Combating Racial Health Disparities through Medical Education: The Need for Anthropological and Genetic Perspectives in Medical Training

Abstract

Despite major public health initiatives, significant disparities persist between racially-and ethnically-defined groups in the prevalence of disease, access to medical care, quality of medical care, and health outcomes for common causes of morbidity and mortality in the United States. It is critical that we develop new and creative strategies to address such inequities, mitigate the social, environmental, institutional, and genetic determinants of poor health, and combat the persistence of racial profiling in clinical contexts that further exacerbates racial/ethnic health disparities. In this article, I argue that medical education is a prime target for intervention, and that there is an important role for anthropologists and human population geneticists to play in efforts to reform medical curricula in this country. Medical education would benefit greatly from the incorporation of anthropological and genetic perspectives on the complexities of race, human genetic variation, epigenetics, and the causes of racial/ethnic disparities. Medical students and practicing physicians should also receive training on how to use this knowledge to improve clinical practice, diagnosis, and treatment for racially diverse populations.For the last two decades, one of the primary goals of the U.S. Department of Health and Human Services (HHS), the National Institutes of Health (NIH), the Institute of Medicine (IOM), the Centers for Disease Control and Prevention (CDC), and many public health programs has been the reduction of health disparities in the United States (Smedley et al. 2003; Centers for Population Health and Health Disparities 2007; CDC 2011; HealthyPeople.gov). However, significant disparities have persisted, not only in the prevalence of disease, access to medical care, and quality of care, but also in health outcomes for the most common causes of morbidity and mortality (including cardiovascular and lung disease, infectious disease, cancer, and diabetes). These disparities fall largely along racial, ethnic, Pre-print version. Visit http://digitalcommons.wayne.edu/humbiol/ after publication to acquire the final version.and class lines, with poor, uninsured, and minority populations affected most negatively (Table 1; Shields et al. 2005;Betancourt 2006; CDC 2011). In some geographic areas, local disparities are even greater than what the national statistics show, and, in many cases, inequalities have increased, rather than decreased, in recent years. Where I live in Central Texas, for example, black infant mortality is now almost four times greater than white infant mortality (Tang 2012), in contrast to the two-fold difference in black and white infant mortality rates nationally (Table 1). Ongoing demographic shifts are expected to further exacerbate this and other disparities, both in Central Texas and nationwide.Given these trends, it is critical that we develop and implement new and creative strategies to address such inequities. There is an urgent need for novel approaches to mitigate (a) the social, env...

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