Racism is Not the Cause of Health Disparities
by Jeffery Temple (bio)
In 2002, a congressionally-commissioned report by the Institute of Medicine (IOM) determined health disparities between whites and minorities were caused by racial bias in America's health care system.
For those who see the world through the prism of race, it was a validation. Dr. Lucille Perez, then president of the race-based National Medical Association, remarked, "It validates what many of us have been saying for so long - that racism is a major culprit in the mix of health disparities and has had a devastating impact on African-Americans."
But does this claim stand up to scrutiny?
On June 12, the U.S. Commission on Civil Rights will revisit these sorts of allegations during a panel discussion that will include former Health and Human Services Secretary Dr. Louis Sullivan and Dr. Sally Satel of the American Enterprise Institute.
Commissioners would be wise to seek the racial "differences" in health issues rather than concentrating on finding "disparity."
This was the methodology of a 2003 report from the Agency for Healthcare Research and Quality (AHRQ), which used the more accurate word "differences" instead of "disparity" to describe health care discrepancies among the races. Liberals quickly became outraged at the perceived downplay of the charge of racial bias because "disparity," in health care circles, is correlated with the product of racism and "differences" is not.
The AHRQ report looked at the socioeconomic situations of individuals and not just their race. In fact, if one removes race from the equation and judges American's health care status based on socioeconomic situations, geographical locations, genetics, lifestyle choices and similar factors, the discrepancies between races are largely diminished.
Disproportions do exist, but cause can be clouded if one fixates on race. For example, poverty-afflicted inner-city neighborhoods often have high-volume, low-quality public hospitals. Racial demographics in these neighborhoods average six percent white, 22 percent Hispanic and 34 percent black.
All patients of these hospitals generally receive the same quality of care regardless of their race, but relying solely on demographic data implies a conspiracy against certain races.
There is also the factor of lifestyle choices. Blacks are unfortunately overrepresented among those more likely to engage in risky behaviors, such as smoking and alcohol abuse. This can lead to chronic conditions such as heart disease, stroke, lung cancer, HIV and diabetes - all major causes of death amongst the community.
Wellness activities such as dieting and exercising can diminish the occurrence of such complications, narrowing the statistical differences along the racial divide.
Most studies regarding racial disparities in health care are also unreliably based on samples of low-income blacks compared to middle-income whites. In order to provide more accurate racial comparisons, a more representative sample must be studied.
The IOM report actually acknowledged this lack of statistical rigor: "Almost of all the studies reviewed here find that as more potentially confounding variables are controlled, the magnitude of racial and ethnic differentials in care decreases."
Why would the IOM forgo a more precise study for one with a misleading conclusion?
Perhaps because the mandate of the IOM report was to "evaluate potential sources of racial and ethnic disparities in healthcare, including the role of bias, discrimination, and stereotyping at the individual, institutional, and health systems levels."
According to a 1994 Harris Poll for the Commonwealth Fund, race does not play a significant role in patients deciding which doctor to see - with only five percent of whites and 12 percent of minorities claiming it is important.
The American Medical Association's list of recommendations on reducing racial disparities, released in May 2009, also did not mention stopping the claimed racial bias as a solution to the "disparity" problem.
If patients and doctors don't see racism causing health care discrepancies, who does? It seems the liberals, the ones looking for excuses to bring radical change to our health care system, are the only one finding a crisis.
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Jeffery Temple is a research associate for the Project 21 black leadership network. Comments may be sent to [email protected].
Published by The National Center for Public Policy Research. Reprints
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