Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity

Abstract

An overwhelming body of evidence points to an inextricable link between race and health disparities in the United States. Although race is best understood as a social construct, its role in health outcomes has historically been attributed to increasingly debunked theories of underlying biological and genetic differences across races. Recently, growing calls for health equity and social justice have raised awareness of the impact of implicit bias and structural racism on social determinants of health, healthcare quality, and ultimately, health outcomes. This more nuanced recognition of the role of race in health disparities has, in turn, facilitated introspective racial disparities research, root cause analyses, and changes in practice within the medical community. Examining the complex interplay between race, social determinants of health, and health outcomes allows systems of health to create mechanisms for checks and balances that mitigate unfair and avoidable health inequalities. As one of the specialties most intertwined with social medicine, emergency medicine (EM) is ideally positioned to address racism in medicine, develop health equity metrics, monitor disparities in clinical performance data, identify research gaps, implement processes and policies to eliminate racial health inequities, and promote anti-racist ideals as advocates for structural change. In this critical review our aim was to (a) provide a synopsis of racial disparities across a broad scope of clinical pathology interests addressed in emergency departments—communicable diseases, non-communicable conditions, and injuries—and (b) through a race-conscious analysis, develop EM practice recommendations for advancing a culture of equity with the potential for measurable impact on healthcare quality and health outcomes.

Antenatal care utilisation and receipt of its components in Nigeria: Assessing disparities between rural and urban areas—A nationwide population-based study

“…Following multivariable analyses, we identified several factors associated with ANC utilisation in Nigeria across rural and urban areas, revealing a complex interplay of intersectional dynamics. Often rooted in systemic inequalities, these dynamics can be better comprehended through the lens of social determinants of health [ 8 , 9 , 34 ]. The dynamics encompass various elements, including geographic location, regional disparities, healthcare system functionality, individual characteristics, socioeconomic status, and cultural influences, all intricately shaping access to and utilisation of healthcare services.…”

“…Briefly, social determinants of health encapsulate how individuals live, learn, work, and play, shaped by the distribution of money, power, and resources [ 8 ]. These determinants profoundly influence a diverse spectrum of health outcomes and quality-of-life indicators [ 9 ]. Conversely, intersectionality elucidates how various systems of marginalisation and privilege intersect, intertwining to form unique experiences for individuals and communities [ 34 ].…”

A Black autoethnography of grief and racial trauma during the COVID‐19 pandemic

“…It is possible that members of minoritized population suffer from racial trauma after experiencing barriers to receiving adequate medical attention due to racism during the COVID-19 pandemic. Racism and racial trauma persisted in the healthcare system far before the COVID-19 pandemic (Giaquinto et al, 2022;Hoang et al, 2023;Macias-konstantopoulos, et al, 2023;Zhou et al, 2022). Black women in particular have reported racial discrimination in the healthcare industry such as dismissal of pain, withholding of care, lack of bodily autonomy, and deferral to White people for decision-making (Hoang et al, 2023).…”

Demystifying African American Spirituality: Exploring the Measurement of Spirituality in the Context of Medical Decision-Making

“…They are more likely to be diagnosed with chronic disease at earlier ages than whites, less likely to have their chronic illnesses managed as well as whites and are more likely to suffer from poorer health outcomes throughout their lifespan until they die (Aaron et al, 2021). These inequitable outcomes are indicative of a healthcare system that still struggles with the long legacy of systemic racism (Macias-Konstantopoulos et al, 2023). As a result, many African Americans, 97% of whom believe in God or a higher power that is intimately involved in their lives (Mohamed et al, 2021), rely on their faith or spirituality to navigate the toxic stress produced by the inadequate access to timely and responsive care, racist interactions, and unconscious bias they often encounter while pursuing treatment (Aaron et al, 2021).…”