Race, Health Care and the Law 
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Why DiversityInc May Issue is Institutional Racism

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Vernellia Randall

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 diversity efforts.
I am talking about heavy hitters in the field that seem to have a true understanding of racial diversity, like DiversityInc.

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 question
 

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.

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.

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.

Why DiversityInc’s Position is  evidence of Institutional  Racism

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: 

Dr. Alvin Poussaint said “There is something embedded in all our heads—including blacks’—that black lives are not worth as much as white lives. A lot of people object to that notion but I think it’s a major issue. . . Class and race are both big issues in all of this.” 

Professor Nancy Alder, University of California, said “race, ethnicity and class are closely linked and it is not possible to address one without considering the other.”

 
Mr. Otha “Skip” Spriggs, senior vice president, CIGNA Group Insurance, said “There are many factors, including race, ethnicity, socioeconomic status. . . All these factors need to be considered when trying to address disparities.”

Ms. Kalahn Taylor-Clark, EK Kellogg Fellow in Health Policy Research, Harvard University, said: “Thus, I believe that healthcare inequalities are ultimately race-based because the etiology of many of the problems [that cause disparities] is based in a foundation of individual, institutional and systemic racism.”

Dr. Anne Beal, senior program officer, Underserved Populations, The Commonwealth Fund, said “However, we also know that race matters. . . studies show that even when patients have the same type of health insurance, members of racial and ethnic minority groups receive lower quality of care. . .”

Dr Nicole Laurie, senior natural scientist, RAND  said “If you look at most of the research, it suggests that both play roles and sometimes the roles overlap.” 
Rep. Michael Honda, D-Calif., said “Race and class are inextricably tied together in the United States; health care inequities cannot be understood without taking both into account.”

Dr. John W. Rowe, executive chairman of Aetna, said “The racial divide in health care is complex, persistent, widespread, and above all, indisputable.”

Indisputable?

Not so much to DiversityInc’s publishers and editors.
 

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.

Again!