Health and Illness Racism's Role in Health Service Inequalities

Racism's Role in Health Service Inequalities

Healthcare has been a divisive topic in the United States for the past two decades in the public and private sectors. This has brought the entire subject to the fore in the eyes of most Americans. Whether an individual is one of the people who has been denied equal access to health care or not, it can be very trying to receive good, fairly priced healthcare in a lot of areas in the United States.

Among the many questions that populate the debate, one is becoming more and more central. There is a divide in the United States that has been present as long as this country has been a recognized nation. That divide is caused by the inequities that do exist, and have existed. This divide is racial in nature and seems to work its way into every facet of society. The Caucasian population apparently has an advantage in the society even though almost 40% of the population is non-white (Wang, Mullins, Brown, Shih, Dagogo-Jack, Hong, & Cushman, 2010). This difference is as apparent when the subject is access to quality and equitable healthcare as it is anywhere else.

Since healthcare is such a large topic now, after the signing of healthcare reform this past year, it is time to reexamine how access to quality healthcare is available to people of all races and ethnicities. Does the sociological research prove that there is an actual disparity in the healthcare given to people of color in deference to their Caucasian counterparts? If this disparity actually does exist, what can be done about it? This essay will offer definitions of the subjects being studied, the history of the issue, evidence for and against racial disparity bin healthcare, and, finally, a verdict as to the evidence that is given.

Definitions

When conducting any study it is necessary to begin a search for evidence by making sure that both the author of the research paper or study and the reader understand what is meant by the terms being investigated. In this particular study, the most important terms are race and ethnicity (which will be discussed corporately), racism, disparity, and difference. These terms are central to whether there is a racial disparity when it comes to healthcare access given to all participants in the healthcare system. The charge of racism is one that also must be understood, as in, is the alleged disparity deliberate or is it simply oversight.

The first two terms are racism and ethnicity. It has been an accepted fact for many years that there are at least three different races -- Negroid, Caucasoid, Mongoloid -- in the world. However, due to the increased influence of science, these differences have been found to be largely based on location rather than actual difference (Krieger, 2003). Genetic science, and the Genome Project in particular, have shed light on humans and racial divisions. Before the science was known, some people advocated for more racial divisions rather than fewer. But genetic science has proven that racial diversity is not a genetic fact (Wang, et al., 2010). Anthropologists have found that all humans have a common ancestor. This means that race and ethnicity are basically the same. Both are based on cultural rather than genetic basis (Krieger, 2003).

Race and ethnicity may make people look different, and act differently, but does this difference cause a disparity. In this discussion, disparity in quality healthcare access due to race smacks of racism. The term connotes a willed difference in the healthcare access that people from different racial and ethnic backgrounds receive. The other term, difference, will be used in this paper not as a term of different levels of healthcare based on some physiological marker, but because people come from different socioeconomic backgrounds. This includes all facets of that word. If there is a difference in healthcare coverage, it is because of where the people live, how much money they make, and so forth. This is the key element of the research; whether there is a racial disparity or a socioeconomic difference in all people's access to healthcare.

Historical Antecedents

As said previously, race has been a factor in the United States since its inception. People have been slaves, indentured, lauded for their race, or despised because of it. Stephen Thomas (2001), a professor in the Center for Minority Health at the University of Pittsburgh states that;

"[T]he original language of White racial differences began with the anxious response of early Americans to waves of immigration, beginning in the 1840s when the Irish (or Celts) entered U.S....

ports, followed by nationals from Central, Southern, and Eastern Europe. Over time, the descendants of these "White ethnic groups" became the monolithic Caucasian race, the majority population, superior in all respects to the Black people of African descent."
Thus, original racial difference was not even confined to Caucasians, but to anyone who was not of a certain European nation. Of course, this did disintegrate into a meaning of racism that included people who looked differently. This means that people of color -- Native Americans, blacks, Hispanics -- have all been easy targets because of differences in pigmentation from people who have a Northern European heritage. Because the Irish and Italians were able to more easily blend into the American mainstream, racism against them was forgotten as they intermarried. Not so with those of more West Indian or African heritage. It is difficult to disguise a stark color difference, and so racism was simpler to perpetrate against these peoples.

Racism is not an isolated entity either. People were discriminated against in all arenas in society. After the Civil War and the release of millions of African-American slaves, blacks still could not find a job that was in any sense equal to a man with white skin. This disparity of treatment was just apparent when it came to healthcare access as it was in any other instance.

In the mid-1800s, leading U.S. abolitionists and physicians, Black and White alike, challenged convention by arguing that the poorer health of the Black relative to the White population resulted not from innate inferiority but rather White privilege, enforced via slavery in the South and legal racial discrimination in the North (Krieger, 2003).

It is a historic fact that people of color were not given the same access to healthcare. Native Americans often died from disease and physical ailments because they had to rely on old superstition rather than modern medicine (Thomas, 2001). From Chinese immigrants In northern California to African-Americans across the country, healthcare access was a major problem. Then it was because of the racial difference that these peoples exhibited, but has it remained a problem, due to race alone, to this day?

Is there Racial Disparity?

A review of the definitions of disparity and difference, as they are to be used in this paper, is necessary. Disparity, with regard to access of people of color to quality healthcare, is based on the fact that those consumers do not receive the same healthcare coverage as light-skinned Americans because of racial or ethnic background. Difference in the quality of healthcare received would be a factor of socioeconomic variation, and would apply to all people in that circumstance, rather than a physiological difference.

As was outlined in the historical section, it is a historical fact that there was institutionalized racism that made it impossible for people to receive equitable healthcare (Krieger, 2003). This can be seen up until the latter part of the twentieth century when civil rights legislation made it a law that people could not be discriminated against, for any reason and from anything, because of their race Unfortunately, there remain some alarming signs that people of color are not receiving the same care as white people are getting.

Medicare is available to all people, regardless any distinction except age, after that person turns 65. However, there are special programs within Medicare that affect people younger than that. Medication Therapy Management (MTM) services help people with how they administer their medication. These service are available to all who are eligible, but one study found what seemed to be a disparity among the people seeking the service.

"This study found that both blacks and Hispanics would have a lower likelihood of meeting MTM eligibility criteria than would whites based on the eligibility thresholds used by Part D plans in 2006 and the new CMS eligibility thresholds for 2010. These disparity patterns also were found among individuals with severe health problems" (Wang, et al., 2010).

Study authors say that these criteria were not designed to be racist, but that, according to the data, they appear to be. This is a federally backed program that is supposed to apply to all people equally, but does not.

In other instances, quality healthcare that is available to the white population is uncharacteristically denied to people of color. It has been noted that, "black people had fewer mammograms, immunisations, and ambulatory care visits than white people, but greater mortality and more admissions to hospital" (Bhopal, 1998). This seems to…