Who owns health inequalities?

Constance A Nathanson, Mailman School of Public Health, Columbia University, New York
The Lancet, Volume 375, Issue 9711,  23 January 2010
Website: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60119-5/fulltext

“…..Are health “inequalities” a problem of the poor (and thus soluble by changing poor people’s circumstances or behaviour) or are they an effect of rigid patterns of social stratification (requiring that resources be redistributed)? Are they “voluntary”—the result of bad choices (“booze and fags”)—or “involuntary”—the consequence of oppressive social structures? Should inequalities be framed as “disparities”—mere differences that may or may not be the result of human action—or as unacceptable “inequities”?

And finally, who “owns” health inequalities? Are they—as in the 19th century—a public health problem or are they a medical care problem? Are they a private problem or a public problem? These are not logical or empirical questions. They are political questions. How they are answered will depend on the policy preferences of those in power, or who aspire to power. I illustrate these points with the examples of the UK and the USA, countries at the extremes of public policy in this domain…..”

Diversity in the Health Professions- A New Report

Sullivan and Mittman, “The State of Diversity in the Health Professions a Century after Flexner,” Academic Medicine, Volume 85 issue, 246-253,   February 2010
Website: http://journals.lww.com/academicmedicine/Abstract/2010/02000/The_State_of_Diversity_in_the_Health_Professions_a.21.aspx

The paper is a review article about diversity in the health professions since the Flexner report of 1910, which while revolutionizing medical education, led to the closure of five out of the only seven medical schools that trained African Americans.  It is among 27 articles published in a special Flexner Centenary issue, focusing on the 19th century educator Abraham Flexner, his legacy and his impact on medical education.  The paper draws attention to the limited gains in diversity in the health professions despite decades of interventions and calls for better integration and coordination of efforts among schools and funders to increase diversity.

One of the key statements of the authors is that arguments for diversity in the health professions tend to emphasize benefits to minority populations only, rather than benefits to all, inadvertently leading to the pigeonholing of minority health professionals while “absolving” other providers from the need to pursue public service.  The paper also stipulates that diversity interventions do not stop at medical school graduation but rather must afford equity in further opportunities to excel and lead. The authors call for statewide collaborations to recruit, support and nurture the growth of minorities in the health professions.

Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities

Issue Brief No. 130, February 2010
Authors: James D. Reschovsky, Ellyn Boukus
Website: http://www.hschange.org/CONTENT/1113/

While many U. S. physicians identify language or cultural barriers as obstacles to providing high-quality patient care, physicians’ efforts to overcome communication barriers are modest and uneven, according to a new national study released today by the Center for Studying Health System Change (HSC).

Racial discrimination and health: A systematic review of scales with a focus on their psychometric properties

Joao Luiz Bastosa, Roger Keller Celesteb, Eduardo Faersteinb and Aluisio J.D. Barrosa
a Post-graduate Program in Epidemiology, Federal University of Pelotas, Department of Social MedicinePelotas, Rio Grande do Sul, Brazil
b Post-graduate Program in Public Health, Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
Social Science & Medicine – Available online 1 February 2010.
Website: http://bit.ly/cW430p

‘……The literature addressing the use of the race variable to study causes of racial inequities in health is characterized by a dense discussion on the pitfalls in interpreting statistical associations as causal relationships.

In contrast, fewer studies have addressed the use of racial discrimination scales to estimate discrimination effects on health, and none of them provided a thorough assessment of the scales’ psychometric properties. Our aim was to systematically review self-reported racial discrimination scales to describe their development processes and to provide a synthesis of their psychometric properties.