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Research and Intervention on Racism as a Fundamental Cause of Ethnic Disparities in Health
[摘要]

The American Public Health Association,

Understanding that in the United States, ethnic disparities in health have persisted during the 20th century and even increased for certain health outcomes, despite major advances in public health, biotechnology, and economic prosperity and wealth;1-7 and

Understanding that “race”-associated differences in health outcomes are routinely documented in this country but the basis of those differences remains poorly explained, and many investigators simply statistically adjust for “race” or restrict their studies to a single “racial” group rather than vigorously investigating the basis of those differences;8-9 and

Understanding that “race” is not a biological measure reflecting innate differences but a social construct capturing the social classification of people in a “race”-conscious society,10-17 and that present day inequalities between so-called “racial” groups are not consequences of their biological inheritance but are products of historical and contemporary sociopolitical and economic systems;18-20 and

Understanding racism as the system of structures, processes, and values that results in differential outcomes by “race”, and that racism is manifest on cultural, institutional, interpersonal, and internalized levels;21-23 and

Acknowledging that ethnic disparities in health may arise on three levels: 

  1. Differences in social, political, economic, or environmental exposures that result in differences in disease incidence;24-26 
  2. differences in access to physical and mental health care including preventive and curative services;27-30a and
  3. differences in the quality of care received within the physical and mental health care delivery system;31-39 and

Acknowledging the importance of identifying the underlying causes of ethnic disparities so that these disparities can be most effectively addressed; and

Realizing that the perception of the occurrence and extent of ethnic disparities in health and health care differs between white and ethnic minority populations in the United States;40 and that many people in the United States believe that racism is no longer a problem, while others deal with its manifestations daily;41-43 and
Recognizing that the science on racism as a risk factor for adverse health outcomes in the United States is still scant but growing;10-12,25-26,44-47 and

Recalling that in 1965, the American Public Health Association passed a resolution on “The Health of Minorities and the Relationship of Discrimination Thereto,”48 and further recalling that in 1974, the American Public Health Association passed a resolution on “Racism in the Health Care Delivery System” which states, “Minority health, as affected by institutional racism, can only improve when efforts from the entire complex of human and public services are purposefully applied to accomplish that specific goal”;49 and

Recognizing that the American Public Health Association has also previously condemned the expression of racism in other countries;50-51 and

Cognizant that Mayor Bob Knight of Wichita, Kansas has called for a National Campaign Against Racism as President of the National League of Cities that challenges and assists city and town governments in becoming Cities Striving to Promote Racial Justice;52-53 and

Noting the Department of Health and Human Services’ Initiative to Eliminate Racial and Ethnic Disparities in Health by the Year 2010 and recognizing this as an opportunity to investigate and address the underlying causes of these disparities;54 and

Recognizing that the American Public Health Association has recently joined with the Department of Health and Human Services in a national Campaign to Eliminate Racial and Ethnic Health Disparities;55 and 

Cognizant that the recent congressional passage of the Minority Health and Health Disparities Research and Education Act of 2000, which established a National Center on Minority Health and Health Disparities at the National Institutes of Health, provides an opportunity for coordinated research on the impacts of racism on health,56 therefore:

  1. Reaffirms previous American Public Health Associations policies that have condemned racism and its impacts on health and health care;
  2. Commends the National League of Cities on their efforts to launch a Campaign to Promote Racial Justice;
  3. Calls on the President and the Congress of the United States to endorse a National Campaign Against Racism;
  4. Calls on the Congress to fund the Institute of Medicine to prepare a report that summarizes our current knowledge on the impacts of racism on health and, by analyzing the processes that mediate these impacts, identifies points of intervention;
  5. Calls on the Department of Health and Human Services to explicitly address racism as a part of its national Initiative to Eliminate Racial and Ethnic Disparities in Health by the Year 2010;
  6. Calls on the Centers for Disease Control and Prevention, the Agency for Healthcare Research Quality, the Health Resources and Services Administration, and the National Institutes of Health to place a high priority on research on the impacts of racism on the health and well-being of the nation;
  7. Calls on the Congress of the United States to appropriate funds for investigating the impacts of racism on the health and well-being of the nation;
  8. Calls on the Congress of the United States to appropriate additional funds for developing evidence-based programs to eliminate ethnic health disparities; and
  9. Calls on the President and the Congress of the United States to recognize and promote legal redress for discrimination in health and health care.

References

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  2. National Center for Health Statistics. Health: United States. Hyattsville, MD: US National Center for Health Statistics, 1976.
  3. National Center for Health Statistics. Health, United States, 2000 with Adolescent Health Chartbook. Hyattsville, MD: Public Health Service, 2000. http:// www.cdc.gov/nchs/data/hus00.pdf
  4. U.S. Department of Health and Human Services, Task Force on Black and Minority Health. Report of the Secretary’s Task Force on Black and Minority Health. Volume I: Executive Summary. Washington, DC: Government Printing Office, 1985.
  5. Centers for Disease Control and Prevention. Chronic Disease in Minority Populations: African-Americans, American Indians and Alaska Natives, Asians and Pacific Islanders, Hispanic Americans, 1994. Atlanta, GA: Centers for Disease Control and Prevention, 1994.
  6. Collins KS, Hall A, Neuhaus C. U.S. Minority Health: A Chartbook. New York, NY: The Commonwealth Fund, 1999.
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  8. Jones CP, LaVeist TA, Lillie-Blanton M. “Race” in the epidemio–logic literature: An examination of the American Journal of Epidemiology, 1921-1990. Am J Epidemiol 1991;134(10):1079-1084.
  9. Jones, CP. “Race”, racism, and the practice of epidemiology. Am J Epidemiol 2001;154(4):299-304.
  10. DuBois WEB. Mortality Among Negroes in Cities. Proceedings of the Conference for Investigation of City Problems. Atlanta, GA: Atlanta University Publications, 1896.
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  22. Batts VA. Modern Racism: New Melody for the Same Old Tunes. Cam–bridge, MA: EDS Occasional Papers, May 1998.
  23. Jones CP. Levels of racism: A theoretic framework and a Gardener’s Tale. Am J Public Health 2000;90(8):1212-1215.
  24. Blau PM, Duncan OD, Tyree A. The American Occupational Structure. New York, NY: Wiley, 1967.
  25. David RJ, Collins JW Jr. Bad outcomes in Black babies: Race or racism? Ethnicity Dis 1991;1(3):236-244.
  26. Kennedy BP, Kawachi I, Lochner K, Jones C, Prothrow-Stith D. (Dis)Respect and Black Mortality. Ethnicity Dis 1997;7(3):207-214.
  27. Graham NM, Jacobson LP, Kuo V, Chmiel JS, Morgenstern H, Zucconi SL. Access to therapy in the Multicenter AIDS Cohort Study, 1989-1992. J Clin Epidemiol 1994;47(9):1003-1012.
  28. Leigh WA, Lillie-Blanton M, Martinez RM, Collins KS. Managed care in three states: Experiences of low-income African Americans and Hispanics. Inquiry 1999;36(3):318-331.
  29. Morehouse Medical Treatment Effectiveness Center (MMEDTEC). A Synthesis of the Literature: Racial and Ethnic Differences in Access to Medical Care. Menlo Park, CA: The Henry J. Kaiser Foundation, October 1999.
  30. Lillie-Blanton M, Hoffman C. Racial and ethnic inequities in access to medical care: Introduction. Med Care Res Rev 2000;57 (Suppl 1):5-10.
  31. Zito JM, Safer DJ, dos Reis S, Riddle MA. Racial disparity in Psychotropic medications prescribed for youths with Medicaid insurance in Maryland. J Am Acad Child Adolesc Psychiatry 1998;37(2):179-184.
  32. Johnson PA, Lee TH, Cook EF, Rouan GW, Goldman L. Effect of race on the presentation and management of patients with acute chest pain. Ann Intern Med 1993;118(8):593-601.
  33. Oddone EZ, Horner RD, Monger ME, Matchar DB. Racial variations in the rates of carotid angiography and endarterectomy in patients with stroke and transient ischemic attack. Arch Intern Med 1993;153(24):2781-2786.
  34. Moore RD, Stanton D, Gopalan R, Chaisson RE. Racial differences in the use of drug therapy for HIV disease in an urban community. N Engl J Med 1994;330 (11):763-768.
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  38. Ramsey DJ, Goff DC, Wear ML, Labarthe DR, Nichaman MZ. Sex and ethnic differences in the use of myocardial revascularization procedures in Mexican Americans and non-Hispanic whites: The Corpus Christi Heart Project. J Clin Epidemiol 1997;50(5):603-609.
  39. van Ryn M, Burke J. The effect of patient race and socio-economic status on physicians’ perceptions of patients. Soc Sci Med 2000;50 (6):813-828.
  40. Rhoades ER (editor). American Indian Health: Innovations in Health Care Promotion and Policy. Baltimore, MD: Johns Hopkins University Press, 2000.
  41. The Henry J. Kaiser Family Foundation. Race, Ethnicity and Medical Care: A Survey of Public Perceptions and Experiences. Menlo Park, CA: The Henry J. Kaiser Family Foundation, October 1999. http://www. kff.org/content/1999/19991014a/Toplines.PDF
  42. Essed P. Understanding Everyday Racism: An Interdisciplinary Theory. Sage Series on Race and Ethnic Relations, Volume 2. New–bury Park, CA: Sage Publications, 1991.
  43. Feagin JR. The continuing significance of race: Antiblack discrim–ination in public places. Am Sociol Rev 1991;56:101-116.
  44. Yen IH, Ragland DR, Greiner BA, Fisher JM. Racial discrimination and alcohol-related behavior in urban transit operators: Findings from the San Francisco Muni Health and Safety Study. Publ Health Rep 1999;114(5):448-458.
  45. James SA, Hartnett SA, Kalsbeek WD. John Henryism and blood pressure differences among black men. J Behav Med 1983;6(3):259-278. A7-9
  46. Williams DR. Racism and health: A research agenda. Ethnicity Dis 1996;6(1 and 2):1-6.
  47. Krieger N, Sidney S. Racial discrimination and blood pressure: The CARDIA Study of young black and white adults. Am J Publ Health 1996;86(10):1370-1378.
  48. Krieger N. Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. Int J Health Serv 1999;29(2):295-352.
  49. APHA Policy Statement 6502: The Health of Minorities and the Relationship of Discrimination Thereto. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association, current volume.
  50. APHA Policy Statement 7424: Racism in the Health Care Delivery System. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association, current volume.
  51. APHA Policy Statement 8225: Apartheid Policy of the Republic of South Africa. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association, current volume.
  52. APHA Policy Statement 8523: Apartheid and Its Impact on Health in the Republic of South Africa. APHA Public Policy Statements, 1948-present, cumulative. Washington, DC: American Public Health Association, current volume.
  53. National League of Cities Advisory Council. Undoing Racism: Fairness and Justice in America’s Cities and Towns. Washington, DC: National League of Cities, 1999.
  54. National League of Cities. Campaign to Promote Racial Justice. http://www.nlc.org/nlc_org/site/programs/race_and_ethnic_relations/index.cfm
  55. U.S. Department of Health and Human Services. The Initiative to Eliminate Racial and Ethnic Disparities in Health. http://www.raceandhealth.hhs.gov
  56. American Public Health Association. Campaign to Eliminate Racial and Ethnic Health Disparities. http://www.apha.org/ppp/racial_disparities.htm
  57. United States 106th Congress. Minority Health and Health Dispari–ties Research and Education Act of 2000 (S. 1880). http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=106_cong_bills& docid=f:s1880enr.txt.pdf

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[发布日期] 2001-01-01 [发布机构] 
[效力级别]  [学科分类] 医学（综合）
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