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Structural causes of health inequality

Posted by plosmedicine on 31 Mar 2009 at 00:15 GMT

Author: Lundy Braun
Position: Professor
Institution: Brown University
Additional Authors: Anne Fausto-Sterling, Duana Fullwiley, Evelynn Hammonds, Alondra Nelson, Susan Reverby, William Quivers, Alexandra Shields
Submitted Date: October 10, 2007
Published Date: October 11, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

We appreciate Ellison and colleagues’ thought-provoking response to our paper “Racial Categories in Medical Practice: How Useful Are They?” However, there are several statements in their response that misread our key points. First, our paper focuses primarily on the clinical encounter, where physicians make decisions about treatment. We argue that in this context racial ascriptions give little useful information and can be harmful. The issues raised in the clinical setting can be quite different from those raised in etiological epidemiological research. Contrary to Ellison and colleagues’ statement that we oppose the use of racial and ethnic categories for studies to examine the underlying structural causes of health inequality, we, in fact, emphasize that race and ethnicity should and must be used to monitor health disparities. How they could overlook such an obvious aspect of our paper is worrisome. To drive home our point on structural inequality, we highlight the embodiment research of Nancy Krieger, Christopher Masi and Olufunmilay Falusi Olopade, and Anne Fausto-Sterling in a dialogue box (Box 2). This research employs racial categories to analyze the biological effects of racism and discriminatory societal structures. Such research, that explicitly acknowledges the material reality of race, makes the key conceptual distinction between the use of racial and ethnic categories to search for differences in DNA polymorphisms (genetic difference) versus studies designed to examine how the environment modulates gene expression to compromise health (socially produced difference).

Second, we agree with Ellison and colleagues that racial and ethnic categorization is context-specific. If anything, that is one of the main points of our paper. Accordingly, the international consensus conference we propose would not impose a uniform classification system on all countries but rather would work with participants to explore the fluidity and historical- and place-specificity of race and ethnicity. We look forward to working with Ellison and his colleagues to make this happen.

No competing interests declared.