Race: A Starting Place

Abstract

Health status, access to and quality of care, and numerous social factors associated with health vary across racial groups [1,2]. Many applaud the collection and use of race data to identify and monitor progress in addressing health disparities [3][4][5][6]. The National Institutes of Health (NIH) requires and the Food and Drug Administration (FDA) recommends the collection of race data in clinical research [7,8]; the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act provided financial incentives for health systems to collect race information through the Medicare and Medicaid Electronic Health Record Incentive Program (i.e., "meaningful use" of electronic health records) [9,10]; and the 2010 Patient Protection and Affordable Care Act (ACA) mandated that the Department of Health and Human Services establish standards for race and ethnicity data collection [11]. Yet, in the face of increasing amounts of "race data," we have created few opportunities for discussing "what race measures." Some journals require authors to explain how race is conceptualized and collected in their studies, but the requirement is not standardized and rarely met [12][13][14]. Thus, race and racial data are frequently interpreted in conflicting ways. This article seeks to provide an overview of race as a foundation for an improved understanding of the relationship between race and health.

Structural Racism and Supporting Black Lives — The Role of Health Professionals

“…For example, dating as far back as the antebellum period, physicians attributed poor health among slaves to their biological inferiority, rather than to their conditions of servitude. 5 Such beliefs persist today. In April 2016, a study found that 50% of white medical students and residents hold false beliefs about biological differences between black and white people (e.g., black people's skin is thicker; black people's blood coagulates more quickly).…”

“…4 In the US, this was carried out through centuries of slavery premised on the social construct of race. 5 In a very literal sense, this country codified the value of black lives as 3/5 that of whites in the Constitution. Historical notions about race have shaped our scientific research and clinical practice.…”

“…5 For example, experimentation on black communities and the segregation of care based on race are deeply embedded in the US healthcare system. 5 Disparate health outcomes and systematic decrements in the well-being and livelihoods of black Americans in the United States must be seen as an extension of a historical context where non-white – and specifically black - lives have been devalued. It is both a collective and individual responsibility for health care professionals to understand the historical roots of contemporary health disparities.…”

Race metatheory: Toward a dissolution of a calamitous concept.

“…reflected a common belief that "white blood" could be tainted by "black blood" due to hypodescent practice (Root, 1992). The U.S. government eventually granted privileges to low-status people considered white and continued to withhold them from people considered black, racial classification had real consequences and membership in racial groups became increasingly important to identity (Cunningham, 2014). The U.S. government has collected data on race or color since its first census in the year 1790 (U.S. Census Bureau, 2002).…”

Primary Care Physicians' Collection, Comfort, and Use of Race and Ethnicity in Clinical Practice in the United States

“… 18 , 19 In the United States, it has been used since the 17th century to subdivide humans from one another phenotypically. 20 , 21 However, race is a fluid construct; a person's racial identity can change over time and self-ascribed race can differ from assigned race. 22 Contrastingly, ethnicity, used as a sociocultural construct, 9 , 16 often refers to shared cultural identification, religion, and language.…”