Search tips
Search criteria 


Logo of jnmaLink to Publisher's site
J Natl Med Assoc. 2006 March; 98(3): 386–396.
PMCID: PMC2576116

Racism and health inequity among Americans.


Research reports often cite socioeconomic status as an underlying factor in the pervasive disparities in health observed for racial/ethnic minority populations. However, often little information or consideration is given to the social history and prevailing social climate that is responsible for racial/ethnic socioeconomic disparities, namely, the role of racism/racial discrimination. Much of the epidemiologic research on health disparities has focused on the relationship between demographic/clinical characteristics and health outcomes in main-effects multivariate models. This approach, however, does not examine the relationship between covariate levels and the processes that create them. It is important to understand the synergistic nature of these relationships to fully understand the impact they have on health status. PURPOSE: A review of the literature was conducted on the role that discrimination in education, housing, employment, the judicial system and the healthcare system plays in the origination, maintenance and perpetuation of racial/ethnic health disparities to serve as background information for funding Program Announcement, PA-05-006, The Effect of Racial/ Ethnic Discrimination/Bias on Healthcare Delivery (http:// guide/pa-files/PA-05-006.html). The effect of targeted marketing of harmful products and environmental justice are also discussed as they relate to racial/ethnic disparities in health. CONCLUSION: Racial/ethnic disparities in health are the result of a combination of social factors that influence exposure to risk factors, health behavior and access to and receipt of appropriate care. Addressing these disparities will require a system that promotes equity and mandates accountability both in the social environment and within health delivery systems.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (2.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Shavers Vickie L, Harlan Linda C, Stevens Jennifer L. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer. 2003 Jan 1;97(1):134–147. [PubMed]
  • Shavers Vickie L, Brown Martin L. Racial and ethnic disparities in the receipt of cancer treatment. J Natl Cancer Inst. 2002 Mar 6;94(5):334–357. [PubMed]
  • Kiefe Catarina I. Race/ethnicity and cancer survival: the elusive target of biological differences. JAMA. 2002 Apr 24;287(16):2138–2139. [PubMed]
  • Woolf Steven H, Johnson Robert E, Fryer George E, Jr, Rust George, Satcher David. The health impact of resolving racial disparities: an analysis of US mortality data. Am J Public Health. 2004 Dec;94(12):2078–2081. [PubMed]
  • Groeneveld Peter W, Laufer Sara B, Garber Alan M. Technology diffusion, hospital variation, and racial disparities among elderly Medicare beneficiaries: 1989-2000. Med Care. 2005 Apr;43(4):320–329. [PubMed]
  • Jones CP. Levels of racism: a theoretic framework and a gardener's tale. Am J Public Health. 2000 Aug;90(8):1212–1215. [PubMed]
  • Williams DR, Neighbors H. Racism, discrimination and hypertension: evidence and needed research. Ethn Dis. 2001 Fall;11(4):800–816. [PubMed]
  • Ren XS, Amick BC, Williams DR. Racial/ethnic disparities in health: the interplay between discrimination and socioeconomic status. Ethn Dis. 1999 Spring-Summer;9(2):151–165. [PubMed]
  • Williams DR, Rucker TD. Understanding and addressing racial disparities in health care. Health Care Financ Rev. 2000 Summer;21(4):75–90. [PubMed]
  • Williams DR, Williams-Morris R. Racism and mental health: the African American experience. Ethn Health. 2000 Aug-Nov;5(3-4):243–268. [PubMed]
  • Carlson Elizabeth D, Chamberlain Robert M. The Black-White perception gap and health disparities research. Public Health Nurs. 2004 Jul-Aug;21(4):372–379. [PubMed]
  • Krieger N, Sidney S. Racial discrimination and blood pressure: the CARDIA Study of young black and white adults. Am J Public Health. 1996 Oct;86(10):1370–1378. [PubMed]
  • Logan John R, Stults Brian J, Farley Reynolds. Segregation of minorities in the metropolis: two decades of change. Demography. 2004 Feb;41(1):1–22. [PubMed]
  • Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001 Sep-Oct;116(5):404–416. [PMC free article] [PubMed]
  • Schulz Amy J, Williams David R, Israel Barbara A, Lempert Lora Bex. Racial and spatial relations as fundamental determinants of health in Detroit. Milbank Q. 2002;80(4):677–iv. [PubMed]
  • Kendall Judy, Hatton Diane. Racism as a source of health disparity in families with children with attention deficit hyperactivity disorder. ANS Adv Nurs Sci. 2002 Dec;25(2):22–39. [PubMed]
  • Pathman Donald E, Konrad Thomas R, Schwartz Robert. The proximity of predominantly African American and Hispanic rural communities to physicians and hospital services. J Rural Health. 2002 Summer;18(3):416–427. [PubMed]
  • Murphy Lillian. Allying health care and housing. Health Prog. 2005 Mar-Apr;86(2):17–20. [PubMed]
  • Update: blood lead levels--United States, 1991-1994. MMWR Morb Mortal Wkly Rep. 1997 Feb 21;46(7):141–146. [PubMed]
  • Matsui Elizabeth C, Simons Elinor, Rand Cynthia, Butz Arlene, Buckley Timothy J, Breysse Patrick, Eggleston Peyton A. Airborne mouse allergen in the homes of inner-city children with asthma. J Allergy Clin Immunol. 2005 Feb;115(2):358–363. [PubMed]
  • Breysse Patrick, Farr Nick, Galke Warren, Lanphear Bruce, Morley Rebecca, Bergofsky Linda. The relationship between housing and health: children at risk. Environ Health Perspect. 2004 Nov;112(15):1583–1588. [PMC free article] [PubMed]
  • De Vera Michelle J, Drapkin Sol, Moy James N. Association of recurrent wheezing with sensitivity to cockroach allergen in inner-city children. Ann Allergy Asthma Immunol. 2003 Nov;91(5):455–459. [PubMed]
  • Mannino David M, Homa David M, Akinbami Lara J, Moorman Jeanne E, Gwynn Charon, Redd Stephen C. Surveillance for asthma--United States, 1980-1999. MMWR Surveill Summ. 2002 Mar 29;51(1):1–13. [PubMed]
  • Stelmach W, Kaczmarczyk-Chałas K, Bielecki W, Drygas W. How education, income, control over life and life style contribute to risk factors for cardiovascular disease among adults in a post-communist country. Public Health. 2005 Jun;119(6):498–508. [PubMed]
  • Schnohr Christina, Højbjerre Lise, Riegels Mette, Ledet Luise, Larsen Tine, Schultz-Larsen Kirsten, Petersen Liselotte, Prescott Eva, Grønbaek Morten. Does educational level influence the effects of smoking, alcohol, physical activity, and obesity on mortality? A prospective population study. Scand J Public Health. 2004;32(4):250–256. [PubMed]
  • Lee JiWon R, Paultre Furcy, Mosca Lori. The association between educational level and risk of cardiovascular disease fatality among women with cardiovascular disease. Womens Health Issues. 2005 Mar-Apr;15(2):80–88. [PubMed]
  • Carlos Ruth C, Fendrick A Mark, Patterson Stephanie K, Bernstein Steven J. Associations in breast and colon cancer screening behavior in women. Acad Radiol. 2005 Apr;12(4):451–458. [PubMed]
  • Gorin Sherri Sheinfeld, Heck Julia E. Cancer screening among Latino subgroups in the United States. Prev Med. 2005 May;40(5):515–526. [PubMed]
  • Seeff Laura C, Nadel Marion R, Klabunde Carrie N, Thompson Trevor, Shapiro Jean A, Vernon Sally W, Coates Ralph J. Patterns and predictors of colorectal cancer test use in the adult U.S. population. Cancer. 2004 May 15;100(10):2093–2103. [PubMed]
  • Gornick Marian E, Eggers Paul W, Riley Gerald F. Associations of race, education, and patterns of preventive service use with stage of cancer at time of diagnosis. Health Serv Res. 2004 Oct;39(5):1403–1427. [PMC free article] [PubMed]
  • Groman Rachel, Ginsburg Jack. Racial and ethnic disparities in health care: a position paper of the American College of Physicians. Ann Intern Med. 2004 Aug 3;141(3):226–232. [PubMed]
  • Freudenberg N. Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health. J Urban Health. 2001 Jun;78(2):214–235. [PubMed]
  • Neuspiel DR. Racism and perinatal addiction. Ethn Dis. 1996 Winter-Spring;6(1-2):47–55. [PubMed]
  • Haney C, Zimbardo P. The past and future of U.S. prison policy. Twenty-five years after the Stanford prison experiment. Am Psychol. 1998 Jul;53(7):709–727. [PubMed]
  • Poland ML, Dombrowski MP, Ager JW, Sokol RJ. Punishing pregnant drug users: enhancing the flight from care. Drug Alcohol Depend. 1993 Feb;31(3):199–203. [PubMed]
  • Rao Sunil V, Schulman Kevin A, Curtis Lesley H, Gersh Bernard J, Jollis James G. Socioeconomic status and outcome following acute myocardial infarction in elderly patients. Arch Intern Med. 2004 May 24;164(10):1128–1133. [PubMed]
  • Singh Gopal K, Miller Barry A, Hankey Benjamin F, Edwards Brenda K. Persistent area socioeconomic disparities in U.S. incidence of cervical cancer, mortality, stage, and survival, 1975-2000. Cancer. 2004 Sep 1;101(5):1051–1057. [PubMed]
  • Ward Elizabeth, Jemal Ahmedin, Cokkinides Vilma, Singh Gopal K, Cardinez Cheryll, Ghafoor Asma, Thun Michael. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin. 2004 Mar-Apr;54(2):78–93. [PubMed]
  • Bell A Colin, Adair Linda S, Popkin Barry M. Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension. Soc Sci Med. 2004 Jul;59(2):275–283. [PubMed]
  • Newacheck Paul W, Hung Yun Yi, Park M Jane, Brindis Claire D, Irwin Charles E., Jr Disparities in adolescent health and health care: does socioeconomic status matter? Health Serv Res. 2003 Oct;38(5):1235–1252. [PMC free article] [PubMed]
  • Sambamoorthi Usha, McAlpine Donna D. Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med. 2003 Nov;37(5):475–484. [PubMed]
  • Tuberculosis transmission in multiple correctional facilities--Kansas, 2002-2003. MMWR Morb Mortal Wkly Rep. 2004 Aug 20;53(32):734–738. [PubMed]
  • Briggs Nathaniel C, Levine Robert S, Hall H Irene, Cosby Otis, Brann Edward A, Hennekens Charles H. Occupational risk factors for selected cancers among African American and White men in the United States. Am J Public Health. 2003 Oct;93(10):1748–1752. [PubMed]
  • Faber Daniel R, Krieg Eric J. Unequal exposure to ecological hazards: environmental injustices in the Commonwealth of Massachusetts. Environ Health Perspect. 2002 Apr;110 (Suppl 2):277–288. [PMC free article] [PubMed]
  • Wilson Sacoby M, Howell Frank, Wing Steve, Sobsey Mark. Environmental injustice and the Mississippi hog industry. Environ Health Perspect. 2002 Apr;110 (Suppl 2):195–201. [PMC free article] [PubMed]
  • Hnizdo Eva, Sullivan Patricia A, Bang Ki Moon, Wagner Gregory. Airflow obstruction attributable to work in industry and occupation among U.S. race/ethnic groups: a study of NHANES III data. Am J Ind Med. 2004 Aug;46(2):126–135. [PubMed]
  • Powell DL, Stewart V. Children. The unwitting target of environmental injustices. Pediatr Clin North Am. 2001 Oct;48(5):1291–1305. [PubMed]
  • Perlin SA, Wong D, Sexton K. Residential proximity to industrial sources of air pollution: interrelationships among race, poverty, and age. J Air Waste Manag Assoc. 2001 Mar;51(3):406–421. [PubMed]
  • Woodruff Tracey J, Parker Jennifer D, Kyle Amy D, Schoendorf Kenneth C. Disparities in exposure to air pollution during pregnancy. Environ Health Perspect. 2003 Jun;111(7):942–946. [PMC free article] [PubMed]
  • Macey GP, Her X, Reibling ET, Ericson J. An investigation of environmental racism claims: testing environmental management approaches with a geographic information system. Environ Manage. 2001 Jun;27(6):893–907. [PubMed]
  • Stoddard JL, Johnson CA, Sussman S, Dent C, Boley-Cruz T. Tailoring outdoor tobacco advertising to minorities in Los Angeles County. J Health Commun. 1998 Apr-Jun;3(2):137–146. [PubMed]
  • Gardiner Phillip S. The African Americanization of menthol cigarette use in the United States. Nicotine Tob Res. 2004 Feb;6 (Suppl 1):S55–S65. [PubMed]
  • Tirodkar Manasi A, Jain Anjali. Food messages on African American television shows. Am J Public Health. 2003 Mar;93(3):439–441. [PubMed]
  • Flegal Katherine M, Graubard Barry I, Williamson David F, Gail Mitchell H. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005 Apr 20;293(15):1861–1867. [PubMed]
  • Peters Rosalind M. Racism and hypertension among African Americans. West J Nurs Res. 2004 Oct;26(6):612–631. [PubMed]
  • Clark R, Anderson NB, Clark VR, Williams DR. Racism as a stressor for African Americans. A biopsychosocial model. Am Psychol. 1999 Oct;54(10):805–816. [PubMed]
  • Stuber Jennifer, Galea Sandro, Ahern Jennifer, Blaney Shannon, Fuller Crystal. The association between multiple domains of discrimination and self-assessed health: a multilevel analysis of Latinos and blacks in four low-income New York City neighborhoods. Health Serv Res. 2003 Dec;38(6 Pt 2):1735–1759. [PMC free article] [PubMed]
  • Nyborg Vanessa M, Curry John F. The impact of perceived racism: psychological symptoms among African American boys. J Clin Child Adolesc Psychol. 2003 Jun;32(2):258–266. [PubMed]
  • Noh Samuel, Kaspar Violet. Perceived discrimination and depression: moderating effects of coping, acculturation, and ethnic support. Am J Public Health. 2003 Feb;93(2):232–238. [PubMed]
  • Williams David R, Neighbors Harold W, Jackson James S. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003 Feb;93(2):200–208. [PubMed]
  • Wyatt Sharon B, Williams David R, Calvin Rosie, Henderson Frances C, Walker Evelyn R, Winters Karen. Racism and cardiovascular disease in African Americans. Am J Med Sci. 2003 Jun;325(6):315–331. [PubMed]
  • Harrell Jules P, Hall Sadiki, Taliaferro James. Physiological responses to racism and discrimination: an assessment of the evidence. Am J Public Health. 2003 Feb;93(2):243–248. [PubMed]
  • Krieger N. Racial and gender discrimination: risk factors for high blood pressure? Soc Sci Med. 1990;30(12):1273–1281. [PubMed]
  • Broman CL. The health consequences of racial discrimination: a study of African Americans. Ethn Dis. 1996 Winter-Spring;6(1-2):148–153. [PubMed]
  • Dressler WW. Social identity and arterial blood pressure in the African-American community. Ethn Dis. 1996 Winter-Spring;6(1-2):176–189. [PubMed]
  • Lawlor Debbie A, Frankel Stephen, Shaw Mary, Ebrahim Shah, Smith George Davey. Smoking and ill health: does lay epidemiology explain the failure of smoking cessation programs among deprived populations? Am J Public Health. 2003 Feb;93(2):266–270. [PubMed]
  • Stead M, MacAskill S, MacKintosh AM, Reece J, Eadie D. "It's as if you're locked in": qualitative explanations for area effects on smoking in disadvantaged communities. Health Place. 2001 Dec;7(4):333–343. [PubMed]
  • Landrine H, Klonoff EA. Racial discrimination and cigarette smoking among Blacks: findings from two studies. Ethn Dis. 2000 Spring-Summer;10(2):195–202. [PubMed]
  • Guthrie Barbara J, Young Amy M, Williams David R, Boyd Carol J, Kintner Eileen K. African American girls' smoking habits and day-to-day experiences with racial discrimination. Nurs Res. 2002 May-Jun;51(3):183–190. [PubMed]
  • Gibbons Frederick X, Gerrard Meg, Cleveland Michael J, Wills Thomas A, Brody Gene. Perceived discrimination and substance use in African American parents and their children: a panel study. J Pers Soc Psychol. 2004 Apr;86(4):517–529. [PubMed]
  • Yen IH, Ragland DR, Greiner BA, Fisher JM. Workplace discrimination and alcohol consumption: findings from the San Francisco Muni Health and Safety Study. Ethn Dis. 1999 Winter;9(1):70–80. [PubMed]
  • van Ryn Michelle, Fu Steven S. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003 Feb;93(2):248–255. [PubMed]
  • Einbinder LC, Schulman KA. The effect of race on the referral process for invasive cardiac procedures. Med Care Res Rev. 2000;57 (Suppl 1):162–180. [PubMed]
  • Epstein AM, Ayanian JZ, Keogh JH, Noonan SJ, Armistead N, Cleary PD, Weissman JS, David-Kasdan JA, Carlson D, Fuller J, et al. Racial disparities in access to renal transplantation--clinically appropriate or due to underuse or overuse? N Engl J Med. 2000 Nov 23;343(21):1537–1537. [PubMed]
  • Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dubé R, Taleghani CK, Burke JE, Williams S, et al. The effect of race and sex on physicians' recommendations for cardiac catheterization. N Engl J Med. 1999 Feb 25;340(8):618–626. [PubMed]
  • Balsa Ana I, McGuire Thomas G. Prejudice, clinical uncertainty and stereotyping as sources of health disparities. J Health Econ. 2003 Jan;22(1):89–116. [PubMed]
  • Blanchard Janice, Lurie Nicole. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004 Sep;53(9):721–730. [PubMed]
  • Bird ST, Bogart LM. Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis. 2001 Autumn;11(3):554–563. [PubMed]
  • Diala C, Muntaner C, Walrath C, Nickerson KJ, LaVeist TA, Leaf PJ. Racial differences in attitudes toward professional mental health care and in the use of services. Am J Orthopsychiatry. 2000 Oct;70(4):455–464. [PubMed]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association