This essay examines the extent to which racial and ethnic disparities in U.S. healthcare access are driven by racism versus socioeconomic inequality. Beginning with definitions of race, ethnicity, racism, and disparity, the paper traces the historical roots of unequal healthcare treatment from the antebellum era through civil rights legislation. It then reviews contemporary research — including studies on Medicare's Medication Therapy Management services and patterns of preventive care utilization — to weigh evidence on both sides of the debate. The paper concludes that while institutionalized racism has had lasting effects, current disparities appear to be driven primarily by socioeconomic factors, though a racial component cannot be entirely dismissed.
Healthcare has been a divisive topic in the United States for the past two decades across both the public and private sectors, bringing the entire subject to the forefront of national attention. Whether an individual has personally been denied equal access to healthcare or not, obtaining good, fairly priced medical care is a challenge in many parts of the country.
Among the many questions that populate this debate, one is becoming increasingly central. There is a divide in the United States that has been present as long as the country has existed as a recognized nation — a divide caused by deep-rooted inequities that persist to this day. This divide is racial in nature and appears to permeate every facet of society. The Caucasian population evidently holds an advantage in American society even though nearly 40% of the population is non-white (Wang, Mullins, Brown, Shih, Dagogo-Jack, Hong, & Cushman, 2010). This difference is as apparent in access to quality and equitable healthcare as it is anywhere else.
Since healthcare has become such a prominent issue — particularly following the signing of healthcare reform legislation — it is time to reexamine how access to quality healthcare is distributed across all races and ethnicities. Does sociological research prove that there is an actual disparity in the healthcare given to people of color compared to their Caucasian counterparts? If this disparity does exist, what can be done about it? This essay offers definitions of the key subjects being studied, a history of the issue, evidence for and against racial disparity in healthcare, and, finally, a verdict based on the evidence presented.
When conducting any study, it is necessary to begin by ensuring that both the author and the reader share a clear understanding of the terms being investigated. In this particular study, the most important terms are race and ethnicity (discussed together), racism, disparity, and difference. These concepts are central to whether a racial disparity exists in healthcare access. The charge of racism must also be understood carefully — specifically, whether any alleged disparity is deliberate or merely a product of oversight.
The first two terms are race and ethnicity. It has long been accepted that there are at least three broad racial classifications — Negroid, Caucasoid, and Mongoloid — in the world. However, advances in science have revealed that these differences are largely based on geographic origin rather than fundamental biological distinction (Krieger, 2003). Genetic science, and the Human Genome Project in particular, has shed new light on human diversity and racial divisions. Before this science was established, some scholars advocated for more racial divisions rather than fewer. Genetic research, however, has demonstrated that racial diversity is not a genetic fact (Wang et al., 2010). Anthropologists have found that all humans share a common ancestor, meaning that race and ethnicity are essentially social rather than biological constructs — both grounded in cultural, rather than genetic, distinctions (Krieger, 2003).
Race and ethnicity may cause people to look and act differently, but does this difference produce a disparity? In this discussion, disparity in quality healthcare access due to race suggests racism — a willed difference in the healthcare that people from different racial and ethnic backgrounds receive. The term difference, as used in this paper, refers not to varying levels of healthcare based on any physiological marker, but to the variation produced by differing socioeconomic backgrounds. This includes all dimensions of that concept: where people live, how much money they earn, and so forth. The central question of this research is therefore whether there is a racial disparity or a socioeconomic difference driving unequal access to healthcare.
Race has been a defining factor in the United States since its inception. People have been enslaved, indentured, celebrated, or despised on account of their race. Stephen Thomas (2001), a professor in the Center for Minority Health, 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, the original racial distinctions were not even confined to differences from people of African descent, but extended to anyone from a non-favored European nation. Over time, however, this evolved into a form of racism directed primarily at people who were visibly different. People of color — Native Americans, Black Americans, Hispanics — became easy targets because of differences in pigmentation from those of Northern European heritage. Because the Irish and Italians were able to more easily blend into the American mainstream, racism against them faded as intermarriage occurred. The same was not true for those of West Indian or African heritage, where a stark difference in skin color made racism far simpler to perpetuate.
Racism has never been an isolated phenomenon. People were discriminated against across all arenas of society. After the Civil War and the emancipation of millions of African Americans, Black people still could not find employment on equal terms with white workers. This disparity of treatment was as apparent in healthcare access as it was in any other domain.
As Krieger (2003) documents, in the mid-1800s, leading U.S. abolitionists and physicians — both Black and white — challenged convention by arguing that the poorer health of the Black population relative to the white population resulted not from innate inferiority but from white privilege, enforced through slavery in the South and legal racial discrimination in the North.
It is a historical fact that people of color were not given the same access to healthcare. Native Americans often died from disease and physical ailments because they were forced to rely on traditional remedies rather than modern medicine (Thomas, 2001). From Chinese immigrants in Northern California to African Americans across the country, healthcare access was a serious problem. The question is whether this problem, once rooted in explicit racial prejudice, has persisted to the present day on racial grounds alone.
"Evidence for and against race-based healthcare gaps"
"Weighing racial versus socioeconomic explanations"
Because both findings carry validity, it is difficult to reach a definitive conclusion. Research would need to control for race and examine whether meaningful differences persist among people of similar socioeconomic status but different racial backgrounds. If a study were conducted exclusively among African-American or Hispanic participants across varying income levels, it would be easier to isolate the racial variable and reach a clearer answer. As it stands, both sides of the debate have valid research supporting their positions.
Disparity of access cannot be attributed solely to racial prejudice any more than it could be attributed to some arbitrary physical characteristic. The research clearly demonstrates that there is a meaningful difference in the quality of care received by middle-class and above Americans compared to those of lower socioeconomic status, and this dimension of the problem may actually be more tractable than dismantling entrenched racist attitudes that some healthcare professionals may hold.
Access to quality healthcare needs to improve, because all people deserve equitable coverage for their illnesses. No one should die simply because they could not afford as skilled a physician as someone else. At the same time, it is difficult to assign blame to healthcare professionals wholesale. Physicians and other providers will naturally gravitate toward areas where they feel safe and where they can earn a sustainable income. Some will act entirely out of altruism and sacrifice financial gain for principle, but that behavior cannot be mandated by law.
It is a societal failing that people cannot obtain better healthcare because of where they live and how much money they make. Yet this too is difficult to change. Many people value a society built on free-market principles rather than a socialized redistribution of wealth, and so some structural inequities will persist. Where the problem is proven to be racial in nature, it should always be prosecuted — laws are in place to combat that. Compelling healthcare professionals to practice in under-served locations is a far more complex policy challenge. Social programs that direct funding to under-resourced institutions — to provide up-to-date medical equipment and the trained personnel to use it — could, however, represent an equitable path forward.
Most likely, racism does exist to some extent within the healthcare system, but to characterize it as the dominant cause of healthcare inequality is an overstatement according to the available research. What is clear is that healthcare access is not equitable, and meaningful changes to the system are necessary.
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