Some overall thoughts about health disparities

Sorry I missed posting yesterday, I was extremely busy -- I had two presentations at the Minority Health Conference, plus an evening meeting, and lots of business to catch up on with colleagues.

Among advocates for equal access and justice in many fields, such as higher education, there is often a tension between people who advocate for racial and ethnic equality, and people who focus on social class. For example, Walter Benn Michaels argues that the emphasis on "diversity" in higher education has covered up for the continuing, indeed growing elitism of selective colleges and universities. Admitting rich black and Latino kids as well as rich white kids is not really doing anything to promote equality of opportunity.

The language of racial and ethnic disparities has become pervasive in health policy in recent years. But in health and health care there really little conflict between concern with race/ethnicity and concern with class, or at least there isn't so far. For one thing, everyone recognizes that a major driver of disparities in health is social inequality, and people who want to reduce health disparities are committed to reducing economic inequality, and working to eliminate poverty and associated environmental causes of ill health such as sub-standard housing, differential exposure to pollution, inadequate opportunities for recreation, malnutrition, etc.

We know that socio-economic status in the U.S. is correlated with race and ethnicity, but that means that policies to reduce economic justice in general will also reduce ethnic disparities. That said, we also know that discrimination and historic disadvantage are part of the reason why inequalities exist in the first place, so that the solutions to inequality must include overcoming racism and correcting historic wrongs. There is no conflict there.

Second, everyone concerned with health care disparities stipulates that universal access is an essential first step. But we also have come to recognize that it is not enough. Once people get in the door of the clinic or hospital, they still face unequal treatment, inappropriate treatment, miscommunication, and unequal outcomes, associated with their culture, identity, skin color, and environmental disadvantages they bring with them from their lifeworlds. So race and ethnicity remain essential categories in the pursuit of justice. We'll have much more to say about this.