Health care and racial/ethnic relations
Health care and racial/ethnic relations in the United States are deeply intertwined, with systemic racism significantly impacting the quality and provision of care. Historically, marginalized racial and ethnic groups have faced notable disparities in health care access, treatment, and outcomes compared to the White population. Despite advancements since the civil rights movement, issues such as provider discrimination, cultural incompetence, and structural inequities continue to perpetuate these disparities. For instance, studies indicate that Black, Indigenous, and other people of color often receive medical treatment less frequently and later in the progression of diseases, contributing to higher mortality and morbidity rates.
Efforts to address these inequalities include advocacy for policies that promote health equity, such as the expansion of health insurance coverage and the importance of culturally competent care in provider training. The Affordable Care Act aimed to close gaps in health care access, resulting in improvements for many racial and ethnic groups, although disparities still persist. The COVID-19 pandemic further exacerbated existing inequities, highlighting the urgent need for targeted public health interventions. Overall, the complex dynamics of race and health care demand ongoing attention and action to ensure equitable health outcomes for all individuals, regardless of their racial or ethnic backgrounds.
Subject Terms
Health care and racial/ethnic relations
SIGNIFICANCE: Systemic racism affects the provision and quality of health care in the United States. Advocates of equality in health care seek to design and implement policies that serve to erode racial inequities and improve intergroup relations.
Racial and ethnic relations intersect with virtually every facet of US society. From the civil rights movement of the 1950s on, race in general—and Black-White relations in particular—has been a dominant construct in intergroup relations in the country. Although considerable progress has been made since the 1950s, prejudice, discrimination, and inequality persist and are systemic. In addition, increasing ethnic, racial, and religious diversity further complicate the situation, as new conflicts emerge between the majority and new entrants and among different minority groups.
Health care is another central societal issue. Therefore, it is no surprise that perspectives on racial and ethnic relations often inform discussions of health care, and vice versa. Most notably, studies have consistently shown that marginalized racial and ethnic groups face considerable disparities in health care compared to the White population. For example, the American Medical Association (AMA) reports that even with overall improvements in public health over the decades, marginalized groups tend to receive lower quality health care, including a lower likelihood of routine care and higher mortality and morbidity rates. These findings have generated further sociological and medical research, as well as political debate and various policy proposals.
Racial Disparities in Health Care
Racial disparities in health care have been noted throughout US history, but by the 1990s there was increasing attention to the issue. The 1998 government report One America in the Twenty-first Century: Forging a New Future noted that gaps in longevity and health care access for racially marginalized people were well documented. The report also noted that the continuing gap in health care access undermined the vision of one America. The authors proclaimed that “America should not be a society where babies of different racial backgrounds have significantly different life expectancies. If our Nation is committed to the proposition that all people are created equal, our most basic indicators of life and health should reflect this principle.”
In discussing the issues of race and health, One America in the Twenty-First Century: Forging a New Future made conclusions about three critical areas in health care in the context of race. The report identifies structural inequities, discrimination by providers, and the cultural competency of providers as key factors that contribute to continuing inequity in health care delivery.
Structural inequities are difficulties in accessing the health care system that stem from disparities in employment, income, and wealth. The statistics show that, on average, Black people, Indigenous people, and other people of color receive medical treatment less frequently and in later stages of disease than White people. Such inequities in access affect rates of sickness, disease, suffering, life expectancy, and mortality among racial groups. Furthermore, studies indicate that racial disparities in health and health care are interrelated and sustained in various socioeconomic groups.
Racial issues may also affect provider-patient relationships and the quality of the care delivered. The health care establishment is disproportionately White. Health care providers, like everyone else, can be affected by racial biases and may lack the language and intercultural skills to serve racially marginalized patients fully. Furthermore, providers may discriminate against patients on the basis of stereotypes. Such discrimination can result in differences in care such as inadequate, denied, or delayed medical treatment, unnecessarily prescribed treatment, or cursory care.
In addition to structural inequities and provider discrimination, racial disparities in health care access may be affected by differences in language or culture between the provider and patient. Providers need to be culturally competent in order to deliver effective medical care to people from different cultural backgrounds. Often, these cultural differences undermine the necessary cooperation between providers and clients, which in turn results in less effective medical services.
Despite widespread awareness of these problems, statistics show that disparities in health care and delivery continued to exist and even to grow in certain areas into the twenty-first century. The Henry J. Kaiser Family Foundation 2010 report "Health Reform and Communities of Color: Implications for Racial and Ethnic Health Disparities" noted that "although people of color represent one-third of the US population, they comprise more than half of the uninsured." In 2020, the Centers for Disease Control and Prevention (CDC) recognized that "though health indicators such as life expectancy and infant mortality have improved for most Americans, some minorities experience a disproportionate burden of preventable disease, death, and disability compared with non-minorities."
Health Equity Efforts
W. Winborne and R. Cohen, editors of Intergroup Relations in the United States: Research Perspectives (1998), observed that “advocates of race consciousness in public policy believe that race functions so powerfully in American society that to ignore it is to perpetuate institutionalized inequalities and marginalization of certain groups.” Furthermore, they concluded that “race-cognizant public policies may be seen as improving race relations by fostering equality and recognition of marginalized groups, despite causing backlash against groups benefiting from them.” This perspective supports the view that in order to realize improvements in overall health care in the United States, it is necessary to design and implement policies that serve to erode racial inequalities and improve intergroup relations.
The authors of One America in the Twenty-First Century: Forging a New Future outlined a range of steps to eliminate disparities in key areas of health care and access. These recommendations included continued advocacy for broad-based expansions in health-insurance coverage; continued advocacy of increased health care access for underserved groups; increased funding for existing programs targeted to underserved and minority populations; enhanced financial and regulatory mechanisms to promote culturally competent care; and increased emphasis on the importance of cultural competence to institutions training health care providers.
At times, the US government has taken concrete steps toward addressing racial and ethnic disparities in health care. In the late 1990s, President Bill Clinton announced efforts to eliminate long-standing racial disparities in infant mortality, cancer screening and management, heart disease, AIDS, and immunizations by the year 2010. While these goals were not met across the board, advocates of health care equity were encouraged by official acknowledgement of the systemic problems in the US health care system. One of the primary objectives of the Patient Protection and Affordable Care Act (ACA), signed by President Barack Obama in 2010, was to close the gap in health care disparity between White Americans and people of color. For example, one of the provisions expanded Medicare benefits to individuals who are below 133 percent of the federal poverty level (FPL). Another provision allowed for affordable care for those who are either not granted insurance through an employer or cannot afford their employer's plan; this provision applies to those whose incomes fall between 133 and 400 percent of the FPL. At the time of the law's passage, 80 percent of Hispanic Americans, Black Americans, American Indians, and Alaska Natives fit into these parameters. According to a Kaiser Family Foundation report, by 2017 the ACA was credited with overall improved health care coverage, access, and utilization for all racial and ethnic groups and a narrowing of some disparities, though gaps remained. According to a September 2023 US Census Bureau report, while 10.8 percent of the US working-age population overall was uninsured in 2022, the percentage of uninsured varied when broken down by race and ethnicity. That year, 6.8 percent of White, non-Hispanic Americans were uninsured, compared to 11.4 percent of Black Americans, 23.4 percent of Hispanic Americans of any race, and 7.4 percent of Asian Americans.
Researchers continue to investigate the complex connections between race/ethnicity and health care, including the social and economic implications of various policies. New challenges also continue to emerge. For example, the coronavirus disease 2019 (COVID-19) pandemic, declared in 2020, further highlighted the discrepancies found in health care treatment provided to historically marginalized racial and ethnic groups. Black Americans were twice as likely as White Americans to die of COVID-19 during the pandemic—even after researchers accounted for higher rates of pre-existing conditions that increase the mortality risk of COVID-19, such as obesity, hypertension, and diabetes among the Black population. American Indian or Alaska Natives, Hispanic or Latino Americans, and Native Hawaiian and Pacific Islander Americans also had higher COVID-19 death rates than White Americans. Such disparities underscored the continued need for targeted public health interventions for people of color and equitable access to health care resources.
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