Systemic racism is a cause of health disparities

Annals of Behavioral Medicine, 2012

The Permanente Journal, 2008

Journal of Perinatology, 2018

Research suggests that health disparities in the United States are often associated with an individual's race and ethnicity, gender, income level, sexual orientation, or geographic location. Of these factors, the literature primarily focuses on racial and ethnic differences. It is well documented that minority populationsgenerally classified as African Americans, Native Americans, Asian/Pacific Islanders, and Hispanics-have more chronic diseases, higher mortality, and poorer health outcomes than individuals classified as white. a Nationally, the commitment to understanding and eliminating racial and ethnic health disparities is strong. The Healthy People 2010 initiative, a set of health promotion and disease prevention objectives for the nation, aims to eliminate health disparities by the year 2010. Healthy People 2010 has led to a number of federal programs designed to support this goal through data collection and research. The U.S. Department of Health and Human Services (HHS) and its agencies spearhead these efforts. HHS agencies with prominent roles include the Centers for Disease Control and Prevention (CDC), the Office for Civil Rights, the Centers for Medicare & Medicaid Services (CMS), the National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA). In 1999, as part of the Healthcare Research and Quality Act, Congress directed the Agency for Healthcare Research and Quality, a division of HHS, to develop an annual National Healthcare Disparities Report to track "prevailing disparities in health care delivery as they relate to racial factors and socioeconomic factors in priority populations." Thirty-four states, including Ohio, have a designated governmental entity addressing minority health. Ohio's Commission on Minority Health, established in 1987, was the first entity of its kind in the nation. Recently, the commission won a federal contract to create the National Association of State Offices of Minority Health. The purpose of this background paper is to create a common understanding on the issue of health disparities. The paper will define and describe current health disparities among racial and ethnic groups as well as present a framework for examining the intricate web of factors that can contribute to disparities. It will then offer potential policy solutions for addressing the issue of health disparities, as well as the challenges associated with each. Health Policy Institute of Ohio 3 Healthy People 2010 defines disparities in health as the "unequal burden in disease morbidity and mortality rates experienced by ethnic/racial groups as compared to the dominant group." 1 The Institute of Medicine's 2002 report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare ("the IOM Report") defines disparities in health care as "differences in the quality of health care that are not due to access-related factors or clinical needs, preferences or appropriateness of intervention." 2 The Health Resources and Services Administration, a key player in the national effort to eliminate disparities in health, defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care." What causes health disparities? Why are minority populations overburdened with disease and poor health outcomes? Are there promising solutions to this complex problem? A review of the research literature suggests that a multitude of complex factors contributes to health disparities, but little is known about the relative importance of these factors. In the 1985 Health and Human Services' "Report of the Secretary's Task Force on Black and Minority Health," health is said to be "influenced by the interaction of physiological, cultural, psychological, and societal factors that are poorly understood for the general population and even less so for minorities." 3 In short, it is challenging for social scientists to find ways to determine if, how, and to what extent each of these factors is related to health disparities experienced by minorities. Why is there such a strong national commitment to eliminate health disparities? With an increasingly diverse population, the health of our nation depends on our ability to keep minority populations healthy. According to Census 2000 results, minorities represent approximately 25 percent of the nation's population. Hispanics-now the nation's largest minority group-represent 12.5 percent of the total population, with 11 percent of the United States population citing Spanish as their primary language. 4 Hispanics and Asians account for more than 50 percent of the nation's population growth; between 2000 and 2050, the Hispanic b and Asian populations will more than triple, with Hispanics representing nearly a quarter of the total population and Asians representing 8 percent. 5 In Ohio, whites represent about 85 percent of the population and minorities represent about 15 percent [African American (11.5 percent), two or more races (1.4 percent), Asian (1.2 percent), other (0.8 percent), and Native American (0.2 percent)]. 6 The Hispanic population in Ohio grew 36 percent between 1990 and 2000, and now accounts for 1.9 percent of the state's total population. 7 b According to the U.S. Census Bureau, "Race and Hispanic origin are two separate concepts in the federal statistical system. People who are Hispanic may be of any race. People in each race group may be either Hispanic or Not Hispanic. Each person has two attributes, their race (or races) and whether or not they are Hispanic." U.S. Census Bureau, "U.S. Census Bureau Guidance on the Presentation and Comparison of Race and Hispanic Origin Data" (2003).

Journal of General Internal Medicine, 2007

Health inequalities by race, ethnicity, and social class in the United States are pervasive. This course introduces students to research that help understanding the social determinants of health and health disparities. The course is an introduction to research frameworks for intervening to improve/eliminate disparities and explores culturally responsive interventions. Introductory epidemiological and statistical concepts will be studied to strengthen research literacy and be better prepared to critically read the existent research literature on health and healthcare disparities. The course will require practical engagement through participatory methods and community engagement, including an understanding of human subjects research ethics. The course will be supplemented with fieldwork experiences and the engagement with health disparities researchers associated to the Center for Health Equity Intervention and Research.

2011

Racial and ethnic disparities in health care have been consistently documented in the diagnosis, treatment, and outcomes of many common clinical conditions, including cardiovascular disease, cancer, and diabetes. The 2003 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, defines disparities as differences in treatment between racial, ethnic or other demographic groups that are not directly attributable to variation in clinical needs or patient preferences and persist even after adjustment for socioeconomic factors. The IOM report Crossing the Quality Chasm has highlighted equity—the absence of disparities—as a key pillar of quality. Although some improvements have been achieved, persistent health care disparities in quality and access, which vary in magnitude and pattern within minority subpopulations, were recently documented in the 2009 AHRQ National Healthcare Disparities Report. Health care disparities have a multidim...

Du Bois Review: …, 2011

Although racial disparities in health have been documented both historically and in more contemporary contexts, the frameworks used to explain these patterns have varied, ranging from earlier theories regarding innate racial differences in biological vulnerability, to more recent theories focusing on the impact of social inequalities. However, despite increasing evidence for the lack of a genetic definition of race, biological explanations for the association between race and health continue in public health and medical discourse. Indeed, there is considerable debate between those adopting a "social determinants" perspective of race and health and those focusing on more individual-level psychological, behavioral, and biologic risk factors. While there are a number of scientifically plausible and evolving reasons for the association between race and health, ranging from broader social forces to factors at the cellular level, in this essay we argue for the need for more transdisciplinary approaches that specify determinants at multiple ecological levels of analysis. We posit that contrasting ways of examining race and health are not necessarily incompatible, and that more productive discussions should explicitly differentiate between determinants of individual health from those of population health; and between inquiries addressing racial patterns in health from those seeking to explain racial disparities in health. Specifically, we advance a socio-psychobiological framework, which is both historically grounded and evidence-based. This model asserts that psychological and biological factors, while playing a central role in determining individual risk for poor health, are relatively less consequential for understanding racial disparities in health at the population level. Such a framework emphasizes the etiologic role of social inequities in generating and perpetuating racial disparities in health and highlights their impact on psychological, behavioral, and biological disease processes.

Annals of health law / Loyola University Chicago, School of Law, Institute for Health Law, 2010

Systematic Reviews

Background In the USA, access to quality healthcare varies greatly across racial and ethnic groups, resulting in significant health disparities. A new term, “racial health equity” (RHE), is increasingly reported in the medical literature, but there is currently no consensus definition of the term. Additionally, related terms such as “health disparities,” “health inequities,” and “equality” have been inconsistently used when defining RHE. Methods The primary purpose of this scoping review is to investigate the current use and underlying concepts used to define racial health equity. The study will address two key questions: (1) “What terminology and definitions have been used to characterize RHE?” and (2) “What knowledge gaps and challenges are present in the current state of RHE research and theory?” The review will collect and analyze data from three sources: (1) websites from key national and international health organizations, (2) theoretical and narrative published articles, and ...

2007