Race: A Starting Place

Race: A Starting Place

Virtual Mentor: American Medical Association Journal of Ethics
Volume 16, Number 6 (June 2014)
pages 472-478

Brooke A. Cunningham, MD, PhD

Health status, access to and quality of care, and numerous social factors associated with health vary across racial groups. Many applaud the collection and use of race data to identify and monitor progress in addressing health disparities. The National Institutes of Health (NIH) requires and the Food and Drug Administration (FDA) recommends the collection of race data in clinical research; the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act provided financial incentives for health systems to collect race information through the Medicare and Medicaid Electronic Health Record Incentive Program (i.e., “meaningful use” of electronic health records); and the 2010 Patient Protection and Affordable Care Act (ACA) mandated that the Department of Health and Human Services establish standards for race and ethnicity data collection. Yet, in the face of increasing amounts of “race data,” we have created few opportunities for discussing “what race measures.” Some journals require authors to explain how race is conceptualized and collected in their studies, but the requirement is not standardized and rarely met. Thus, race and racial data are frequently interpreted in conflicting ways. This article seeks to provide an overview of race as a foundation for an improved understanding of the relationship between race and health.

Many challenges await those who wish to consider the role of race in health outcomes critically. Careful consideration of race requires identifying and setting aside much tacit knowledge about race—those ideas that come easily, are taken for granted, and simply seem right. Although “race…appears obvious, intuitive, and in need of no special knowledge to discuss or analyze…[u]sing race in biomedical contexts requires great care and expertise”. Such an approach is difficult because from childhood we learn the ways that racial groups are supposed to differ from one another. Frequently the lesson has been that differences between the races are intrinsic or inherited, and those beliefs have justified discrimination against members of racial minority groups. Finally, it seems that, to many, newer understandings of race that have emerged from the social sciences seem less scientific, less reliable, and more political than the biological or genetic explanations that they seek to unseat…

…Racial categories vary across the world. Thus, identical twins separated and raised in different countries could end up identifying their race differently. Similarly, were we able to send a person back through time, his or her race might change. Social scientists point to this variation in racial categories across time and space to argue that race is a social construct. Further support for the fluidity of race also comes from recent studies that show that some people report membership in different races at different times in their lives. The race that one selects often depends upon one’s current social position…

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