How Has Racial Segregation Affected Health Care?

Assessing the legacy, impact and remedies racial segregation in American health care

David Barton Smith, PhD, studied the historical link between racial segregation and discrimination in health care, described efforts through the courts and U.S. regulation to end discrimination in health care, and examined possible approaches to address, through regulatory and health care reform, certain continuing discrepancies and the persistence of segregation.

The project was part of the Robert Wood Johnson Foundation (RWJF) national program Investigator Awards in Health Policy Research.

Key Results: Smith published his study in Health Care Divided: Race and Healing a Nation, published by the University of Michigan Press in 1999.

Six conclusions are presented in the book:

  • The advocacy of independent health practitioners was one of the keys to the emergence of the civil rights movement; the largest threat embedded in the current transition of health care is the elimination of their ability to serve as advocates for their patients and communities.
  • Voluntary health care organizations, insulated from public accountability, contributed both to the perpetuation of segregation and to its elimination.
  • The purchasers of health care define the self-interests of providers and, in the process, either narrow or widen health care's racial divisions.
  • The selective enforcement of Title VI of the Civil Rights Act of 1964 exerted a profound, unintended, and unacknowledged influence on the organization of health services in the United States.
  • A divided health system persists, both exacerbating and distorting racial disparities.
  • Health care settings can close racial divisions.

Principal Deputy Assistant Secretary for Health at the time the book was published, Nicole Lurie, MD, lauded Health Care Divided as recommended reading for U.S. Department of Health and Human Services staff, commending its potential contribution to the reduction of health disparities.

Key Recommendations: Smith recommends routine and ongoing examination of racial disparities in the use of health care services and in the choices of diagnostic and therapeutic alternatives. Such monitoring should be part of the quality assurance protocols of all health care organizations and could easily be added to existing quality-assurance-reporting formats.

As of February 2000, the book had sold more than 1,000 copies.