are much more likely
to have toxic and other unhealthy uses sited in their communities than Whites,
regardless of income.(57) For example, over- concentration of alcohol and
tobacco outlets and the legal and illegal dumping of pollutants both pose
serious health risks to minorities.(58) Exposure to these risks is not a matter
of individual control or even individual choice. It is a direct result of
discriminatory policies designed to protect white privilege at the expense of
minority health.
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38. [FN38]. U.S. COMMISSION ON CIVIL RIGHTS I, supra note 2, at 11.
39. [FN39]. Id.
40. [FN40]. Id. (147 deaths per 100,000 for African-Americans compared to 105 deaths per 100,000 for Whites).
41. [FN41]. Id.
42. [FN42]. Id.
43. [FN43]. U.S. COMMISSION ON CIVIL RIGHTS I, supra note 2, at 31.
44. [FN44]. Id.
45. [FN45]. Id. at 14-15.
46. [FN46]. Id.
47. [FN47]. See BYRD & CLAYTON, AN AMERICAN HEALTH DILEMMA I, supra note 3; BYRD &
CLAYTON, AN AMERICAN DILEMMA II, supra note 3.
48. [FN48]. Supra note 47.
49. [FN49]. Id.
50. [FN50]. Id.
51. [FN51]. BYRD & CLAYTON, AN AMERICAN DILEMMA II, supra note 3.
52. [FN52]. Id.
53. [FN53]. In 1993, the high school dropout rate was 13.6% for African- Americans and 27.5% for Hispanics,
compared to 7.9% for Whites. U.S. Department of Education, National Center for Education Statistics, Digest of
Education Statistics, 2000, Table 106, available at www.nces.ed.gov/pubs2001/digest/dt106.html (last visited Oct.
25, 2002). See also Rebecca Gordon et al., Facing the Consequences: An Examination of Racial Discrimination in
U.S. Public Schools (Mar. 2000), available at http:// www.arc.org/erase/FTC1intro.html (last visited June 26,
2002); White Privilege Shadow Report, supra note 30, at 38-41; U.S. COMMISSION ON CIVIL RIGHTS I, supra
note 2, at 15-18.
54. [FN54]. Home ownership nationally stands at 47.7% for African-Americans, 47.3% for Hispanics, compared to
74.3% for Whites. Deborah Kenn, Institutionalized, Legal Racism: Housing Segregation And Beyond, 11 B.U.
PUB. INT. L.J. 35, 67 (2001) (less than 50% ofBlacks own homes compared to 70% of Whites). See also, e.g.,
White Privilege Shadow Report, supra note 30, at 46-71. Forty percent of homeless clients served were minorities.
Homelessness: Programs and the People They Serve -- Technical Report (December 1999), available at
http://www.huduser.org/publications/homeless/homeless_tech.html (last visited June 26, 2002); ALL OTHER
THINGS BEING EQUAL: A PAIRED TESTING STUDY OF MORTGAGE LENDING INSTITUTIONS, at 94
(Apr. 2002) (finding that African-American and Hispanic home buyers in both Los Angeles and Chicago face a
significant risk of unequal treatment when they visit mainstream mortgage lending institutions to make
pre-application inquiries); U.S. COMMISSION ON CIVIL RIGHTS I, supra note 2, at 15-18.
55. [FN55]. OS TB 04/10/2002 -- TABLE R38. Number of nonfatal occupational injuries and illnesses involving
days away from work by industry and race or ethnic origin of worker for 2000, available at http://
www.bls.gov/iif/oshwc/osh/case/ostb1071.txt (last visited June 26, 2002); U.S. COMMISSION ON CIVIL
RIGHTS I, supra note 2, at 18.
56. [FN56]. See, e.g., White Privilege Shadow Report, supra note 30, at 54-71; DOUGLAS S. MASSEY &
NANCY A. DENTON, AMERICAN APARTHEID: SEGREGATION AND THE MAKING OF THE
UNDERCLASS 36 (1993).
57. [FN57]. See, e.g., Jill E. Evans, Challenging The Racism in Environmental Racism: Redefining The Concept of
Intent, 40 ARIZ. L. REV. 1219 (1998); U.S. COMMISSION ON CIVIL RIGHTS I, supra note 2, at 18-20.
58. [FN58]. See, e.g., Vernellia R. Randall, Smoking, the African-American Community, and the Proposed
National Tobacco Settlement, 29 U. TOL. L. REV. 677 (1998); Kathryn A. Kelly, The Target Marketing of
Alcohol and Tobacco Billboards to Minority Communities, 5 U. FLA. J.L. & PUB. POL'Y 33 (1992).
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