How Health Care Providers and Racism Interact

Benjamins, M., Whitman, S. (2014). Relationships between discrimination in health

care and health care outcomes among four race/ethnic groups. Journal of Behavioral Medicine, 37: 402-413.

The researchers are based out of Sinai Urban Health Institute in Chicago, IL. Their study focuses on the ways in which discrimination impacts health care by providing a comparison of the discrimination levels (both ethnic and racial0 in health care in four different ethnic groups. The study then analyzes the relationship between the acts of discrimination and the consequences in health care services. An assessment is made of ways in which mediators and moderators might be utilized in order to mitigate the risk of discrimination and its impact on care. The method used by the researchers to conduct this study included the adoption of multivariate logistic regression models. The sample studied consisted of 1700 individuals of white, black, Mexican, and Puerto Rican descent. Of this sample, nearly a quarter responded that they had experienced health care discrimination. There was a consistent skew that evidenced that discrimination correlated with race. The types of discrimination cited by the sample included not receiving the care they required, and not receiving quality of care. The researchers suggest that further studies be conducted in order to address qualitative issues and questions, such as "What happened or who was the perpetrator?" in the case of discrimination, so that a better assessment of the nature of the discrimination and its effects in health care can be used (p. 411). This information can then be utilized to develop methods of intervention that might help curb this phenomenon.

This study is helpful in providing a quantitative assessment of the matter of discrimination in the health care industry, with some 25% of a sample reporting that they have experienced discrimination. The study lacks in terms of qualitative analysis, which the researchers themselves assert should be conducted so as to deepen their understanding of the problem. Thus there is a gap in qualitative literature regarding discriminatory practices among health care providers that might be filled by a study utilizing a phenomenological approach.

Browne, A., Varcoe, C., Wong, S., Smye, V., Khan, K. (2014). Can ethnicity data collected at an organizational level be useful in addressing health and healthcare inequities? Ethnicity & Health, 19(2): 240-254.

The researchers are based in the School of Nursing at the University of British Columbia in Vancouver, Canada as well as at the Centre for Health Services and Policy Research at the same university. The study's focus is on the initiative of Canadian authorities to collect data on ethnicity types relating to patients receiving health care from specific health care providers and organizations. The study's intent is to monitor and assess the "potential quality, utility and relevance of ethnicity data" as it pertains to the authorities' ability to treat health/healthcare inequities (p. 240). The researchers use a qualitative framework to collect data from a single city, from which interviews are conducted with a sample of 104 patients, health care providers and community leaders, with an eye to monitoring diversity. The assessment of these interviews was made using interpretive thematic analysis.

The researchers found that there exist problematic issues relating to the quality of data provided by the interviews, exacerbated by the researchers' assessment that those individuals who are most likely to be at the receiving end of the negative impact of inequity provide some of the most problematic information in terms of data quality, and that there is little in the way of data to suggest that there is discrimination occurring. Thus the researchers conclude that racialized groups typically provide unreliable data in spite of their belonging to at risk groups. The researchers recommend better controls for measuring and collecting data from ethnocultural groups and that a mechanism be devised that can be used to show correlation between perceptions of discrimination and ethnicity/race. Currently such a mechanism is missing in the literature and this is a gap that needs to be addressed. Thus, this study is helpful for assessing the need in research for obtaining reliable qualitative data that is free of bias.

Grace, B.S., Kara, T., Kennedy, S. E., McDonald, S. P. (2014). Racial disparities in pediatric kidney transplantation in New England. Pediatr Transplant, 18: 689-697.

This study is conducted by researchers of the Australia and New Zealand Dialysis and Transplant Registry and the Discipline of Medicine in Adelaide, Australia. It addresses a gap in literature relating to racial variance in transplantations and outcomes in New Zealand. The study is located in New Zealand because of the country's unique demographic diversity. The sample consists of 215 patients under 18 years of age undergoing renal replacement therapy from 1990 to 2012. The findings showed that the highest percentage of the populace to have a transplant consisted of Asians and Europeans while Pacific and Maori patients were only half as likely as Europeans to receive a transplant. Patients of Pacific descent were most likely to have FSGS and no Pacific patients received re-transplant after losing their initial grafts. The findings also show that programs are in place to reduce the disparity among the ethnicities by supporting the proper donation spectrum. This study is helpful for showing how health care services can be limited in terms of providing the needed transplant services and organs for specific groups and/or minorities. The study is also helpful for showing that this limitation is being addressed within the same health care community as programs to generate more donors to meet the needs of these groups are encouraged by health care providers.

Greene, M. (2006). To restore faith and trust: Justice and biological access to cellular therapies. Hastings Center Report, 36(1): 57-63.

This study focuses on the need to make reparations for past discriminatory acts on the part of health care providers towards minorities. The method of reparations comes in the form of reorganizing stem cell banks so that stem cell therapy can be conducted and provided for minority groups rather than mainly for majority groups. The study shows that the majority of stem cells that are used at the clinic come from lines maintained at the cell bank that will not be used for minority groups. The researcher concludes that in order to make up for past wrongs committed against minorities by the medical community (wrongs such as the Tuskegee experiments), a right should now be done, namely the facilitation of the development of cell lines that will go to helping racial minority groups. This study is helpful for putting a historical perspective on discriminatory practices within the medical establishment in the U.S. and how such practices can always be redressed in current situations with a little concentration of awareness on such fields as stem cell research and cultivation.

Johnstone, M., Kanitsaki, O. (2010). The neglect of racism as an ethical issue in health care. Journal of Immigrant Minority Health, 12: 489-495.

The researchers are based in the School of Nursing at Deakin University in Melbourne, Australia and RMIT University also in Melbourne. The study focuses on the issue of race and racism as a cause of health care disparities and the ethical implications that arise as a result. The researchers highlight the fact that racism as an issue of ethics within the overall discourse of health care provisions is largely absent. Thus the study aims to address a gap in the literature regarding the interrelatedness of racism, ethics, and health care. The main aim of the study is to address the question of why racism is worthy of being addressed as an ethical/moral issue in health care as well as the question of why it has so far in academic circles failed to have been addressed from an ethical perspective. The study concludes that racism must be approached from an ethics perspective within the health care framework so as to legitimize the groundwork that must be lain in order to prevent racism in the health care industry. The researchers conduct their study by defining racism as "a highly charged moral issue" (p. 493) that divides people along controversial lines. This study is helpful for illustrating the need to view these lines from an objective and ethical standpoint so as to bring clarity to an issue that is otherwise muddied by different groups.

Khankeh, H., Ranjbar, M., Khorasani-Zavarch, D., Zargham-Boroujeni, Johansson, E.

(2015). Challenges in conducting qualitative research in health: A conceptual paper. Iranian Journal of Nursing and Midwifery Research, 20(6): 635-641.

This study is conducted in order to provide a better understanding of the ways in which qualitative analysis can be utilized in health care research. It notes that qualitative studies can be oriented towards assessing a social order or phenomenon within the health care framework by emphasizing the personal experience of those involved in the phenomenon. The main challenge that qualitative research presents is in posing the problem/framework and addressing the right question that will facilitate a proper study. Design and methodology are also deemed essential characteristics of the qualitative approach in health care research. Practical problems associated with this particular approach are addressed within the study -- namely the function of interpreting results/data, conducting a full literature review and avoiding "method slurring" (p. 641). The study concludes with the finding that by avoiding these pitfalls in qualitative design research, a better study can be conducted. This study is helpful for pointing out the ways in which qualitative analysis/research can go wrong, which is perhaps one reason so little of it is performed (although another reason may be that it is deemed less scientific because of its lack hard-numbers/quantitative data).

MacIntosh, T., Desai, M., Lewis, T., Jones, B., Nunez-Smith, M. (2013). Socially-

assigned race, healthcare discrimination and preventive healthcare services. PLoS One, 8(5): e64522.

The researchers are based in the Department of Emergency Medicine at Yale, the Department of Chronic Disease Epidemiology at Yale, the Robert Wood Johnson Foundation Clinical Scholars Program, the Department of Epidemiology at Emory University, and the Global Health Leadership Institute at Yale. The focus of the study is on the relationship between health care services and discrimination on the part of providers towards various racial groups. The manner in which these groups self-identify as of a particular race is also examined so as to clarify the nature of the social construct of race. The method utilized in this study was a cross-sectional analysis of the response of a sample size drawn from seven different states plus D.C., categorized into 3 groups using a two-fold classification of self-identified race and socially-assigned race (so as to determine whether there was any discrepancy between how individuals were perceived by society and how individuals perceived themselves. In total, more than 30,000 respondents participated in the survey. The findings showed that individuals who self-identified as minorities perceived racial discrimination from healthcare providers more than any other respondent (compared to those who identified as white or minority/white).

Another finding was that minorities viewed as being white by society standards received preventive vaccines more often than minorities viewed as minorities and that individuals who report being viewed as white by society also faced less discrimination from healthcare providers. This study supports the studies of this literature review in pointing out how racial constructs impact the health care industry. One weakness of it, however, is as Browne et al. (2014) pointed out in their study, that racialized groups typically represent unreliable data. Thus this study is helpful for raising the issue of discrimination in health care, but it mainly serves to illustrate only that racialized groups (minorities) feel discriminated against more than groups who are not viewed by society as minorities. The ramifications of this study are unclear.

Richardson, L., Norris, M. (2010). Access to health and health care: How race and ethnicity matter. Mount Sinai Journal of Medicine, 77: 166-177.

This study focuses on the issue of disparities in health care provisions among racial and ethnic groups. It shows that there are variant factors that contribute to these disparities, from biological vulnerability to lack of social resources, factors of environment, and interventions from health care providers. The aim of the study is to highlight the causative factors that lead to inequity in health care among different groups. The conclusion of the study is that via education and the expansion of access to health information, active health promotion programs can facilitate the effort to remedy these inequities and establish a more equal system of provisions for all groups. One way to do this is to provide access to health insurance along with a committed health care professional, dedicated to treating specific groups and/or regions within a populace regardless of race or ethnicity. The study discusses the impact of the built environment on these groups as well. This study is mainly helpful because it widens the vision of the available research on discrimination in health care by focusing on factors such as economic and social that impact the disparity in health care reception by certain groups. Because of these factors, and not solely because of race, these groups and not receiving the same amount of care as others. So there is a lack of health insurance coverage, a lack of committed providers, and a lack of understanding of what options are available to these groups. This issues must be addressed in order for the disparities to be overcome: it is not just as simple as saying that it is all the effect of racism and discrimination on the part of providers, according to the study, for such a view is too simplistic. Thus, this study supports indirectly the findings of Brown et al. (2014).