Racial and Ethnic Disparities in Health and Health Care Kevin Fiscella, MD, MPH University of Rochester School of Medicine & Dentistry Departments of Family Medicine Community & Preventive Medicine What is race?
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Kevin Fiscella, MD, MPH
University of Rochester School of Medicine & Dentistry
Departments of Family Medicine
Community & Preventive Medicine
How we define race strongly affects how we conceptualize the relationships between race and health and health care.
-Collins English dictionary, 1998
– Massey, 1989
Institutional and individual practices that create and reinforce oppressive systems of race relations whereby people and institutions engaging in discrimination adversely restrict by judgment and action, the lives of whom they discriminate against.-Krieger 2003
Exposure to toxins, allergens, & infections less than whites
Access to health care
cognitive and emotional development
Access to social networks
Acute & chronic pain less than whites
Congestive heart failure
Coronary artery disease
StrokeDisparities in medical treatment
Societal factors - Differences in presence and type of health insurance and systems of care.
Patient factors - Literacy, knowledge, beliefs, attitudes, language and norms.
Physician factors - Unconscious stereotyping, cultural insensitivity, and poor communication skills
provide less information, and engage in less partnership with minority patients.