Introduction
Although modern society asserts its allegiance to the idea of universal human rights, the extent to which human individuals can exercise those rights varies significantly based on several factors. Despite prohibitions on official discrimination based on race and occasional claims of an approaching postracial era, the individual’s racial classification continues to be one of those factors (Constance-Huggins 163). Indeed, racial discrimination can be regarded as one of the principal forces interfering with many people’s ability to avail themselves of their human rights. One of those rights, enshrined in Article 25 of the Universal Declaration of Human Rights, is the right to health, which includes access to adequate medical care. In this paper, I intend to gauge the enduring influence of race by examining how it can impact American citizens’ access to healthcare.
Persistence of Racial Essentialism
In modern Western culture, there are two competing and logically incompatible understandings of race. One, which can be referred to as racial essentialism, holds that different races, such as whites or blacks, possess distinctive and innate characteristics that naturally manifest in individuals of those races. Among those who share this understanding, the race is generally regarded as a more or less inflexible fact of human biology. The opposite position, racial anti-essentialism, regards race as a purely social construct with minimal or nonexistent connection to biology. The latter view is reinforced by historical studies that track the emergence of race as a concept, reflecting social dynamics and strategies rather than scientific understanding (Middleton 130). While pure racial essentialism has long since gone out of favor and anti-essentialism has firmly entered the mainstream, elements of both concepts continue to clash and coexist in people’s minds.
Indeed, the historic racial classifications in America appear very loosely attached to the biological category of human populations, given how arbitrary and blatantly political many of those assignments have been. The one-drop rule, codified in 1910 when the State of Tennessee officially defined blacks as “persons of color” with “any African blood in their veins” (qtd. in Middleton 11), still informs views of black identity. It is patently absurd when taken as a biological description – even if it is accepted that race is an objective and innate characteristic, why would someone who is 99% white be automatically considered black? Instead, this classification has its roots in the 19th and 20th-century politics of white supremacy, in which it was deemed to be essential to set up and maintain a racial hierarchy (Middleton 12). Other racial or ethnic categories in the United States, such as Hispanics or Native Americans, can likewise be shown to be political and social constructs.
Scientific racist scholarship that depicts traits like intelligence and competence as directly connected with racial categories has been largely discredited in modern academia. It has also acquired a substantial social stigma, though this does not prevent it from being occasionally deployed in political rhetoric at the highest level of government (Cogburn 748). However, the more pervasive and impactful racial essentialist survivals in present-day American culture tend to be informal and often unspoken or unconscious (Shah 25). The automatic stereotypical association of blackness with violence and lack of intelligence is a classic example (Cogburn 749). Such stereotypes survive in part due to the lingering influence of earlier racial essentialist propaganda, but partly also because of observable social phenomena. The lower average living standards of blacks make it more likely that they would be less educated, less assertive, or more involved in crime than whites, reinforcing negative stereotypes (Shah 30). As the prevalence of such stereotypes damages the life prospects of members of disadvantaged racial groups, this creates a vicious cycle that ensures the survival of racial essentialist perceptions.
Problems of Race and Healthcare
One particular area of concern in which the impact of the vicious cycle of negative stereotyping and social disadvantage can be observed is access to healthcare. Studies from around the world have confirmed significant disparities in health and healthcare outcomes based on socially-assigned race (White). In other words, people who are perceived as belonging to a less privileged group tend to be both less healthy and receive inferior care. The causes of this inequality cannot be reduced to socioeconomic factors, as racial health disparities can also be found among higher-status or upwardly mobile blacks and Hispanics, sometimes in more pronounced forms (Cogburn 738). Racial inequality in healthcare outcomes can manifest both in access to adequate medical care and in the quality and effectiveness of engagement with health professionals (White). This disparity, in turn, exacerbates the inequality in health and overall living standards.
The disparity in healthcare outcomes can reflect the influence of multiple forms of racial bias. At this point in America’s history, conscious individual and institutional discrimination based on race no longer represent the most significant obstacle to more equitable outcomes in health (Shah 29). After all, the official policy of healthcare institutions is to provide equal treatment regardless of race, and the majority of healthcare providers do not regard themselves as racist. Though well-intentioned, the color-blind stance adopted by most of those institutions often serves to obscure the disparities caused by structural factors affecting racial minorities. For example, lower average education leads to poorly informed patients who are less able to derive full benefits from doctor visits, and lower economic status makes compliance with prescriptions more difficult (Shah 30). It also blinds health professionals to their own unconscious biases, hindering their interactions with patients as well as any attempts to mitigate healthcare inequality at the institutional level.
Further problems for reducing the disparity in health outcomes lie on the plane of national health politics. For many people, both the availability and the quality of medical care depend primarily on government healthcare programs, and this is particularly true for members of racial minorities. The partisan debate over healthcare, which has become especially acrimonious and racially tinged during the Obama administration, makes any progress in this area particularly difficult. Partisan polarization and the decrease in pragmatism in both federal and state politics make policymaking more vulnerable to racial bias. Morone notes that Medicaid expansion was rejected in eight out of ten states with the largest proportional black populations, but accepted in Republican-controlled states with small black minorities (841). This outcome can be partly attributed to the common stereotypical perception that the new recipients of Medicaid in the former states would be lazy and anti-social, and therefore unworthy of it. With Republicans and Democrats increasingly acting as parties of the white majority and racial minorities respectively, the partisan considerations in healthcare policy grow more complex and less tractable.
Even assuming that the influence of broader societal factors on racial health disparities could be widely accepted and that the vagaries of politics could be navigated, the question of how to overcome those disparities remains. The two approaches available to policymakers are to focus on population health goals without regard to race or to provide targeted assistance to disadvantaged racial groups (Cogburn 744). While the former strategy is seemingly more consonant with a universal and egalitarian approach to healthcare, it can leave serious problems affecting specific groups completely unaddressed. Meanwhile, the latter path requires serious adjustments to institutional procedures and structures to be genuinely successful.
How to Make Healthcare More Equitable?
I believe that providing its constituents with maximally equitable access to healthcare constitutes one of the primary duties of government. This understanding follows naturally from the social contract principle, according to which the purpose of the society is to secure the individual interests of its members through collective action. By allocating resources and creating an organizational framework for a healthcare system, a government can ensure better health outcomes than what individuals could achieve by themselves. However, every individual’s access to this shared pool of health resources is complicated by various factors. Conscious and unconscious racial prejudice, stereotypes, and ignorance of particular obstacles faced by racial minorities in society are some of the most significant factors in question (Cogburn 738). Individuals who are perceived as belonging to the racial majority studies access and utilize healthcare services with greater ease and effectiveness than those who appear to belong to historically oppressed minority groups (White). This discrepancy confirms that the problem is caused in large part by specific social constructions of race.
While perfect equality in health and healthcare outcomes may not be attainable, reducing disparities based on socially-assigned externals like race is both possible and desirable. It seems to me that the optimal way to tackle this elusive general problem is to focus on resolving specific issues that keep racial minorities from making full use of healthcare. Targeted assistance to communities that are particularly disadvantaged in terms of health outcomes can be one part of this solution, and perhaps necessary to alleviate the most pressing predicaments. In the long run, however, a change in institutional culture and norms is essential, which can be best attained through adjustments to medical education (Cogburn 751). If healthcare providers are trained from the start to recognize the structural obstacles that their patients face due to their race, they will be better equipped to assist them and win their cooperation (Shah 30). To provide the necessary structural support for this shift, though, the healthcare system as a whole would need to shed the counterproductive color-blind approach, which obscures racial disparities but cannot make them go away.
Why Racial Inequality in Healthcare Matters
The principle of universal human rights mandates that societies must extend a guaranteed minimum of resources and protections to all of their members. Of those rights, the right to health is one of the most critical, as it impacts on all areas of human activity, whether it is business, education, or family life. The insufficient ability to exercise the right to health can even undermine the more fundamental human right to life. As such, the disparity in access to quality healthcare based on socially-assigned race has grave implications for racial inequality in society more generally (White). Identifying the causes of this disparity is necessary both to improve health outcomes and for broader social progress.
This question is a particularly urgent one for American citizens, given the current fraught state of health politics in the United States. Writing before the divisive 2016 election, Morone speculated that after the Obama administration, the partisan controversy that overtook health policy might either fade away or become the new normal (843). The developments that occurred since then, including the continued political battle over the Affordable Care Act, point towards the latter scenario. Ideological and political considerations, which are informed by cultural racism, override the usual impetus towards compromise and pragmatic policymaking. While this situation damages the short-term prospects of a more fair and consistent approach to healthcare, it also makes it crucial for policymakers and citizens to think about the shape of that approach. Given the ubiquitous and endemic nature of racial inequality in health and healthcare outcomes, any such conversation must address this issue.
Conclusion
The principle of the right to health requires governments to provide their citizens with access to adequate medical care. While ideally, all citizens should be able to exercise their right to health equally, in practice, this is complicated by external factors. I see no reason to doubt that socially-assigned race is one of those factors. Stereotypes and prejudice, as well as pure ignorance of structural problems connected to race, play a significant role in the inequality of healthcare outcomes between racial groups. This dynamic plays out on several levels, from political decisions regarding access to health resources to quality of engagement with health professionals. I think that promoting racial sensitivity throughout the healthcare system represents the most promising method of mitigating this inequality, as it would empower medical professionals to address specific obstacles faced by their patients. If this is done, it will lead to greater equality in health outcomes and all other parts of life, resulting in an America that is healthier in both physical and socioeconomic terms.
Works Cited
Cogburn, Courtney D. “Culture, Race, and Health: Implications for Racial Inequities and Population Health.” The Milbank Quarterly 97, no. 3, 2019, pp. 736-761.
Constance-Huggins, Monique. “Critical race theory and social work.” The Routledge Handbook of Critical Social Work, edited by Stephen A. Webb, 2019, pp. 163-170.
Shah, Karishma. “The Dyadic Conversation of Racial Inequality in Employment, Criminal Justice, and Healthcare: Using the Color-Blind Fallacy to Understand Differing Perceptions.” Hinckley Journal of Politics 20, 2019, pp. 25-33.
Middleton, Stephen, et al., editors. The Construction of Whiteness: An Interdisciplinary Analysis of Race Formation and the Meaning of a White Identity. University Press of Mississippi, 2016.
Morone, James A. “Partisanship, Dysfunction, and Racial Fears: the New Normal in Health Care Policy?” Journal of Health Politics, Policy and Law 41, no. 4, 2016, pp. 827-846.
White, Kellee, et al. “Socially-Assigned Race and Health: a Scoping Review with Global Implications for Population Health Equity.” International Journal for Equity in Health 19, no. 1, 2020. Web.