Race is a Social Construct
To start, it’s important to understand that there is no biological basis for race. Race is purely a social construct, and racial inequities in health all have social roots (although health impacts on a social group can lead to genetic consequences for that group’s descendents, such as in sickle cell or Tay-Sachs disease).
The Role of Race Politics in the Development of the U.S. Healthcare System
The history of race politics in the U.S. is deeply intertwined with the unique development of our inequitable healthcare system, in ways that may surprise you. Gerard Boychuk’s book National Health Insurance argues that a primary reason universal healthcare passed in Canada was the national government’s attempt to prevent Quebec from seceding by instituting essential national services. In the United States on the other hand, segregationist politics in Congress blocked national healthcare for much of the 20th century – not, as is often claimed, the growth of employer-based insurance during WWII.
Treating Healthcare as a Commodity Allows Broader Racial Inequities to Impact Health
The growth and political entrenchment of a healthcare system that links access to care with ability to pay creates a dangerous dynamic in the U.S. as other large systems characterized by racial discrimination – such as access to employment, income, family wealth, housing, loans, social services, and more – translate into healthcare barriers. The literature here is vast, but we recommend Ira Katznelson’s history of how large federal programs that created the middle-class in the U.S. (Social Security, the right to unionize, the GI Bill, etc) largely excluded people of color, leading to a massive wealth gap, as well as recent studies showing the continued prevalence of racial discrimination across all areas of life – affecting employers, salespeople, doctors, legislators, and others – often due to “implicit bias” as opposed to intentional discrimination.
Experience of Racism as a Determinant of Health
These barriers to healthcare are all the worse since racial discrimination leads to greater health needs for some communities of color. In particular, a new body of a research in the last decade is showing that the daily experience of racism and the stress/self-doubt it causes, is a major cause of poor health itself, particularly for African Americans. This “embodied inequality” may also explain why immigrants, who are generally much healthier than native U.S. residents, experience declining health outcomes the longer they live here.
Racial Injustice in Medical Research and the Delivery of Care
Finally, for those who are able to access the healthcare system, medical research and the practice of medicine in the U.S. are marked by deep histories of racism as well. The Congressionally-funded 2002 study Unequal Treatment was a damning summary of the evidence that people of color are treated differently for the same medical conditions: receiving less routine care, lower-quality care, and more undesirable treatments such as lower-limb amputations.
The most notorious example of racist medical research is the Tuskegee syphilis experiment, conducted on rural African American men over the course of four decades up through the 1970s, to observe the end-of-life impacts of the disease. The men were not told they had syphilis or treated for it. Harriet Washington’s book Medical Apartheid places the Tuskegee experiment in the longer and larger context of inhumane medical experimentation on people of color – often in attempts to prove the racial basis of social behavior – which continues today.
We Can End Racial Inequities in Healthcare
We can and must end racial inequities in health. PNHP researchers have found, for example, that single-payer healthcare has almost eliminated racial gaps in unmet medical needs in Canada. Equity in health will require more than an equitable healthcare system, though: it will also require equity in the social determinants of health, such as education, housing, a healthy environment, and the equitable delivery of healthcare!