Debating the Cause of Health Disparities: Implications for Bioethics and Racial Equality

In 2002, the health arm of the National Academy of Sciences, the Institute of Medicine (IOM), scientifically documented widespread racial disparities in healthcare and suggested that they stemmed, at least in part, from physician bias. Its 562-page report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, noted that, although these disparities are associated with socioeconomic status, the majority of studies it surveyed “find that racial and ethnic disparities remain even after adjustment for socioeconomic differences and other healthcare access-related factors.”Footnote¹ As directed by Congress, the IOM committee defined “disparities” in healthcare as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of intervention” (pp. 3–4). Unequal Treatment concludes that, after factoring out these access-related differences, remaining disparities can be attributed in part to discrimination by the medical profession—physician prejudices, biases, or stereotyping of their minority patients.