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). |
