Race and health care: problems with using race to classify, assess, and treat patients

Race and health care: problems with using race to classify, assess, and treat patients

University of Texas
May 2010
64 pages

Atalie Nitibhon

Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Master of Public Affairs

Though racial classifications may serve as a mechanism for identifying and correcting disparities among various groups, using such classifications in a clinical setting to detect and treat patient needs can be problematic. This report explores how medical professionals and researchers use race in health care for purposes of data collection, risk assessment, and diagnosis and treatment options. Using mixed race individuals as an example, it then discusses some of the problems associated with using race to group individuals, assess risk, and inform patient care. Finally, it discusses how certain components of personalized medicine, such as genetic testing, Electronic Health Records, and Rapid Learning Systems could help address some of the concerns that arise from the application of race in a health care setting.

Table of Contents

  • Chapter 1: Introduction
    • What is Race?
  • Chapter 2: Race and Health Care
    • Data Collection/Health Statistics
    • Risk Assessment
    • Diagnosis/Treatment
  • Chapter 3: The Case of Mixed Race
  • Chapter 4: Addressing the Issue
    • Genetic Testing
    • Genetic Testing Policy
      • Privacy and Security
      • Accuracy
      • Medical Education
      • Access
      • Research
    • Electronic Health Records and Rapid Learning Systems
    • Electronic Health Records Policy
    • Meaningful Use of Electronic Health Records
  • Chapter 5: Conclusion
  • References
  • Vita

…Chapter 3: The Case of Mixed Race

As mentioned during the previous discussion entitled “What is Race?”, no such thing as “pure race” exists, so it stands to reason that everyone is, to some degree, “multiracial” or of “mixed race.” However, for the purposes of this discussion, the terms “multiracial,” “mixed race,” and “mixed heritage” refer to individuals with parents who are classified as being from two distinct racial or ethnic categories. Mixed heritage individuals described by such a definition provide an excellent example of some of the problems associated with relying on race to classify individuals, assess risk, or inform patient care.

Racial identification, either on the part of the individual or by an external actor (e.g., a medical professional) is an area of concern, particularly in terms of the reliability of using race to assess health risk. For example, an individual who has one black parent and one Hispanic parent may self-identify as only one or the other. If she identifies as black and does not think to share the racial or ethnic identities of both of her parents with the medical professionals administering care, how comprehensive will the patient assessment be? Or, if a patient has one Asian parent and one white parent, but a medical professional identifies her as Hispanic, what effects does that external misidentification have on the adequacy, accuracy, and equitability of the physician’s assessment of the patient? Furthermore, patients do not inform health care professionals that they believe they have disease X, thus allowing the clinician to then administer exams to confirm that diagnosis. Instead, patients present a list of symptoms to their physician, and then expect a diagnosis and treatment. While most physicians will follow proper medical protocol in assessing and diagnosing a patient, her beliefs and biases, however well-meaning they may be, could influence the type of treatment the patient receives. Thus, if the physician believes the Asian/White patient to be Hispanic, the physician’s perceptions about Hispanics in the health care setting may subconsciously influence her assessment and care of the patient…

…In general, the absence of options for multiethnic or multiracial individuals reveals part of the problem in using race as a risk assessment tool: it neglects to account for the extent of genetic variation that underlies the concept of race. Thus, not only does it disregard a number of people who do not fit neatly into any of the given categories, but it may also misgauge the genetic contributions of individuals who do select a specific race or ethnicity with which they identify socially….

…The 2000 Census marked the first time individuals had the option to “mark one or more” race; the resulting data reveal that nearly 7-million individuals self-identified as multiple races. Another study projects that individuals who self-identify as mixed race will make up 21 percent of the population by 2050. The growing number of individuals who self-identify as multiracial indicates that the “traditional” methods of grouping people according to race need reassessment. Similarly, the manner in which medical professionals consider race to inform patient care needs reassessment. Nonetheless, inclusion of the option to mark one or more on the Census does not mean that mixed heritage individuals are a new “phenomenon.” Recalling the idea that nobody is purely one race, it stands to reason that doctors have been treating “mixed heritage” patients for quite some time now. In some respects, that illustrates the notion that the actual “race” of an individual is irrelevant; the only way to treat the patient is to treat the patient…

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