Race getting the silent treatment in healthcare debate

"Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane." --- Martin Luther King, Jr.

In June the Obama administration launched its national initiative for healthcare reform. With healthcare taking center stage on the domestic policy agenda Americans will soon be debating the relative merits of universal access, the efficacy of expanded insurance coverage, and the strategies for cost effective provision of medical care.

Policy makers probably will not talk much about racial inequality because race talk makes it harder to build the political coalitions necessary to pass major reform. But as Americans we should work to make racial inequality part of the health care agenda.

Racial health disparities are deep and persistent in this country. Over the past forty years, the racial income gap has narrowed, African Americans have made significant gains in education, and our workplaces are more integrated. Despite these gains there has been little progress addressing the stark racial inequalities in American health.

Black infants are twice as likely as white infants to die before their first birthday. Black women are less likely to be diagnosed with breast cancer, but more likely to die from the disease. African Americans suffer from higher rates of diabetes, asthma, fibroids, and several forms of cancer. HIV infection rates are exponentially higher for African Americans with young black women being most vulnerable. Life expectancy for black men is the worst in the nation. These differences cannot be explained away simply by accounting for socioeconomic differences between racial groups. Black Americans have worse health outcomes even when we account for income.

American health is, in part, a racial issue. If we want to truly understand the failures of our nation's healthcare and create a system that is fair for all Americans then we should not ignore race, we should carefully consider it.

American medicine ascended at the turn of the century, ushered in by the processes of urbanization, modernization, and rapid scientific discovery of the industrial revolution. But this was also an era of characterized by rigid racial segregation enforced by racial violence. America's health care system is still marked by the troubling reality that it emerged during our country's racial nadir.

For example, the unwillingness to treat black and white patients in the same hospitals contributed to needless redundancy in health service delivery. Though legal medical segregation has ended the effects of this inefficiency persist. These separate systems also, in part, account for the continuing problems with creating a physician corps that represents America's racial diversity.

The persistence of racial health disparities also forces us to consider the structural aspects of American health. Too often the public discourse on health focuses on individual behaviors without enough attention to concerns about environment, access, and doctor-patient interactions. Understanding racial health disparities squarely focuses our attention on how unequal outcomes emerge from the broad systems that surround and encompass healthcare.

For example, black children's asthma rates can be directly linked to environmental injustices that expose some neighborhoods to more traffic and debris. Black men's lower life expectancy is largely rooted in their greater vulnerability to violence. Limited availability of quality food in black neighborhoods is implicated in the racial diabetes gap. African American health reminds us of the persistence of historical injustice and continuing residential segregation.

It is important to note that our First Lady, Michelle Obama, has particular expertise in this area. Her years in hospital administration involved understanding and negotiating the relationship between university medical care and Chicago's largely black Southside community. Although she is unlikely to take a leading policy role on this issue, she may prove a valuable ally to efforts to keep health disparities on the agenda.

Healthcare is a big issue. The process of improving our national health and healthcare will be long, difficult, and complicated. As we engage in this debate let's keep the lessons of racial inequality in the conversation.

Melissa Harris-Lacewell is Associate Professor of Politics and African American Studies at Princeton University. She is the author of the award-winning book, Barbershops, Bibles, and BET: Everyday Talk and Black Political Thought, (Princeton 2004). And she is currently at work on a new book: Sister Citizen: A Text For Colored Girls Who've Considered Politics When Being Strong Wasn't Enough.