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HEALTH SCENARIO

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Two male coworkers were referred by their supervisor to the same primary care physician for annual physical examinations. One patient was a 55-year-old African American man; the other was a 55-year-old European American man. Both men worked at the same job for nearly 30 years and had the same insurance coverage. Both patients were previously diagnosed with diabetes, which was managed by taking oral medications. An indicator of long-term blood glucose levels, the glycosylated hemoglobin A1c (HbA1c), for the African American and European American men, were 10.9% and 8.2%, respectively, which are both elevated. The African American patient had a positive family history of diabetes, with several first-degree relatives having amputations secondary to poor glycemic control. Amputations are performed because of recurrent severe infections of skin ulcerations that cannot be controlled otherwise.

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During the visits, physical examinations were completed on each patient, and blood samples for appropriate laboratory tests were obtained. After examinations of his feet for evidence of ulceration, the European American patient was offered the influenza vaccination and received counseling on preventive services, such as annual dental and eye examinations. Despite a personal and extensive family history of risk factors for diabetes, the African American patient did not receive recommendations for preventive care services, including getting his feet examined. Months later, the African American patient developed septicemia (a blood infection arising from the infected foot ulcers), was hospitalized and treated with intravenous antibiotics, and ultimately underwent a lower limb amputation as a result.

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CLINICAL BACKGROUND

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Despite significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that (1) racial and ethnic minorities tend to receive lower quality of care, including preventive care, than nonminorities and (2) patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than nonminorities. In 2002, the Institute of Medicine (IOM) published a report on unequal treatment, concluding that “racial and ethnic disparities in healthcare exist and, because they are associated with worse outcomes in many cases, are unacceptable.” The IOM report defined disparities in health care 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.” Since the publication of the IOM report, there has been renewed interest in understanding the sources of disparities, identifying contributing factors, and designing and evaluating effective interventions to reduce or eliminate racial and ethnic disparities in health care.

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Racial variations in health might be assumed to arise from genetic factors. Under this model, race is considered in biologic terms, genes that differ between races are linked with the genes that determine health, and the health of a population is determined predominantly by biologic factors. Recent studies have shown, however, that there is more genetic variation within races than between races and that race is more of a social construct than a biologic ...

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