Race, Health Care and the Law 
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Racial Disparity in Health Status

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Vernellia R. Randall
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Racial Discrimination in Health Care in the United States as a Violation Of the International Convention on the Elimination of All Forms of Racial Discrimination, [a1] 14 University of Florida Journal of Law and Public Policy 45-91 (Fall, 2002)

 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.


Racial Disparity in Health Status
Institutional Racism in US Health Care
Inadequacy of Legal Efforts
US Violations of ICERD
Recommendations and Conclusions
Appendix A US Report
Appendix B White Shadow Report Excerpts
Appendix C: Concluding Remarks 1475th CERD Meeting
Appendix D Concluding Observations



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.


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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Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
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Email: randall@udayton.edu


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