Disparities and discrimination in health care: an introduction.

Racial disparities in health care and health outcomes are a disturbing feature of the American health care system. Efforts to reduce or ameliorate these disparities must be informed by an understanding of the factors that underlie and contribute to them. The papers in this issue are based on a recent conference that was held at the University of Chicago to address this problem. Socioeconomic status is an important determinant of health, and socioeconomic disparities are major determinants of the racial disparities in health. These socioeconomic disparities are complicated by access to health insurance, geographic factors, and unhealthy behaviors. Geographic disparities, both regional and local, also contribute to racial disparities in health. Moreover, current disparities in the health of adult populations may reflect socioeconomic disparities that prevailed during their intrauterine or early infant development. There seems little evidence that either overt or unconscious discrimination on the part of physicians is an important cause of racial disparities in health; blaming physicians for this problem is counterproductive. Improving the quality of medical care holds the promise not only of improving health for all Americans, but of decreasing the racial disparities in health care that are so troubling today.