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LETTER |
Correspondence: Requests for reprints should be sent to Philomina N. Gwanfogbe, PhD, Missouri Department of Health and Senior Services, Division of Nutritional Health and Services, PO Box 570, Jefferson, MO 65102-0570 (e-mail: gwanfp{at}dhss.state.mo.us).
Several questions came to mind as I read through the different views on racial/ethnic bias and health in the February issue of the Journal. My questions are addressed to the authors of "Investigating the Role of Racial/Ethnic Bias in Health Outcomes."1
It has been repeatedly demonstrated that certain racial/ethnic minority patients receive diagnosis and treatment recommendations differing from those of similar White patients.2 According to USA Today, "even when their insurance and income are the same as those of whites, minorities often receive fewer tests and less sophisticated treatment for a panoply of ailments, including heart disease, cancer, diabetes and HIV/AIDS."3 This occurs even when access-related factors such as patients’ insurance status and income are controlled. Racial/ethnic disparities in health care exist, and, because they are associated with worse outcomes in many cases, they are unacceptable.
The authors suggest that one important avenue of intervention to prevent differential diagnosis and treatment recommendations is training of patients as well as health care professionals. They suggest that patients could receive training in effective doctor–patient interaction. Oddly, the most important issue related to such training is not addressed: Why do Black and economically disadvantaged patients need to do something extra (be more assertive in their interaction) in order to receive the diagnosis and treatment they deserve by virtue of being patients?
Another possible area of intervention suggested by the authors is teaching individuals stress-reduction techniques and methods for drawing on the strength of their communities. How would that change racism and ethnic prejudice, a major source of stress? Maybe what needs to be done is to first eliminate the cause of stress.
While developing and testing evidence-based interventions and providing training to those who wish to research the role of racial/ethnic bias in disparate health outcomes are praiseworthy goals, they could to take forever to accomplish. In the meantime, individuals affected by discrimination based on race/ethnicity will continue to suffer. Some authors have observed that differential diagnosis and treatment recommendations are associated with greater mortality among African American patients.4,5
Let us start at the right place. Considering that health care providers, rather than patients, are the more powerful actors in clinical encounters, providers’ behaviors are a more important target for intervention efforts.2 Any action taken at this level is crucial, because the lives and deaths of helpless minorities are involved.
References
1. Cain VS, Kington RS. Investigating the role of racial/ethnic bias in health outcomes. Am J Public Health. 2003;93:191–192.
2. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academies Press; 2002.
3. Racial bias in health care. USA Today. March 21, 2002. Available at: http://www.usatoday.com/news/opinion/2002/03/22/edtwof.htm. Accessed October 16, 2003.
4. Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-vascularization procedures. Are the differences real? Do they matter? N Engl J Med.1997;336:480–486.
5. Bach PB, Cramer LD, Warren JL, Begg CB. Racial differences in the treatment of early-stage lung cancer. N Engl J Med.1999;341:1198–205.
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