Health Affairs, 24, no. 2 (2005): 316 doi: 10.1377/hlthaff.24.2.316 © 2005 by Project HOPE	New Online   Senate Health Reform Bill   Rewarding Providers   Public Option Policy Brief   Health Reform & Abortion   Delivery System Reform

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Origins Of Disparities

PROLOGUE

The Origins Of Racial/Ethnic Disparities

The very persistence and intractability of these symptoms may constitute an insidious disincentive to act. But as David Barton Smith shows in the first of the following three papers, effective intervention can be accomplished in part through public policy. In tandem with the federal Civil Rights Act of 1964, Medicare’s non-discrimination provisions achieved a swift and sweeping desegregation of hospital facilities nationwide, although policymakers stopped short of attempting to integrate doctors’ offices. When we put our money where our mouths are, it seems, we can get the job done. But when it comes to tackling the full array of socioeconomic determinants that compound the effects of racial discrimination in health care, challenges arise of another order of magnitude. As discouraging as our progress has been in abating racial disparities, we have at least a nominal commitment to pursuing this goal. The social contract in the United States does not, however, include any promise to pursue parity of economic status. On the contrary, our culture celebrates discrepancies in wealth, which grow greater year by year.

So, given that health and socioeconomic status (SES) are inextricably intertwined, the declared national goal of reducing racial disparities in health runs afoul of a well-protected right to the lawful pursuit of affluence. The resulting policy conundrums are the subject of the next two papers here, one by David Williams and Pamela Jackson, the other by Ichiro Kawachi, Norman Daniels, and Dean Robinson. Williams and Jackson outline some of the interactions between race, health, and SES and the expanded scope of policy interventions that their analysis implies. Kawachi and colleagues emphasize the neglect of class factors in the analysis of health disparities and in policy making; they propose the use of "health equity impact assessments" to sharpen awareness of race and class effects of health policies. Perspectives on the paper by Williams and Jackson are offered by David Mechanic and by Judith Bell and Marion Standish.

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