Article contents
Racial/Ethnic Health Disparities and Ethics
The Need for a Multilevel Approach
Published online by Cambridge University Press: 25 May 2012
Abstract
- Type
- Special Section: Bioethics and Health Disparities
- Information
- Copyright
- Copyright © Cambridge University Press 2012
References
Notes
1. Smedley, BD, Stith, AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2003.Google Scholar
2 Hunt, LM, Megyesi, MS.Genes, race and research ethics: Who’s minding the store? Journal of Medical Ethics 2008;34:495–500.CrossRefGoogle ScholarPubMed
3 Brody, H. Race and health disparities. In: The Future of Bioethics. New York: Oxford University Press; 2009:138–41.Google Scholar
4 Montagu, A.Statement on Race: An Annotated Elaboration and Exposition of the Four Statements on Race Issued by United Nations Educational, Scientific, and Cultural Organization (UNESCO). New York: Oxford University Press; 1972Google Scholar. See also Collins, FS.What we do and don’t know about “race,” “ethnicity,” genetics and health at the dawn of the genome era. Nature Genetics Supplement 2004;36(11):13–5.CrossRefGoogle Scholar
5 Schwartz, RS.Racial profiling in medical research. New England Journal of Medicine 2001;344:1392–3.CrossRefGoogle ScholarPubMed
6 Risch, N, Burchard, E, Ziv, E, Tang, H.Categorization of humans in biomedical research: Genes, race, and disease. Genome Biology 2002;3(7):comment 2007.CrossRefGoogle ScholarPubMed
7 Duster, T.Deep roots and tangled branches. Chronicle of Higher Education 2006 Feb 3;52(22):13–6.Google Scholar
8 Duster, T.Lessons from history: Why race and ethnicity have played a major role in biomedical research. Journal of Law, Medicine & Ethics 2006;34:487–500.CrossRefGoogle Scholar
9 Sankar, P, Cho, MK, Condit, CM, Hunt, LM, Koenig, B, Marshall, P, et al. . Genetic research and health disparities. JAMA 2004;291:2985–9.CrossRefGoogle ScholarPubMed
10 Bhopal, R.Race and ethnicity: Responsible use from epidemiological and public health perspectives. Journal of Law, Medicine & Ethics 2006;34:500–9.CrossRefGoogle ScholarPubMed
11 Daniels, N.Equity and population health: Toward a broader bioethics agenda. Hastings Center Report 2006;36(4):22–35.CrossRefGoogle Scholar
12 See note 3, Brody 2009, at 148–54.
13 King, P.Race, equity, health policy, and the African American community. In: Prograis, L Jr., Pellegrino, ED, eds. African American Bioethics: Culture, Race, and Identity. Washington, DC: Georgetown University Press; 2007:67–92.Google Scholar
14 Green, AR, Carney, DR, Pallin, DJ, Ngo, LH, Raymond, KL, Iezzoni, LI, et al. . Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of General Internal Medicine 2007;22:1231–8.CrossRefGoogle ScholarPubMed
15 Brody, H, Hunt, LM. BiDil: Assessing a race-based pharmaceutical. Annals of Family Medicine 2006;4:556–60.CrossRefGoogle ScholarPubMed
16 Bibbins-Domingo, K, Fernandez, A.BiDil for heart failure in black patients: Implications of the U.S. Food and Drug Administration approval. Annals of Internal Medicine 2007;146:52–6.CrossRefGoogle ScholarPubMed
17 Yu, JH, Goering, S, Fullerton, SM.Race-based medicine and justice as recognition: Exploring the phenomenon of BiDil. Cambridge Quarterly of Healthcare Ethics 2009;18(1):57–67.CrossRefGoogle ScholarPubMed
18 Powers, M, Faden, R.Social Justice: The Moral Foundations of Public Health and Health Policy. New York: Oxford University Press; 2006, esp. pp. 95–99.Google Scholar
19 See note 18, Powers, Faden 2006, at 64–79.
20 Institute of Medicine. Care Without Coverage: Too Little, Too Late. Washington, DC: National Academy Press; 2002, at 162.Google Scholar
21 Freeman, JD, Kadiyala, S, Bell, JF, Martin, DP. The causal effect of health insurance on utilization and outcomes in adults. Medical Care 2008;48(10):1023–32.CrossRefGoogle Scholar
22 Hadley J. Sicker and Poorer: The Consequences of Being Uninsured. Kaiser Comm. on Medicaid and the Uninsured; 2002, at 16–43; available at www.kff.org/uninsured/upload/Full-Report.pdf (last accessed 23 Apr 2012).
23 DeNavas-Walt, C, Proctor, BD, Smith, JC.Income, Poverty, and Health Insurance Coverage in the United States: 2009. Washington DC: U.S. Census Bureau; 2010, at 23Google Scholar; available at http://www.census.gov/prod/2010pubs/p60-238.pdf (last accessed 23 Apr 2012).
24 Kaiser Family Foundation. Health Reform and Communities of Color: Implications for Racial and Ethnic Disparities. Washington DC: Kaiser Family Foundation; 2010, at 8Google Scholar; available at http://www.kff.org/healthreform/upload/8016-02.pdf (last accessed 23 Apr 2012).
25 Patient Protection and Affordable Care Act, sec. 2001(a).
26 Bradley, CJ, Dahman, B, Given, CW.Inadequate access to surgeons: Reason for disparate cancer care? Medical Care 2009;47(7):758–64.CrossRefGoogle ScholarPubMed
27 Scaggs, DL, Lehmann, CL, Rice, C, Killelea, BK, Bauer, RM, Kay, RM, et al. . Access to orthopaedic care for children with Medicaid versus private insurance: Results of a national survey. Journal of Pediatric Orthopedics 2006;26(3):400–4.CrossRefGoogle Scholar
28 Resnick, J, Pletcher, MJ, Lozano, N.Medicare, Medicaid, and access to dermatologists: The effect of patient insurance on appointment access and wait times. Journal of the American Academy of Dermatology 2004;50(1):85–92.CrossRefGoogle Scholar
29 See note 22, Hadley 2002, at 16–43.
30 Patient Protection and Affordable Care Act, sec. 1501(a).
31 Patient Protection and Affordable Care Act, sec. 1401(a).
32 Smedley, BD, Stith, AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: National Academies Press; 2003, at 42.Google Scholar
33 See note 32.
34 Patient Protection and Affordable Care Act, sec. 10503(a).
35 Patient Protection and Affordable Care Act, sec. 4101(a).
36 Patient Protection and Affordable Care Act, sec. 4201(c).
37 Patient Protection and Affordable Care Act, sec. 5203.
38 Health Care and Education Reconciliation Act of 2010, sec. 1201.
39 Patient Protection and Affordable Care Act, sec. 5307.
40 Stone, D. How market ideology guarantees racial inequality. In: Morone, JA, Jacobs, LR, eds. Healthy, Wealthy, and Fair: Health Care and the Good Society. Oxford: Oxford University Press; 2005:65–90.CrossRefGoogle Scholar
41 Schlesinger, M. The dangers of the market panacea. In: Morone, JA, Jacobs, LR, eds. Healthy, Wealthy, and Fair: Health Care and the Good Society. Oxford: Oxford University Press; 2005:91–136.Google Scholar
42 Buchanan, D, Witlen, R.Balancing service and education: Ethical management of student-run clinics. Journal of Health Care for the Poor and Underserved 2006;17(3):477–85.CrossRefGoogle ScholarPubMed
43 Myser, C.Community-based participatory research in United States bioethics: Steps toward more democratic theory and policy. American Journal of Bioethics 2004;4:67–8.CrossRefGoogle ScholarPubMed
44 IRB-approved consent was taken from each patient before conducting the interviews, and patients were asked to discuss their health challenges and to allow themselves to be photographed. They were informed that the information discussed would be shared with other students with the express purpose of matching together real faces, real stories, and real people on the crisis in health disparities we face in the United States. Patients who wanted to tell their story but wanted remain anonymous were also permitted to do so. Because the aforementioned patient who revealed information critical to her care requested anonymity, all the student could do was advise her that such information would be important for her healthcare provider to know and offer referrals to other providers and social service agencies that might have been able to help if she continued to be uncomfortable sharing her information with her primary provider.
45 Appleby, J.Hospitals sock uninsured with much bigger bills. USA Today 2004 Feb 25:1B.Google Scholar
46 Lagnado, L.Anatomy of a hospital bill: Uninsured patients often face big markups on small items. Wall Street Journal 2004 Sept 21:B1.Google Scholar
47 Austin, M.Uninsured pay higher price: Hospital collection agents demand full cost of care. Denver Post 2003 Jan 28:1A.Google Scholar
48 Lagnado, L.Call it Yale v. Yale: Law-school clinic is taking affiliated hospital to court over debt-collection tactics. Wall Street Journal 2003 Nov 14:B1.Google Scholar
49 Doty, MM, Edwards, JN, Holmgren, AL.Seeing red: Americans driven into debt by medical bills. Results from a national survey. Commonwealth Fund Issue Brief 2005;837:1–12.Google Scholar
50 Cunningham, PJ.Overburdened and overwhelmed: The struggles of communities with high medical cost burdens. Commonwealth Fund Issue Brief 2007;28:1–14.Google ScholarPubMed
51 Smedley, BD, Stith, AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.Google Scholar
52 EMTALA (Emergency Medical Treatment and Active Labor Act of 1986) legislation continues to bind all hospitals with emergency departments to assess and stabilize emergency conditions. Students learned from some of the M.D. preceptors at the clinic that hospitals’ implementation of the EMTALA has continually shifted toward the slimmest possible meaning of the term “stabilize.”
53 Lantz, PM, Richardson, LC, Sever, LE, Macklem, DJ, Hare, ML, Henson, R. et al. . Mass screening in low-income populations: The challenges of securing diagnostic and treatment services in a national cancer screening program. Journal of Health Politics, Policy and Law 2000;25(3):451–71.CrossRefGoogle Scholar
54 French, CS, True, SR, McIntyre, R, Sciulli, M, Maloy, KA. State implementation of the Breast and Cervical Cancer Prevention and Treatment Act of 2000: A collaborative effort among government agencies. Public Health Reports 2004;119:279–85.CrossRefGoogle ScholarPubMed
55 McCammon, S.In-class communication, 15 Aug 2010.Google Scholar
56 Black, JL, Macinko, J.Neighborhoods and obesity. Nutrition Reviews 2008;66(1):2–20.CrossRefGoogle ScholarPubMed
57 Gard, M, Wright, J.The Obesity Epidemic: Science, Morality, and Ideology. New York: Routledge; 2005.Google Scholar
58 Black, D, Townsend, P, Davidson, N.Inequalities in Health: The Black Report. Harmondsworth, UK: Penguin Books, 1982.Google Scholar
59 Bennett, A.In-class communication, 15 Aug 2010.Google Scholar
60 Alina Bennett, communication during in-class discussion about the inability of students to walk away from their interview experiences without being traumatically affected by what they learned, and about feeling a sense of urgency to find some solution to the problems they uncovered.
- 4
- Cited by