Theoretical Medicine and Bioethics

, Volume 23, Issue 6, pp 499–518 | Cite as

Race and Healthcare Disparities: Overcoming Vulnerability

  • John Stone


The paper summarizes recently published dataand recommendations about healthcaredisparities experienced by African Americanswho have Medicare or other healthcare coverage.Against this background the paper addresses theethics of such disparities and howdisadvantages of vulnerable populations likeAfrican Americans are typically maintained indecision making about how to respond to suchdisparities. Considering how to respond todisparities reveals much that vulnerablepopulations would bring to the policy-makingtable, if they can also be heard when they getthere. The paper argues that vulnerablepopulations like African Americans need fairrepresentation in bodies deciding what to doabout such disparities and that fairnessrequires proportional representation at alllevels of decisions that affect healthcare – aradical change. In this decision setting, howto provide adequate protection of minoritiesneeds much further attention. The mostattractive decision-making model isdeliberative democracy. The paper shows thatin deliberation, fair representation requiresnot only having a voice in decisions, but afair hearing of those voices. Achieving a fairhearing requires changes in norms ofcommunication and training of all to giveimportance to greetings and other measures ofcivility and trust building, and to be open todiverse forms of expression. Decisions abouthow to respond to healthcare disparities wouldinclude what programs to initiate for whom, howto evaluate the programs, and what to do inresponse to such evaluations. Conclusions arethat achieving such goals will take a seachange in how healthcare institutions andproviders do their business, and that socialactivism at every level will be needed toeffect these changes. The discussionhighlights many ethical issues that need muchgreater attention.

African Americans beneficence communication diversity fair equality of opportunity health disparities healthcare disparities justice Institute of Medicine racism respect for persons socioeconomic class voice vulnerable population 


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Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • John Stone
    • 1
  1. 1.Tuskegee InstituteTuskegee University National Center for Bioethics in Research and Health CareAlabamaUSA

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