Race, Health Care and the Law 
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Institutional Racism in the US Health Care System

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 Institutional Racism in the US Health Care System
Statement to the Committee on the Elimination of Racial Discrimination

The present health crisis for racial minorities in the United States is part of a long continuum dating back over 400 years. After hundred of years of active discrimination, efforts were made to admit minorities into the "mainstream" health system but these efforts were flawed. Since 1975 minority health status has steadily eroded and there has been no significant improvements in the removal of barriers that are due to institutional racism.

Health Status and Institutional Racism. Minorities are sicker than White Americans; they have more illness and are dying at a significantly higher rate. Because of institutional racism, minorities have less education and fewer educational opportunities. Minorities are disproportionately homeless and have significantly poorer housing options. Racial residential segregation contributes to the concentration of poverty in minority communities. Communities with a high proportion of minorities are more likely than predominantly white communities to be exposed to environmental toxins, including lead and asbestos. Minorities disproportionately work in jobs with higher physical and psycho-social health risks (i.e., migrant farm workers, fast food workers, garment industry workers). Minority communities are frequently the targets of institutions promoting unhealthy products, such as alcohol and tobacco. Thus, the current health status disparity of minorities is the cumulative result of both past and current racism throughout the American culture.

Manifestation of Institutional Racism in US Health Care. Institutional racism in health care has significantly affected not only access to health care, but also the quality of health care received. Institutional racial discrimination in health care delivery, financing, and research continues to exist. In 1999, the U.S. Commission on Civil Rights reported to the President and the Congress that: "[The Government’s] failure to recognize and eliminate [racial] differences in health care delivery, financing, and research presents a discriminatory barrier that creates and perpetuates differences in health status." Racial discrimination in health care manifests itself in many different ways including:

Barriers to Hospitals and Health Care Institutions. The institutional racism that exists in hospitals and health care institutions manifests itself in a number of ways, including the disproportionate closure of hospitals that primarily serve the minority community.

Barriers to Nursing Homes. Minorities are disproportionately excluded from nursing homes because of Medicaid policies which result in fewer expenditures on minority populations for nursing home care.

Barriers to Physicians and Other Providers. Minority physicians are significantly more likely to practice in minority communities. Yet, minorities are seriously under represented in health care professions and the minuscule efforts to solve that problem (affirmative action) is under serious political and legal attack.

Lack of Economic Access to Health Care. A disproportionate number of racial minorities have no insurance, are unemployed, are employed in jobs that do not provide health care insurance, disqualify for government assistance programs, or fail to participate because of administrative barriers.

Racial Disparities in Medical Treatment. There is overwhelming evidence of racial and ethnic disparities across a wide range of in clinical care in the U.S. Studies document that the most favored patient is "White, male between the ages of 25 and 44".

Disparate Impact of the Intersection of Race and Gender. The unique experiences of minority women have been largely ignored by the health care system. Race discrimination and sex discrimination intersect to magnify the difficulties minority women face in gaining equal access to quality health care.

Lack of data and standardized collection methods. The existing data collection does not allow for regular collection of race data on provider and institutional behavior. The lack of a uniform data collection method makes obtaining an accurate and specific description of race discrimination in the health care system extremely difficult.

Lack of Language and Culturally Competent Care. The failure to use bilingual, professionally and culturally competent, and ethnically matched staff in patient/client contact positions has resulted in lack of access, miscommunication and mistreatment for minorities with limited proficiency in English.

Rationing Through Managed Care. The health care financing system has been steadily moving to managed care as a means of rationing health care. There is inadequate oversight to assure that managed care develops more expensive but culturally appropriate treatment modalities, to assure that they do not refuse or minimize the expenditures necessary to develop adequate infrastructure for minority communities, or to assure that the rationing does not result in disproportionately affecting minorities.

Institutional Racism and the Law. Racial inequality in health care persists in the United States because the laws prohibiting racial discrimination are inadequate for addressing issues of institutional racial discrimination. The US legal system has been particularly reluctant to address issues of racial discrimination that result from policies and practices that have a disparate racial impact. In fact, the federal law explicitly allows for such discrimination as long as the institution can demonstrate "business necessity".

In addition, the legal system requires individuals to be aware that the provider or institution has discriminated against them and that they have been injured by the provider, two conditions that are highly unlikely in racial discrimination in health care. Finally, the health care system, through managed care, has actually built in incentives which may encourage discrimination. Unlike housing, education, lending and employment, the federal government has not taken any action to address these unique civil rights enforcement problems in health care. State and federal law has proven ineffective in reducing and eliminating racial discrimination in health care and the US government has taken little action to correct the problem. In 1999, the U.S. Commission on Civil Rights reported that "[the government’s] failure to address . . . deeper, systemic problems is part of a larger deficiency . . . . a seeming inability to assert its authority within the health care system."

Summary. Medicine has found cures and controls for many afflictions, improving the health of all Americans. However, health institutions have failed to extend the same magnitude of improvement in health among White Americans to minority Americans. Health institutions have failed to eliminate the racially disparate distribution of health care. In fact, health institutions perpetuate distinctions among racial groups. In the case of health care discrimination, domestic laws do not address the current barriers faced by minorities; the executive branch, the legislatures and the courts are singularly reluctant to hold health care institutions and providers responsible for institutional racism. Thus, the United States has failed to meet its obligation under the Convention on the Elimination of All Forms of Racial Discrimination.


The Institute on Race, Health Care and the Law is dedicated to improving the health status of African Americans, Asian Americans, Latino(a) Americans, Native Americans, and Pacific Americans by helping legislators, policy makers, lawyers, health care professionals and consumers examine race, health and human rights; with particular attention to the role of domestic and international law in promoting and/or eliminating racial disparities in health status and health care. Professor Vernellia R. Randall is the founder and Executive Director of the Institute (randall@udayton.edu).

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Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu


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