Abstract

This paper focuses on the causes of racial and ethnic disparities in the U.S. healthcare system in the past and today.  This is a problem that affects all people in the United States and it should concern everyone because we live in such a diverse country.  Throughout this paper I have analyzed data from different studies to arrive at my conclusion while an ethical analysis is also included.  The facts and statistics you will read throughout the paper are alarming because the disparities result from differences in treatment in the healthcare system directly relating to minority care.  These differences are a result of lack of access to primary care, different education and income levels among races and ethnicities, cultural and language barriers in healthcare, and the composition of the United States healthcare workforce.  This paper serves as a sign that reform is vital and warranted to improve the current healthcare disparities.

Introduction

There is evidence to suggest that racial and ethnic disparities exist in the United State’s healthcare system.  A health disparity can be defined as “a chain of events resulting by a difference in: 1) the environment; 2) access to, utilization of, and quality of care; 3) health status; or 4) a particular health outcome.”¹   Race is viewed as the physical (skin color, facial features, etc.) and genetic differences among various groups.²  Ethnicity is a concept of religious, political, socioeconomic, and cultural differences among groups.³  Addressing racial and ethnic healthcare disparities has become part of the United State’s national agenda in healthcare reform.  Healthy People 2010 was developed by federal agencies in hopes to accomplish two goals regarding health care in the U.S. that they feel were a priority.  One of these goals was eliminating racial and ethnic health disparities ⁴, specifically focusing on cancer screening, cardiovascular disease, diabetes, HIV/AIDS, immunization rates, and infant mortality.⁵

Differences in health outcomes have been apparent since the U.S. was founded in 1776.  Today, this is still true with differences in life expectancy at birth.  For instance, the life expectancy for all people at birth is 77.8 years.  However, the life expectancy among white people is 75.7 years for males and 80.8 years for females.  The life expectancy among black people is 69.5 years for males and 76.5 years for females.⁶  This is just one statistic of many that will show racial and ethnic healthcare disparities are present in the U.S.  

The United States ranks in the bottom of all industrialized countries in overall mortality, life expectancy, and infant mortality.⁷  If the US can begin to eliminate the differences in healthcare outcomes among different races and ethnicities, then they can improve upon their mortality, life expectancy, and infant mortality statistics, which will in essence improve the overall healthcare of this country. 

            This paper will present racial and ethnic disparities from a medical, social, legal, and ethical standpoint.  The various sub-topics that fall under the medical issues of racial and ethnic disparities are access to primary care, differences in disease outcomes, and differences in biology among races.

The Institute of Medicine released a report in 2008 stating that access to healthcare is the important first step to eliminating disparities in the healthcare system.⁸  The amount of people currently in the United States lacking primary care is alarming: 32% of Hispanics, 19.5% of black Americans, 16.8% of Asians, and 10.4% of whites.⁹  

Differences in the treatment of diseases are also evident in racial and ethnic minorities.  For example, it is more probable for minorities to be diagnosed with late-stage breast cancer and colorectal cancer compared with whites; Hispanics are less likely to receive the standard of care when hospitalized for a heart attack compared to other populations; and Hispanics and Asian/Pacific Islanders are more likely to have physical restraints used on them in a nursing home than non-Hispanic whites.  Minorities and those with low socioeconomic status are less likely to afford cancer screenings and screenings for cardiac risk factors which results in their diseases being diagnosed at later stages which makes these diseases harder to treat and thus more deadly. ¹⁰

Biology also affects the differences in health outcomes.  For example, white people are more prone to cystic fibrosis where as black people are more prone to diabetes and sick cell anemia.  There are certain inherent characteristics that are a result of genetic mutations among races and ethnicities.¹¹

The social issues causing disparities in healthcare are vast and result from different education and income levels, cultural and language differences among providers and healthcare consumers, and the make-up of the United States healthcare workforce. 

People with higher education levels and higher income levels typically do not fall into the lower social class rankings.  This is important because Health Affairs proved that the 14 major causes of death and every form of mental health disorder are more prevalent in the lower social classes.  This results in a major healthcare disadvantage for the uneducated and the poor.¹²

The ability for healthcare personnel to adapt to different cultures is key in the healing process.  A more diverse workforce will be better prepared to address patients’ needs not only through communicating more effectively but also by understanding consumers’ values and beliefs. ¹³  In 2006, 55% of all physicians were white, 3.5% black, 5% Hispanic, and 12% Asian.  In order to better address the U.S.’s needs, more diversity in healthcare is essential.¹⁴

Legally, there have been two major changes that affect racial and ethnic health disparities in the United States.  The adjustment made to the Civil Rights Act of 1964 will be examined and also the Supreme Court’s decision in the Bakke case.

When healthcare disparities exist, there are ethical principles being violated.  The principles going to be discussed throughout this paper are: autonomy, beneficence, justice (distributive justice), nonmaleficence, truthfulness, fidelity, and confidentiality.

This paper is going to focus on why racial and ethnic disparities in the U.S. healthcare system still exist today.  First, it will examine how these disparities are caused by medical and social issues.  Next, an ethical analysis will be provided to argue for and against the differences in racial and ethnic disparities; and lastly, my personal conclusions on this issue will be included.  My position is that racial and ethnic disparities are present in today’s healthcare system due to environmental and social factors and not primarily because of people’s lifestyle choices.

Medical Issues

            Access to primary care is a main reason why medical differences among races and ethnicities exist.  The Harvard School of Public Health and the Robert Wood Johnson Foundation completed a study on racial and ethnic minorities and their ability to receive healthcare.  One of the questions in this study focused on wait time for getting an appointment to see a doctor.  63% of whites, 42% of Cuban-Americans, 41% of Central/South Americans, 39% of African-Americans born in the Caribbean, and 20% of African-Americans born in Africa said that they could get an appointment the same day they called or the following day.¹⁵  This is important because it shows that white people have better and quicker access to see a healthcare professional which is a large determinate of your overall healthcare. 

Minorities are more likely to be uninsured than white people, which can explain some of the discrepancy in the quality of care among races.  Latinos make up 15.4% of the U.S. population but make up 32.7% of the uninsured population.  12.8% of the U.S. population is black people but they result in 19.5% of the uninsured population. ¹⁶  If minority populations are more likely to be uninsured, this will deter them from seeking primary care because they will have to pay out-of-pocket to see physicians.  This can be very costly and unaffordable for many people in this situation.

The following statistics comprise the percentage of people who have private health insurance and are under 65 years of age: 71.5% of Caucasian people, 71.4% of Asian people, 55.7% of Hispanic or Latino people, 54.9% of African-Americans, and 45% of American Indian.¹⁷  American-Indian women that are pregnant are 2.1 times less likely than white women to receive first trimester prenatal care.¹⁸  This shows that since American-Indian people are least likely to have health insurance, they also are least likely to receive prenatal care.  From these statistics we can conclude that it is evident that white people have better access to healthcare because they are more likely to have health insurance than other races and ethnicities.  3.4% of white people, 6.7% of black people, and 12.1% of Hispanic people have no usual source of health care and are under the age of 18.¹⁹  This is important because statistically speaking, treatment for diseases in the beginning stages results in improved health outcomes.  If minority children have less access to healthcare, successful healthcare outcomes will be diminished.

Since everyone has different preferences, there will always be differences in the treatment of care among people.  This becomes a problem when physicians have a bias against certain races and ethnicities.  As a physician, all treatment options should be discussed and equally available to patients, regardless of their race or ethnicity which results in informed consent on the patients’ behalf.  The Agency for Healthcare Research and Quality (AHRQ) discovered that race and ethnicity do play a role in the treatment a patient will receive.  For example, 21% of white children were given medications to prevent future asthma-related hospitalizations compared to 7% of black children and 2% of Hispanic children.  When a woman undergoes a mammogram screening and their results are abnormal, it takes twice as long for Asian-Americans, African-Americans, and Hispanics to receive the results to the follow-up test as it does for white women.  Finally, African-Americans are one-third less likely to have bypass surgery on their heart than whites.  There are several different reasons that could be a result of these differences in care, such as, insurance coverage, income and education level, physician bias’ and assumptions, and language barriers. ²⁰

The Massachusetts Medical Society found that Hispanics and African Americans with diabetes were three to five times more likely to be hospitalized for this disease compared to whites.²¹  This shows that minorities are less likely to  have adequate glucose control. (This could be a result of differences in treatment for various diseases among physicians or lack of access to primary care).  Hispanics are also 3.5 times more likely to have a new diagnosed case of AIDS compared to white people.²²  This shows that white people who are HIV positive get that disease under control more often than Hispanic people.  Yet again, another example showing the differences in treatment among races and ethnicities.

Not only are there differences in the quality of care received, but statistically speaking black people do not live as long as white people.  African-Americans have a mortality rate 1.6 times higher than that of white people.  What makes this picture worse is that the ratio has been the same since the 1950’s.²³  Infant mortality rates are also different among races.  African-Americans have twice the national average in infant mortality.²⁴  These mortality rates are likely to result from the variations of biology among different races, the lack of insurance and access to primary care, and the differences in prenatal care among races and ethnicities. 

Differences in healthcare outcomes can result from the history of different races too.  According to the American Public Health Association “race…represents how biological, cultural, socioeconomic, sociopolitical, and discrimination factors…influence health practices…and ultimately health outcomes.”²⁵  People who have similar histories, also experienced similar disease patterns.  So, when this is the situation, these people (usually from the same race and ethnicity) have alike genotypes and therefore are at risk for the same diseases.²⁶  The Institute of Medicine found that differences in healthcare outcomes can be the result of differences in peoples’ biological and physical make-up.²⁷

Racial and ethnic healthcare disparities can be a result of different practices among communities.  For example, some minorities choose being treated at home for a sickness rather than in a traditional healthcare setting.  Furthermore, minorities are considerably more likely to use home-made remedies when compared to non-minorities.²⁸

Social Issues

            Socioeconomic status (SES) accounts for a large portion of health disparities in the United States.  SES is comprised of education, income, and occupation.  It is proven that people with low SES have higher needs for serious medical conditions, such as cancer, stroke, or heart disease.  A reason why people with low SES have unmet medical needs for life-threatening conditions is because they are less likely to use screening programs and/or see a primary care physician.²⁹  This results in an impediment to the patient’s autonomy.  Minorities, especially African Americans, are more fearful of physicians and the medical community because of events in history that resulted in discrimination of the black community (Tuskegee Study).

When considering SES, you can look at how it affects an individual, a household, and a community.  “SES at the individual level helps to detect exposure to occupational hazard; at the household level, living standards and sociocultural patterns of behavior; and at the community level, exposure to environmental toxins, violence, and other neighborhood hazards.”³⁰  People who fit the low SES category typically are in poorer health; therefore they require more healthcare resources.  Data has found that those in low SES have high levels of depression and hostility and they have low levels of self-esteem, self-efficacy, and trust.³¹  When a person’s SES can be improved, it is found to have positive effects on the persons health status, health behaviors, and understanding of health-related information.³² 

Although there are different segments to SES, it is believed that education is the most important.  It is considered to be the strongest determinant to receiving healthcare because people with a higher education level typically have a higher income.  If someone has more money, they can afford to see a doctor and they also tend to have healthier behaviors and values.³³  The more educated an adult is and the more income they make, the lower the chance for developing a disease.  According to a study completed by Gerontological Society of America, there is a correlation between income level and infections leading to chronic disease.  This study found that those with low income had 33% higher odds of an additional infection.  Those with high income had 45% of a lesser chance of being infected compared to the middle income group.³⁴  These statistics show that the poor have higher rates of infections for chronic diseases because they cannot afford to see a doctor, and/or they are not educated enough on healthcare diseases to know they are showing symptoms.

Research from that same study associated a connection between education level and rate of infection.  People with less than a high school education had 50% greater odds of having an additional infection compared to those with a high school degree.  Those who completed college had a 50% lesser chance of having an infection compared to people with a high school degree. ³⁵

The example below proves the link that more education equals better health outcomes.  A study was conducted in Uganda between 1990-2000.  In 1990, it was believed that there was no correlation between education level and the incidence of AIDS.  Between 1990-2000, many campaigns promoting condom usage and information pamphlets were distributed and displayed throughout the country.  Again in 2000, the incidence level of AIDS was measured.  However, this time around it was reported that the more educated people were less likely to have AIDS.  This is due to the fact that these people reported reading the informational material which resulted in them using condoms to prevent the spreading of the disease.³⁶

Education also plays a role with technology, whether it is information technology or health-related technical progress.  The Population Association of America discovered that more educated people are more likely to use technology that improves their health.³⁷  This means that those with higher education levels treat diseases with state-of-the-art technology.  This puts them at a greater advantage than the less educated, and thus these people have higher rates of survival.  (For example, chemotherapy to treat cancer or cardiac catherization to treat heart disease).  From this finding in the study, we can state that improvements in healthcare technology creates increases in healthcare disparities.³⁸

More educated people also are more likely to see first-class physicians.  This is due to the fact that more educated people can use technology to their advantage; therefore they can search on-line for the best healthcare providers.³⁹  For obvious reasons, it is in a patient’s best interests if they see the physicians who are rated the best in their field.

                Communication is a key factor in obtaining quality healthcare.  Cultural and language differences can deter racial and ethnic minorities from seeking healthcare.  (Differences being defined as diverse races, ethnicities, languages spoken, nationality, religious beliefs, etc.)  13% of white people reported ever having a communication problem with a healthcare provider due to language or cultural differences compared to 34% of Korean-Americans, 29% of Vietnamese-Americans, and 27% of Central/South-Americans.⁴⁰  In 2002, the Office of Management and Budget estimated that physicians and patients confront language barriers 66 million times each year.  Spanish-speaking Latinos do not obtain medical care 1 out of 5 times because of communication barriers.⁴¹

The Harvard School of Public Health and the Robert Wood Johnson Foundation completed a study on racial and ethnic minorities and their ability to receive healthcare. When these people were asked if their physician explained things in a way that they could understand, 81% of Caucasians agreed while 55% of Central/South-Americans, 59% of Chinese-Americans, and 61% of Korean-Americans agreed.⁴²  If people are frequenting a doctor but do not understand what the doctor is telling them due to language barriers or medical illiteracy, the visit is more or less pointless.  Improving communication between physicians and patients is a crucial area that needs to be focused on.

                Another area for improvement is the lack of minority healthcare providers.  As already discussed, Latinos make up 15.4% and African Americans make up 12.8% of the U.S. population, but Latinos account for only 5% and blacks account for 3.5% of all physicians in the U.S.⁴³  More minority providers will aid in improving the communication process among physicians and their patients.⁴⁴  

Minority providers also are more interested in addressing the issues that affect racial and ethnic healthcare disparities.⁴⁵  It is more common for minority physicians to treat minority patients.  In the year 2000, 63% of the patients minority physicians saw were also minorities compared to 42% for non-minority physicians.  Also, minority physicians see more uninsured and Medicaid patients, 53%, versus 40% for non-minority physicians.⁴⁶ 

Hispanic, Asian, and African-Americans also said that they spend less time with a physician during a visit and that they distrust physicians’ more often than white people.⁴⁷  The distrust between minorities and physicians can be minimized.  It was discovered that when minorities are seeking healthcare, they are four times more likely to seek medical care from a minority physician than a nonminority physician.⁴⁸  If we know this information, then we should begin making strides to increasing the number of minorities there are in the healthcare workforce.  This can improve the overall healthcare of minority populations because they will be more likely to seek medical care. 

                Medical schools need to get on board with eliminating racial and ethnic disparities in healthcare as well.  They can help by recruiting and retaining more minority faculty. Minorities account for only 3% of medical school faculty but at the 3 historically black universities in the U.S., minorities make up 16% of the faculty.⁴⁹  Also, most medical schools today use race and ethnicity to help in determining acceptance into medical school because schools want to diversify classes.⁵⁰  Without affirmative action, they would have 80% fewer minorities in medical schools according to the Association of American Medical Colleges.⁵¹ 

                In addition to physicians and medical schools making changes, leadership positions in healthcare need to see more adjustments.  98% of senior leaders in healthcare are white; 83% of city and county health officers are white; and 83% of public health school faculty are white.⁵²  In order to eliminate racial and ethnic disparities in healthcare, the U.S. needs more diverse leaders in healthcare.  As already stated, it is proven that minority healthcare leaders focus on eliminating healthcare disparities more often than non-minority leaders.

Legal Issues

In the year 2000, the Civil Rights Act of 1964 had a rule put into place by the Department of Health and Human Services Office of Minority Health.  Included in this statute was the parameter that Medicare and Medicaid cannot be denied to people as a result of their race, ethnicity, or language they speak; and any medical facility that receives funding through the federal government must provide interpretation services to patients who cannot speak English.  These services must be provided free of charge.⁵³  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expects healthcare facilities to provide interpretation services when needed also.⁵⁴

The U.S. Supreme Court made a ruling in the 1978 court case of Bakke.  It stated that medical schools could use race as one of the determining factors of acceptance into medical school but medical schools could not have a quota of a certain number of minorities.⁵⁵

Ethical Issues

This paper has examined racial and ethnic health disparities that are present throughout the United States.  Now it is time to address why they are present.  Some argue that these disparities result from peoples’ own personal choices (diet, lifestyle, going to see a doctor, etc.).  Others claim that these inequalities are the result of environmental and social discrimination (insurance coverage, access to care, biology and genetics, differences in treatment of diseases, etc.).

First, I am going to focus on how these disparities could result from one’s own personal choices.  Everyone is born with free will, which is the ability to make your own decisions.  This is similar to the principle of autonomy which is defined as a patient’s self-rule.  Autonomy includes healthcare related decisions because of the ability for a patient to request and determine their medical care and treatment.⁵⁶  A patient-physician relationship is one that is based on trust and when a doctor violates that trust the patients’ informed consent and autonomy are being violated.  Throughout this paper, the information and statistics provided show that people are having their informed consent violated.  Since we all have free will and autonomy, it can be argued that we make choices regarding diet, exercise, and choosing to see a doctor.  Ethicists and researchers believe that 30% of your mortality can be determined by your lifestyle.⁵⁷  People looking to change their lifestyle may be conflicted with impediments, such as ignorance, fear, or force.

Secondly, minorities are more likely to be obese.  53% of African-American women and 52% of Mexican-American women are overweight compared to only 34% of Caucasian women.⁵⁸  Obesity usually results from your personal choices, for instance diet and exercise.  Obesity can lead to several other life-threatening diseases such as, heart disease, hypertension, diabetes, and high cholesterol.  So, it is not surprising to learn that minority populations, specifically African-Americans and Mexican-Americans, report high cases of heart disease, hypertension, and high cholesterol.⁵⁹  

Access to care and utilizing healthcare resources is another area that is often disputed.  Some people believe that with free will you have a choice to see a doctor if you are feeling ill.  Healthcare Ethicist Erika Blacksher states that “factors other than access to health care are stronger indicators of one’s likelihood to die prematurely. These include social circumstances, genetic disposition, and behavioral patterns around smoking, diet, exercise, and alcohol consumption.”⁶⁰

In this paper we learned that communication barriers do exist between patients and physicians due to cultural and language differences.  Patients need to become more informed and educated to know that they have a right to ask for an interpreter due to the Patients Bill of Rights. Dayna Bowen Matthew, an expert in public health law, policy and ethics was quoted saying “….minorities commonly receive different treatment and prescriptions than others and, often, the physician-patient relationship is impacted by misconceptions and miscommunication between these patients and their doctors."⁶¹  The inability to treat all patients as equal results in mistrust among patients and physicians and it shows that all doctors are not truthful.

Differences in healthcare treatment and outcomes can influence or deter people to access a healthcare provider.  Even though it is evident throughout this paper that differences occur among races and ethnicities in treatment, minorities should still utilize healthcare services.  Minority people have a personal responsibility to become a more informed health care consumer and educate themselves on different disease symptoms and possible treatments.  This will result in the best care possible for all persons. 

Lastly, there is the dispute that biology and genetics determines your healthcare outcome or at least play a role.  As stated earlier, minorities in the U.S. do not live as long as white people.  You cannot change your gene pool or the diseases you are more prone to; therefore the only way to positively change your health history is through adopting good eating and exercising habits, adjusting your lifestyle to involve more healthy choices, and by being well-educated on diseases that could affect you.

On the flip side to this argument is the idea that environment and social conditions influence health disparities more.  Advocates of this side think that minorities are more obese because of the environment they live.  Professor of Ethics at Loyola University Chicago Anna Marie Vigen believes that an inequality in healthcare in the United States is a result of gender and social class.⁶² (Your social class determines the environment you live in).  Fast food restaurants are more likely to be located in inner cities (where minorities reside more than white people); therefore, it can be argued that minorities are exposed more to less healthy food options, a reason for their obesity.⁶³ 

Next, these proponents argue that minorities are more limited in their choices to see a doctor because they have less access to care.  There are less primary care providers in minority communities compared to non-minority communities which results in minorities frequenting inner-cities hospitals for care.⁶⁴  Philosopher Norman Daniels believes that due to differences in equality and opportunity healthcare disparities exist.⁶⁵  This idea violates the principle of justice which is equal distribution of goods and services among all people.

Differences in healthcare outcomes result from physicians treating patients differently depending on their race and ethnicity (some would say this is discrimination).  For example, black men and women have a cancer death rate 35% higher than those of white people.⁶⁶  Changing the way society views minorities through different bias and stereotypes will aid in eliminating the variations in healthcare outcomes among race and ethnicities. 

There needs to be increases in education levels among minorities.  This paper demonstrated the lack of education among minorities and how that resulted in worse healthcare outcomes.  The education you receive is a determinate of the environment you grow up in (poor inner city schools vs. suburban schools).  Richard McCormick made a statement regarding diversity in education.  He said "Everybody gets a better education when they go to school with kids who are not just like themselves."  "If you go to school with people whose backgrounds are the same as yours, who look like you, you′ll probably make a lot of friends, but you′re not nearly as well prepared for the diverse, international, multicultural 21st century."⁶⁷

Genetic differences among races and ethnicities can only take you so far when determining why disparities exist in the U.S. healthcare system.  The U.S. still has some segregation in the way people live because people of similar races and ethnicities tend to reside in the same communities.  This puts the same races and ethnicities at risk for diseases that are a product of their own environment.

My Viewpoint

As an advocate of principlism, I believe that environment and social factors are a larger determinate of racial and ethnic health disparities in the United States rather than your own personal choices.  The four principles I will focus on throughout this section are autonomy, beneficence, nonmaleficence, and justice.  The principles of autonomy and justice are the most important in this case outweighing the principles of beneficence and nonmaleficence.

Autonomy is the ability for a patient to request and determine their own medical care treatment.  A patient’s autonomy is violated when communication barriers exist between a physician and the healthcare consumer.  The violation occurs because people of low educational background (typically minorities) tend to have more difficulty comprehending information a doctor conveys to them. (A lack of informed consent for patients.)  Therefore, physicians have to be aware of the competence and medical literacy rate of patients they treat.  If a physician ignores the language and cultural differences and they still perform a procedure, prescribe medication, etc., then the physician is breaching the patients’ informed consent.  According to a study by the Institute of Medicine, about half of the adults in the U.S. do not understand health information which compromises their ability to care for themselves.⁶⁷  Epidemiologist Michael Marmont thinks that improvements in patient autonomy will result in less health disparities because people will begin to make better choices about their health.⁶⁸

Autonomy can also be seen from the physician’s viewpoint.  In this regard, physicians have to show respect for persons.  When considering the principle of autonomy from this position, physicians must make sure they provide the best standard of care for patients.⁶⁹  When this is not done, the principle of autonomy is negated.  It has been proven throughout this paper that minority patients are not given the same treatment for the same diseases when compared to white patients.  This can result from /subtle prejudice which is when doctors choose and only they choose the care they think is best for patients.  In this violation of autonomy, the doctors do not take into consideration what the patient wants or their values and beliefs.  This results in distrust from minorities for the medical community and it illustrates that some healthcare personnel are performing their job with bias and prejudice.

The next ethical principle to consider is beneficence.  In the healthcare sense, this principle requires that healthcare personnel only request procedures/treatments that will benefit the patient.  The main idea behind this principle is that physicians enhance the well-being of their patient.⁷⁰  When this principle is respected by healthcare personnel, people involved in the treatment of the patient shall act in the patient’s best interests.⁷¹  If physicians provided the care necessary to treat the disease, minorities would not end up in the hospital so often for something treatable from a primary care physician.⁷¹

Nonmaleficence has similarities to the principle of beneficence. Nonmaleficence comes from the Latin term primum non nocere that translates into “above all, do no harm.”⁷²  The healthcare professionals number one priority is patient safety, which requires not harming healthcare consumers.  Throughout history there have been cases of harm being done to minorities (Examples: Tuskegee Study, new AIDS trial in Thailand) which infringes upon this principle.  As healthcare professionals, the principle of nonmaleficence needs to be improved upon so that minorities will trust physicians more. Developing trust between a patient and their physician has shown positive results and improvements in the patient’s healthcare outcomes.

Justice can be viewed as equal and fair healthcare for everyone.  More specifically, distributive justice is vital when discussing this topic because it focuses on the fair distribution of healthcare resources.⁷³  Those with low SES have less access to healthcare; this is a clear abuse of the principle of justice and distributive justice.  Philosopher Nancy Fraser believes that justice is not only the fair distribution of resources but also mutual respect of other races and ethnicities.⁷⁴  Other socioeconomic factors are environment, lifestyle, and diet.  If there are less healthy options and more pollution, which negatively affects your health, then injustices exist in our society.

With respect to the differences in disease outcomes among different races, it is evident that white people have better healthcare results.  Distributive justice is violated in this regard because the most technologically advanced healthcare options are being offered more frequently to white people compared to minorities.  Also, the ability for the rich (less likely to be minorities) to receive more healthcare treatment because they have higher income levels also opposes the principle of justice.

Recommendations

The difference in treatment among races and ethnicities is not a problem that will go away over night.  This problem has been going on for decades and will continue unless changes are made throughout the medical community.  This section will include my personal recommendations on how to improve upon this situation. 

An increase in education for physicians and healthcare consumers is vital to overcoming these differences in care.  Physicians need to more aware of their own prejudices when treating patients.  Continuing medical education classes should be offered to tackle this difficult issue of prejudice in the healthcare arena.  The American College of Physicians announced their support for these types of education programs.⁷⁵  Physicians need to better understand other cultures values and ideals to more adequately treat minority patients. 

Healthcare consumers need to be better informed about their own medical issues and learn of ways to overcome their diseases.  If healthcare consumers can increase their medical literacy, their understanding of different treatments for diseases should increase as well.  It is critical to examine the education of minorities when they are young.  Improving upon their math and science skills at a young age will make them more competitive with non-minorities with acceptance into medical school and perusing other healthcare related jobs.⁷⁶

Increasing the number of minority physicians should help decrease the amount of disparities among people.  Minority physicians are more likely to treat minorities, which can help eliminate the lack of access to care minorities have.  Also, minorities are more likely to trust doctors with similar ethnic backgrounds as themselves, so increases in minority doctors can have a positive aspect in this regard.

Not only increasing the number of physicians but also increasing the number of community health centers in the U.S. is a step in the right direction to eliminate disparities.  Community health centers are where the uninsured or underinsured get access to primary care.  This helps to eliminate people from going to the ER for something treatable through a primary care physician, which decreases costs in the long run.  Employees at these centers tend to be people from the surrounding community.  This results in less of a communication barrier because the healthcare professional and patient will be from the same background and therefore able to understand each other.⁷⁷

Making health care more accessible to everyone will result in better healthcare outcomes for the nation.  A way to achieve this goal is universal health care.  This will result in all people being able to access a primary care physician which enables people to get their disease under control at the beginning stage.  A universal system will also decrease administration costs and eliminate people profiting off of our health.

Increasing health promotion and disease prevention practices can help eliminate racial and ethnic health disparities.  This is a good idea because this is an inexpensive solution.  The more education available about disease prevention, the increase in primary care visits.  This will result from people understanding their illness and seeking treatment for it in the beginning stages.

By stating that reducing and eliminating health disparities in the U.S. is a national priority, the appropriate amount of funds can be sunk into this area.  More research on this topic is essential to understand the causes of the problems and then ways to remedy the solution.  From a policy perspective, the number of fast food restaurants in the U.S. needs to be regulated.  The result of these fast food restaurants is an increase in obesity, especially among minority populations.

Conclusion

Racial and ethnic disparities do exist in the U.S. healthcare system.  These disparities vary across the healthcare spectrum and they result in minorities receiving substandard healthcare, which result in poor outcomes and higher mortality rates.  The United State’s society and environmental factors are the main reasons why healthcare disparities are still present in 2009.  Currently the United States is going through healthcare reform, which enables reformers the time and resources to address these disparities and propose solutions to remedy the problem.  The United States as a whole must come together to rectify this problem. 

References

¹ Carter-Porkas, O, & Baquet, C. (2002). What is a Health disparity. Public Health Reports, 117. Pg 427. Retrieved from http://www.publichealthreports.org/userfiles/117_5/117426.pdf

² Soo-Jin Lee, S, Mountain, J, & Koenig, B. (2001). The Meanings of "race" in the new genomics: implications for health disparities research. Yale Journal of Healt Policy, Law, and Ethics, 1, 37-38.

³ Soo-Jin Lee, S, Mountain, J, & Koenig, B., 38.

⁴ Schiff, G, & Fegan, C. (2003). Community health centers and the underserved: eliminating disparities or increasing despair. Journal of Public Health Policy, 3,4 , 307.

⁵ Satcher, D. (2001). Our Commitment to eliminate racial and ethnic health disparities. Yale Journal of Healt Policy, Law, and Ethics, 1, 2.

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