文章基本信息

标题：Paved With Good Intentions: Do Public Health and Human Service Providers Contribute to Racial/Ethnic Disparities in Health?
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作者：Michelle van Ryn ; Steven S. Fu
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2003
卷号：93
期号：2
页码：248-255
语种：English
出版社：American Public Health Association
摘要：There is extensive evidence of racial/ethnic disparities in receipt of health care. The potential contribution of provider behavior to such disparities has remained largely unexplored. Do health and human service providers behave in ways that contribute to systematic inequities in care and outcomes? If so, why does this occur? The authors build on existing evidence to provide an integrated, coherent, and sound approach to research on providers’ contributions to racial/ethnic disparities. They review the evidence regarding provider contributions to disparities in outcomes and describe a causal model representing an integrated set of hypothesized mechanisms through which health care providers’ behaviors may contribute to these disparities. THERE IS EXTENSIVE EVIDENCE of racial/ethnic disparities in receipt of a wide range of health and social services. The past decade has seen an explosion of empirical literature documenting racial/ethnic disparities in medical care received, independent of clinical appropriateness, insurance status, treatment site, and other clinical and socioeconomic status (SES) correlates. 1– 6 These findings parallel documentations of disparities in the justice, child welfare, education, labor, and housing sectors. This deluge of evidence leads us to some painful questions. Because institutional racism (differential processes or outcomes according to race/ethnicity) is the result of the sum total of policies and procedures created and enforced, and the behaviors engaged in, by institutional members, we must ask whether health and human service providers directly contribute to these racial/ethnic disparities in care and health outcomes. If so, how does this occur? Our intent here is to begin to answer such questions by applying existing theory and evidence to a framework designed to guide future inquiry and intervention. First, we provide a brief summary of the empirical evidence supporting the hypothesis that the behavior of health and human service providers contributes to race/ethnicity differences in care and, thus, institutional discrimination. Second, we integrate the empirical evidence regarding social cognition, unintentional bias, and provider behavior into a hypothesized causal model. Social cognition is a subfield of social psychology that studies how we make sense of other people, that is, the mental representations and processes that underlie social perception, social judgment, social interaction, and social influence. Social psychologists focusing on social cognition have been studying the ways in which group characteristics influence person perception and interpersonal processes for several decades, resulting in a massive body of evidence with significant implications for understanding how race/ethnicity influences provider behavior. Finally, we briefly discuss implications for future directions and interventions.