Racial and ethnic disparities in health care quality have been extensively documented.5
Much of this literature has focused on technical aspects of health care, such as whether or not patients receive appropriate tests, procedures, or medications. However, there is also increasing evidence that racial and ethnic minority patients receive lower quality interpersonal care than white patients.6
In 2002, the Institute of Medicine report Unequal Treatment7
confirmed that racial and ethnic disparities in health care are not entirely explained by differences in access, clinical appropriateness, or patient preferences, and suggested that disparities in health care exist in the broader historical and contemporary context of social and economic inequality, prejudice, and systematic bias.
Perhaps because of their lengthy presence in American society, health and health care disparities are most documented for African Americans relative to whites.8
However, the literature that documents disparities in health and health care for other ethnic minority groups has also grown. To the extent that the term ethnicity describes national origin and language in addition to culture and social status, its role in producing disparities may be distinct from that of race. The latter term has been used throughout U.S. history to de-humanize African Americans in particular.9–11
For example, while there is evidence that language proficiency, socioeconomic status, and acculturation can explain disparities in health and health care for many Hispanic populations,12
racial disparities for African Americans persist despite adjusting for factors such as socioeconomic position.12
Nevertheless, the consistency of patterns of disparity in different aspects of society supports the argument that a common underlying set of mechanisms exists through which race and ethnicity affect inequalities in health care and health status.13–15
The social environment is one such set of mechanisms. It includes socioeconomic factors (e.g., employment and education), physical surroundings (e.g., neighborhood and work conditions), social relations within one's community and/or workplace, and power arrangements (e.g., political empowerment, individual and community control, and influence).14
A detailed examination of the myriad of ways in which the social environment might impact race relationships in health care is beyond the scope of this paper. However, there is substantial evidence to suggest that the social meaning attributable to race and ethnicity within a given societal context is at the root of its largest effects on health and health care.16–18
We submit that race and ethnicity are both socially constructed and have unique societal and individual meanings, and that the health implications of race and ethnicity result primarily from their effects on social interactions rather than on biology.