Abstract
The paper summarizes recently published dataand recommendations about healthcaredisparities experienced by African Americanswho have Medicare or other healthcare coverage.Against this background the paper addresses theethics of such disparities and howdisadvantages of vulnerable populations likeAfrican Americans are typically maintained indecision making about how to respond to suchdisparities. Considering how to respond todisparities reveals much that vulnerablepopulations would bring to the policy-makingtable, if they can also be heard when they getthere. The paper argues that vulnerablepopulations like African Americans need fairrepresentation in bodies deciding what to doabout such disparities and that fairnessrequires proportional representation at alllevels of decisions that affect healthcare – aradical change. In this decision setting, howto provide adequate protection of minoritiesneeds much further attention. The mostattractive decision-making model isdeliberative democracy. The paper shows thatin deliberation, fair representation requiresnot only having a voice in decisions, but afair hearing of those voices. Achieving a fairhearing requires changes in norms ofcommunication and training of all to giveimportance to greetings and other measures ofcivility and trust building, and to be open todiverse forms of expression. Decisions abouthow to respond to healthcare disparities wouldinclude what programs to initiate for whom, howto evaluate the programs, and what to do inresponse to such evaluations. Conclusions arethat achieving such goals will take a seachange in how healthcare institutions andproviders do their business, and that socialactivism at every level will be needed toeffect these changes. The discussionhighlights many ethical issues that need muchgreater attention.
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REFERENCES
Taylor SE, Braithwaite RL. African American health: An overview: In: Braithwaite RL, Taylor SE, eds. Health Issues in the black Community, 2nd ed. San Francisco: Jossey-Bass, 2001: 3–12.
Marmot M. Inequalities in health. New Engl J Med2001; 345: 134–136.
Mechanic D. Rediscovering the social determinants of health. Health Affairs2000; 19(3): 267–276.
Bullard RD, Warren RC, Johnson GS. The quest for environmental justice. In: Braithwaite RL, Taylor SE, eds. Health Issues in the Black Community, 2nd ed. San Francisco: Jossey-Bass, 2001: 471–488.
Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002), http://www.nap.edu/books/030908265X/html/.
Schneider EC, Cleary PD, Zaslavsky AM, Epstein AM. Racial disparity in influenza vaccination: Does managed care narrow the gap between African Americans and whites? JAMA2001; 286(12): 1455–1460.
Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in medicare managed care. JAMA2002; 287(10): 1288–1293.
Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Amer J Public Health1997; 87(11): 1773–1778.
Thomas SB, Quinn SC. Public health then and now: the Tuskegee syphilis study, 1932 to 1972: indications for HIV education and aids risk education programs in the black community. Amer J Public Health1991; 81(11): 1498–1504.
Dula A, Stone JR. Wakeup call: Healthcare and racism. Hastings Center Report2002; 32(4): 48.
Cose E. The Rage of a Privileged Class. New York: HarperCollins, 1993.
Harrington W. Crossings: A White Man's Journey into Black America. New York: Harper Collins, 1992.
Wellman DT. Portraits of White Racism. New York: Cambridge University Press, 1993.
Tatum BD. Why Are All the Black Kids Sitting Together in the Cafeteria: And Other Conversations about Race. New York: Basic Books, 1997.
Feagin JR, Vera H, Batur P. White Racism, 2nd ed. New York: Routledge, 2001.
McIntosh P. White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences Through Work in Women's Studies, No. 189. Wellesley, MA: Center for Research on Women, Wellesley College, 1988.
Gutmann A, Thompson D. Democracy and Disagreement. Cambridge, MA: Harvard University Press, 1996.
Young IM. Communication and the other: Beyond deliberative democracy. In: Benhabib S, ed. Democracy and Difference: Contesting the Boundaries of the Political. Princeton, NJ: Princeton University Press, 1996: 120–135.
Young IM. Intersecting Voices: Dilemmas of Gender, Political Philosophy, and Policy. Princeton, NJ: Princeton University Press, 1997.
Kochman T. Black and White Styles in Conflict. Chicago: University of Chicago Press, 1981.
Blight DW. Race and Reunion. Cambridge, MA: Harvard University Press, 2001.
Feagin JR, Sikes MP. Living with Racism: The Black Middle-Class Experience. Boston: Beacon Press, 1994.
Krieger N, Sidney S. Racial discrimination and blood pressure: The CARDIA study of young black and white adults. Amer J Public Health1996; 86(10): 1370–1378.
Office of Minority Health. http://www.omhrc.gov/.
National Center on Minority Health and Health Disparities. http://www.ncmhd. nih.gov/.
Sen A. Inequality Reexamined. Cambridge, MA: Harvard University Press, 1992.
Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press, 1971.
Rawls J. Political Liberalism. New York: Columbia University Press, 1993.
Daniels N. Just Health Care. New York: Cambridge University Press, 1985.
Powers M, Faden R. Racial and ethnic disparities in healthcare: An ethical analysis of why and how they matter. Appendix in [5].
Roussos ST, Fawcett SB. A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health2000; 21: 369–402.
Kritek PB. Negotiating at an Uneven Table: Developing Moral Courage in Resolving our Conflicts, 2nd ed. San Francisco: Jossey-Bass, 2002.
Gutmann A, Thompson D. Deliberating about bioethics. Hastings Center Report1997; 27(3): 38–41.
Macedo S, ed. Deliberative Politics: Essays on Democracy and Disagreement. New York: Oxford University Press, 1999.
Helms JE, ed. Black and White Racial Identity: Theory, Research, and Practice. Westport, CT: Praeger, 1993.
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Stone, J. Race and Healthcare Disparities: Overcoming Vulnerability. Theor Med Bioeth 23, 499–518 (2002). https://doi.org/10.1023/A:1021524431845
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DOI: https://doi.org/10.1023/A:1021524431845