TY - JOUR
T1 - Race and healthcare disparities overcoming vulnerability
AU - Stone, John
N1 - Funding Information:
In the spring of 2002, the Institute of Medicine (IOM) published a comprehensive review of studies of healthcare disparities over the previous decade: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2002) [5]. The IOM is one of The National Academies, a private, non-profit organization. The National Academy is a congressionally chartered organization with the charge of advising the United States federal government in matters of science and technology [5:iv]. Unequal Treatment was funded by the Office of Minority Health, U.S. Department of Health and Human Services.
PY - 2002
Y1 - 2002
N2 - The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable population like African Americans are typically maintained in decision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable population would bring to the policy-making table, if they can also be heard when they get ther. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare - a radical change. In this decision setting, how to provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building. and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, how to evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention.
AB - The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable population like African Americans are typically maintained in decision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable population would bring to the policy-making table, if they can also be heard when they get ther. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare - a radical change. In this decision setting, how to provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building. and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, how to evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention.
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U2 - 10.1023/A:1021524431845
DO - 10.1023/A:1021524431845
M3 - Review article
C2 - 12546167
AN - SCOPUS:0036955824
VL - 23
SP - 499
EP - 518
JO - Metamedicine
JF - Metamedicine
SN - 1386-7415
IS - 6
ER -